- Reduction of 17,000 positions opposed by Democrats in House
- Care for children, pregnant women at risk, critics say
The Pentagon, seeking to save about $2 billion a year, wants to cull 17,000 positions from its health-care system. Critics say that would come at the expense of care for pregnant women and children.
Pediatrics and obstetrics/gynecology are among specialties to be targeted, a senior Defense Department official said, speaking on condition of anonymity. That would amount to a 14% reduction in the uniformed medical workforce that will begin in the coming year, Pentagon figures show. Much of the savings could be plowed back into the services and priorities such as new weapons and technology.
Congress is weighing whether to halt the cutbacks. “They are moving directly to just making these cuts and I think there is bipartisan opposition to that,” said Rep. Jackie Speier (D-Calif.), chairwoman of the Armed Services Military Personnel Subcommittee. “I can’t think of anything worse to a service member than to make those kinds of cuts.” The House version of the annual defense authorization bill (H.R. 2500) would block reductions until more studies are done. Whether the Senate will back the measure in final negotiations remains to be seen.
The prospect of cuts in the military’s health-care system comes as a broader revamping of the nation’s medical care, including an expansion of Medicare, has emerged as a central issue in the 2020 presidential campaign. Progressive proponents say “Medicare for All” would ensure everyone is covered. Skeptics question the potential cost and level of care.
The military’s reductions would be spread across Army, Navy, and Air Force active-duty medical positions, which total about 117,000. Posts currently vacant would be the first eliminated in the fiscal year starting Oct. 1. The rest would be cut through attrition over the following four years.
The Pentagon estimates $2 billion in net savings annually once all 17,000 positions are eliminated. An analysis of facilities is underway to determine which jobs will go, but specialties such as pediatrics are likely to take the brunt, the senior defense official said in an interview.
Defense officials insist the Pentagon is committed to keeping up the quality of care for its 9.4 million troops, spouses, dependent children and retirees.
To make up for the cuts, civilian health-care providers may be hired to replace some uniformed troops at military hospitals, or beneficiaries will be sent to civilian providers who are part of the military’s Tricare insurance network, Thomas McCaffery, the assistant secretary of defense for health affairs, said in a statement.
“Those changes do not affect our continued commitment to provide outstanding care,” he said.
Defense Secretary Mark Esper is focusing on finding savings across the department and the services to free up funds for pursuits such as hypersonic weapons and space capabilities to counter growing threats from China and Russia.
A major overhaul of the health system is also underway as the services turn over control of about 375 treatment facilities in the U.S. to the Defense Health Agency. An oversized medical force is one of the most studied facets of the military, the senior official said.
The military health system has more than twice the number of staff needed if the U.S. becomes embroiled in two wars such as Iraq and Afghanistan, but only 71% of the needed medical expertise, an independent 2018 review by the nonprofit Institute for Defense Analyses showed.
The 17,000 reductions will remove the excess staff and allow the military to refocus on battlefield treatment as it balances managing general health care, the senior official said.
‘Into the Bone’
Still, the cuts are politically risky because family health care has become an expected benefit for the all-volunteer force. The military spends about $50 billion per year on health care, or about 8% of the total defense budget, according to the Congressional Research Service.
“With these reductions they’re actually going to be cutting right into the bone,” said Kathy Beasley, the director of government relations on health affairs for the Military Officers Association of America, which is advocating against the plan on Capitol Hill.
The loss of positions could mean less access for children and pregnant women and also hit military specialty care for eyes, ears, nose and throat, Beasley said.
Wider use of Tricare coverage for civilian care might not fill the need because the insurance’s low reimbursement rates have left it struggling to attract providers, and rural or remote military bases such of Fort Leonard Wood, Fort Hood, and Fort Bragg already face a dearth of care outside their gates, she said.
“There’s a physician shortage and a lot of communities would be unable to supply that kind of care if there aren’t military personnel to do it,” said Ronald Blanck, a former Army surgeon general, who said the Pentagon hasn’t done sufficient planning.
The move has drawn wide opposition from health-care professions, with 18 medical associations including the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists urging Congress to halt the cuts until more studies are done.
Sen. Josh Hawley (R-Mo.) said the workforce reductions could have a significant effect on health care at his state’s Fort Leonard Wood, about 150 miles southwest of St. Louis and already under strain. He pressed the nominee for Army secretary to protect the base during a Senate Armed Services hearing Sept. 12.
The base and other remote facilities will be challenged by the cuts and a “tremendous amount of attention” is being paid to the issue, acting Army Secretary Ryan McCarthy, the nominee, told Hawley.
The House, in its defense bill passed in July, would bar any cuts to medical positions until the services report on specific positions to be culled and how to ensure access to care at medical facilities.
“They’ve basically failed in their responsibility to provide the Congress with a plan and an assessment,” Speier said.
Much of that analysis is continuing, according to the Pentagon.
Meanwhile, the Senate’s bill (S. 1790) is silent on the issue. The two chambers’ armed services committees are now negotiating a final bill expected to be released in the coming weeks.
Senate Armed Services Chairman Jim Inhofe (R-Okla.) said in a statement that his panel supports the goal of making the Pentagon’s health-care system “more effective, efficient and less costly.” Lawmakers are negotiating to improve battlefield care as well as access for all beneficiaries, he said.
The top priority of the military is being able to deploy troops quickly to combat with adequate medical personnel, said Sen. Jack Reed (R.I.), the committee’s ranking Democrat.
“But we don’t want to neglect families that are here at home,” he said.
To contact the reporter on this story: Travis J. Tritten at firstname.lastname@example.org