[House Hearing, 111 Congress]
[From the U.S. Government Printing Office]
[H.A.S.C. No. 111-135]
LEGISLATIVE PRIORITIES IN SUPPORT
OF FAMILIES
__________
HEARING
BEFORE THE
MILITARY PERSONNEL SUBCOMMITTEE
OF THE
COMMITTEE ON ARMED SERVICES
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
HEARING HELD
MARCH 15, 2010
[GRAPHIC] [TIFF OMITTED] TONGRESS.#13
U.S. GOVERNMENT PRINTING OFFICE
57-699 WASHINGTON : 2010
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MILITARY PERSONNEL SUBCOMMITTEE
SUSAN A. DAVIS, California, Chairwoman
VIC SNYDER, Arkansas JOE WILSON, South Carolina
LORETTA SANCHEZ, California WALTER B. JONES, North Carolina
MADELEINE Z. BORDALLO, Guam JOHN KLINE, Minnesota
PATRICK J. MURPHY, Pennsylvania THOMAS J. ROONEY, Florida
HANK JOHNSON, Georgia MARY FALLIN, Oklahoma
CAROL SHEA-PORTER, New Hampshire JOHN C. FLEMING, Louisiana
DAVID LOEBSACK, Iowa
NIKI TSONGAS, Massachusetts
Mike Higgins, Professional Staff Member
Jeanette James, Professional Staff Member
James Weiss, Staff Assistant
C O N T E N T S
----------
CHRONOLOGICAL LIST OF HEARINGS
2010
Page
Hearing:
Monday, March 15, 2010, Legislative Priorities in Support of
Families....................................................... 1
Appendix:
Monday, March 15, 2010........................................... 21
----------
MONDAY, MARCH 15, 2010
LEGISLATIVE PRIORITIES IN SUPPORT OF FAMILIES
STATEMENTS PRESENTED BY MEMBERS OF CONGRESS
Davis, Hon. Susan A., a Representative from California,
Chairwoman, Military Personnel Subcommittee.................... 1
Wilson, Hon. Joe, a Representative from South Carolina, Ranking
Member, Military Personnel Subcommittee........................ 2
WITNESSES
Cohoon, Dr. Barbara, Government Relations Deputy Director,
National Military Family Association........................... 4
Hruska, Kelly, Government Relations Deputy Director, National
Military Family Association.................................... 4
Moakler, Kathleen B., Government Relations Director, National
Military Family Association.................................... 3
Savant, Katie, Government Relations Deputy Director, National
Military Family Association.................................... 5
Wheeler, Candace, Government Relations Deputy Director, National
Military Family Association.................................... 5
APPENDIX
Prepared Statements:
Davis, Hon. Susan A.......................................... 25
Moakler, Kathleen B., joint with Dr. Barbara Cohoon, Kelly
Hruska, Candace Wheeler, and Katie Savant.................. 28
Wilson, Hon. Joe............................................. 26
Documents Submitted for the Record:
[There are were no Documents submitted.]
Witness Responses to Questions Asked During the Hearing:
[There were no Questions submitted during the hearing.]
Questions Submitted by Members Post Hearing:
[There were no Questions submitted post hearing.]
LEGISLATIVE PRIORITIES IN SUPPORT OF FAMILIES
----------
House of Representatives,
Committee on Armed Services,
Military Personnel Subcommittee,
Washington, DC, Monday, March 15, 2010.
The subcommittee met, pursuant to call, at 5:34 p.m., in
room 2118, Rayburn House Office Building, Hon. Susan A. Davis
(chairwoman of the subcommittee) presiding.
OPENING STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE FROM
CALIFORNIA, CHAIRWOMAN, MILITARY PERSONNEL SUBCOMMITTEE
Mrs. Davis. Good afternoon, everybody. Let me just get my
sea legs for two seconds, having just flown in, but I really
appreciate your all being here. This is such an important topic
and we are pleased that such a broad group of folks from the
Military Family Association, with your expertise and help and
support, could be with us. We are looking forward to this
hearing. Thank you.
The hearing will come to order.
The focus of today's hearing is a review of the priority
legislative initiatives needed to support military families,
and we have asked the National Military Family Association, the
association with the greatest expertise regarding family
issues, to help us understand how the Congress can best assist
our military families.
This hearing follows a subcommittee hearing on March 9,
just last week, that featured researchers from the RAND
Corporation and the Army War College, who related the
conclusions of two studies to assess the effects of deployment
on military children. The RAND study, as you know, was
sponsored by the National Military Family Association, and I
want to congratulate the association for investing in an
excellent study that advanced our knowledge of the toll that
war exacts from the children of those that serve.
This is the second of our hearings scheduled to last for
the one hour that is available to us prior to our votes at
6:30, so I would ask you to remain mindful of that.
I think this is a terribly important topic, and as I read
through all of your comments and the work that you have put
into it, it may be that we need to go on and schedule again,
but I know trying to get here are at 5:30 isn't always easy
from California; so we will do what we can.
I also wanted to thank you for the emphasis that you had on
mental health and for looking at the whole family because I
think those are very important issues. I think we have
addressed it to a limited extent, but I am hoping that
throughout the discussion that we can focus on it some more.
I want to welcome our witnesses: Mrs. Kathleen Moakler,
Government Relations Director, and I know you have been in that
place for a long time. Thank you. Dr. Barbara Cohoon,
Government Relations Deputy Director; Ms. Kelly Hruska,
Government Relations Deputy Director as well; Mrs. Candace
Wheeler, also Government Relations Deputy Director; and Ms.
Katie Savant, a Government Relations Deputy Director also.
So once again thank you so much and I know Mr. Wilson that
you will have a comment. Thank you.
[The prepared statement of Mrs. Davis can be found in the
Appendix on page 25.]
STATEMENT OF HON. JOE WILSON, A REPRESENTATIVE FROM SOUTH
CAROLINA, RANKING MEMBER, MILITARY PERSONNEL SUBCOMMITTEE
Mr. Wilson. Thank you, Chairwoman Davis, for holding this
hearing and thank each of you for being here today. We
certainly appreciate all of your service on behalf of military
families.
Meeting the needs of military families continues to be
challenging and complex. We are a nation at war fighting on two
fronts and the strains of those wars translate directly and
immediately to the families of members of the armed forces.
When the military family unit is disrupted by deployment of a
key member of the family, a host of issues arise that stress
all aspects of family life--physical and mental health,
personal finances, interpersonal relationships just to name a
few.
With two sons having served in Iraq and another in Egypt, I
know the challenges. This subcommittee, the Department of
Defense, and the military services have taken a number of
initiatives to address the needs of military families. Yet
there remains evidence much more needs to be done and the
system of support that has been created may not be adequately
meeting the needs of military families.
Last week we heard testimony on the results of two studies
that looked at the effects on military children who have
deployed parents. Thankfully, these studies seem to suggest our
military children are more resilient than we could expect. With
that said, it is also clear that the well-being of our children
is affected by the stability of their family and the emotional
strength of the non-deployed parent among other factors.
While I appreciate the Department of Defense and military
services are committed to assisting and supporting military
families, I am not convinced the right services are getting to
the right family members at the right time. I am also concerned
the provisions of family support services are not always
completely coordinated and integrated. I am also interested in
hearing from our witnesses how effective the coordination and
integration effort is. I am also interested in hearing where we
must provide additional effort in the form of policy and
resources to improve what is already being done.
With that, Madam Chairwoman, I join you in welcoming our
witnesses and I look forward to the testimony.
[The prepared statement of Mr. Wilson can be found in the
Appendix on page 26.]
Mrs. Davis. Thank you, Mr. Wilson.
I know that you have a plan to present a rather quick
overview and we look forward to that. Thank you.
Mrs. Moakler, if you would like to begin.
STATEMENT OF KATHLEEN B. MOAKLER, GOVERNMENT RELATIONS
DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION
Mrs. Moakler. Thank you. Chairwoman Davis, Ranking Member
Wilson, and other distinguished committee members, thank you
for the opportunity to speak today on behalf of military
families, our nation's families. Many families are facing their
eighth year of deployments. Many have dealt with multiple
deployments. We have second graders who have lived with a
parent absent from their lives for months at a time over and
over again. It is the only life they know. We appreciate the
many initiatives and programs supported by this subcommittee in
years past for our service members, retirees, their families,
and their survivors. They have become part of the overall
fabric of family readiness.
The challenge that now faces us is making sure that our
family readiness programs receive sustained funding and are
included in the annual budget process. With budget cuts and
shortfalls looming, we should not randomly reduce funding to
family programs and services across the board. Service members
and their families cite morale, welfare, and recreation (MWR)
programs like gyms, libraries, and other installation-provided
service as important to their well-being during deployments.
Substantial cuts to these programs make them wonder why
services talk about support yet often cut or reduce the same
programs that are identified as the most important by our
families.
One of the ways to evaluate the efficacy of programs is
research. In May 2008, we commissioned the RAND Corporation to
do a longitudinal study on the experience of 1,500 families.
You had the opportunities to hear the result of that study in a
hearing last week. Our role now is to determine how we use
these findings to target support to enhance the strength of
military families. If total months deployed matter, how do we
maintain health in the families that are doing okay--that is 70
percent--as they experience more deployments? How do we target
programs to meet the needs of families of school-aged children
while not diminishing support for families with younger
children? How do we engage those who interact with older youth,
especially girls, with additional information and resources?
How do we foster relationships between deployed parents,
at-home caregivers and older children to facilitate healthy
reintegration? And how do we help caregivers of older children
and youth strike a work/life balance? What can Congress,
Department of Defense (DOD), and communities do to help in this
effort? Ensure funding for military family programs consistent
with the demands created by eight plus years of war; fund YMCA
memberships for teams and families through the existing DOD
contract for at least six months post-deployment; develop
effectiveness measures for all family programs; identify and
replicate best practices, camping programs, community outreach,
and a focus on reintegration.
And, as a point of information, we have had 2,552
applications submitted since our Operation Purple site opened
this morning.
We also need to publicize resources available to support
military families and engage nonprofits to identify and meet
needs of local military families.
The National Military Family Association for our part is
going to gather the best minds at a summit in May to engage in
a national conversation focused on military children and
families. We hope to develop recommendations into a blueprint
for action. And now we will hear from Dr. Cohoon.
STATEMENT OF DR. BARBARA COHOON, GOVERNMENT RELATIONS DEPUTY
DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION
Dr. Cohoon. Chairman Davis, Ranking Member Wilson, and
distinguished members of this subcommittee, health care access
continues to be an issue. The recent implementation and then
deferment of Medicare reimbursement rate cuts has only
heightened our military families' access concerns. Our
Association asserts that behind every wounded service member is
a wounded family. As the war continues, families are also
experiencing their own invisible wounds and their need for
behavioral health services will remain high even after military
operations scale down. We appreciate the inclusion of service
member caregiver compensation in the National Defense
Authorization Act (NDAA) fiscal year 2010; however, we believe
this provision did not go far enough. Compensation should be a
priority. Current law creates a potential gap in compensation
following transition and did not include training, health care,
and expanded respite care benefits.
In order for caregivers to perform their job well, they
must be given the skills to succeed. This will require training
through a standardized civilian-certified program and
appropriately compensated. The caregiver self-selection process
occurs during the early phase of recovery; therefore benefits
must be established while they are still upstream on active
duty.
And now we will hear from Kelly Hruska.
STATEMENT OF KELLY HRUSKA, GOVERNMENT RELATIONS DEPUTY
DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION
Ms. Hruska. Chairwoman Davis, Ranking Member Wilson,
distinguished members of the subcommittee, thank you for the
opportunity to speak today about the exceptional family member
program. We appreciate the legislation to establish an office
for community support for military families with special needs
in this year's NDAA. Our families are anxious for it to stand
up and we are closely monitoring its progress. However, we must
remember that our special needs families often require medical,
educational, and family support resources. This new office must
address all these various needs in order to effectively
implement change. This new office will go a long way in
identifying and addressing special needs, and we will look
forward to working with you to remedy these issues as they
arise.
And now we will hear from Candace Wheeler.
STATEMENT OF CANDACE WHEELER, GOVERNMENT RELATIONS DEPUTY
DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION
Mrs. Wheeler. Chairwoman Davis, Ranking Member Wilson, and
distinguished members of our subcommittee, our association has
long realized the unique challenges our National Guard and
Reserve families face and their need for additional support.
Our Reserve Component families are often geographically
dispersed, live in rural areas, and do not have the same family
support programs as their active duty counterparts. However, in
the past several years, great strides have been made by
Congress and the services to help strengthen Reserve Component
families. We thank you for these important provisions and ask
that their funding be included in the baseline budget.
We appreciate Congress's attention to the Yellow Ribbon
program by including reporting requirements in last year's
NDAA. To ensure that Yellow Ribbon services are consistent
across the nation, we urge you to conduct oversight hearings as
well. We also ask that the definition of family member be
expanded to allow non-I.D. cardholders to attend these
important programs in order to support their service member and
gain valuable information. Although our association applauds
the innovative behavioral health support programs for our
Reserve Component families such as Military OneSource, TRICARE
Assistance Program (TRIAP), and Military Family Life
Consultants, we remain concerned that not all National Guard
and Reserve families have mental health care services where
they live.
And now we will hear from Katie Savant.
STATEMENT OF KATIE SAVANT, GOVERNMENT RELATIONS DEPUTY
DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION
Ms. Savant. Chairwoman Davis, Ranking Member Wilson and
distinguished members of this subcommittee, enhanced military
spouse education and employment opportunities are critical to
the quality of life of military families. The sudden halt of
the DOD MyCAA program was a financial and emotional strain to
nearly 137,000 spouses. We are pleased the program has been
reinstated for those currently enrolled. MyCAA provides
critical financial support to spouses through all levels of
their career progression whether the spouse is new to the
workforce or a mid-level professional. Military spouses feel
empowered and recognized by DOD through this program.
We ask this subcommittee to fully fund the program not only
for currently enrolled spouses but for those who will need the
funding in the future. Our military community is experiencing a
shortage of medical, mental health, and child care providers.
Many of our spouses would like to seek training in these
professions. We encourage DOD to create portable career
opportunities for spouses seeking in-demand professions. By
providing the opportunity to grow our own, DOD will help
alleviate provider efficiencies.
Thank you for your support of service members and their
families. We urge you to remember their service as you work to
resolve the many issues facing our country. Working together we
can improve the quality of life for all military families.
We welcome any questions you may have.
[The joint prepared statement of Mrs. Moakler, Dr. Cohoon,
Ms. Hruska, Mrs. Wheeler, and Ms. Savant can be found in the
Appendix on page 28.]
Mrs. Davis. Thank you very much. I appreciate all of your
comments.
Perhaps before we start, I think one of the things that is
so difficult, and I mentioned in my opening remarks briefly, is
prioritizing among all these demanding issues that we have
before us, and I know that is really difficult. We may try from
time to time to see if we can do some of that. I think that
part of the difficulty is we are not comparing apples to apples
here, and I don't want to use that in a flippant way, but I
think that it is very difficult to say, well, this is more
important than that. And yet somehow in there we need to try to
do important things to the best of our ability and I think that
we look to you because you know the situation of our families
far better and you are far closer to the families than we are
individually here.
And so as we go through if there is a way of helping us out
with that issue, I think, it would be very helpful to do that.
If I may just go to Ms. Savant for a second because you
brought up MyCAA. We call it MICA here. I know that is probably
not the best way to do it. But I wanted to just say as well
that I think the reason that we were able to move so swiftly
with this was because of the response of our military family
members who reacted very quickly. They were alarmed and
concerned and I think very upset when they saw initially that
the program had been pulled at least temporarily. So we are
very pleased to see that come back online.
I am wondering as we deal with this, and you mentioned
those spouses particularly, who perhaps did not have their
applications in and we know will want to do that in the future,
I am wondering how you might suggest that we go forward, what
suggestions you might have to structure the program to fulfill
the promise of these real educational opportunities and
portable professions that we need desperately in the services
in a fair and cost-effective manner. And I don't know if you
have any thoughts about how to reduce the costs at all or how
you see this coming together. Do you have some thoughts and
suggestions?
Ms. Savant. Sure. Chairwoman Davis, I would definitely say
that costs are not something that is my expertise, but I would
say that this is something that was initially open to all DOD
military spouses. And as you know, the sudden halt was
definitely detrimental to their education and career paths. We
had students who not only were dropped out of courses but some
had to take incompletes, and that can really impact their
future career progression. So I think that it is great that DOD
is doing a review of the program, but we do need to make sure
that funding continues for military spouses who want to
continue to pursue portable careers. It is something that maybe
a spouse shouldn't use initially because they weren't expecting
permanent change of station (PCS) orders to move, but they are
this summer and they might be going to a new state where they
are required to take new courses in order to continue their
profession. This funding is critical to them. So I apologize I
am not able to help with determining funding, but I do think
that it is critical that we continue this program.
Mrs. Davis. Does anybody else want to comment on that?
Great.
One of the larger areas that we deal with is pay raise, and
over the last number of years, there has been a real attempt to
provide an additional bump of a half a percentage point to
bring military salaries more in line with the private sector.
This year the proposal does not include that, and yet we know
that it really is reflecting a raise but not the additional
bump and partly because we have so many needs out there and I
know that the Department of Defense is suggesting that we have
come very close, but I would suggest that we are not quite
there yet. Can you help us to see--we have about 11 years of
history by which to judge these relatively minor advancements
to pay levels and does it trump other issues in terms of the
number one priority that families have? Are there other
priorities that you think may really be more critical right
now?
Mrs. Moakler. We don't usually address pay issues as an
organization, but I know as members of the military coalition
we are in favor of a pay raise. And as long as there wasn't a
great discrepancy as there was several years ago, we are very
pleased of the fact that it has caught up to outside pay
raises. But if we could focus on the mid-career folks because
they are the ones that are getting out and so we would like to
make sure that they have some incentive to stay in.
Mrs. Davis. I have just a second, but can I ask along with
those priorities as we look at that issue the Survivor Benefit
Plan-Dependency and Indemnity Compensation (SBP-DIC) offsets,
how that really fits into this? A tough question, I know. I
understand that.
Mrs. Moakler. We have long been supporters of the
elimination of the DIC offset to the SBP, and we feel that that
is an important way to respect both the wishes of the service
member who had, for the most part, for retirees had paid into
the SBP fund to provide for his family and that the DIC is a
separate benefit. That is supposed to reimburse you for any
injuries or the death of the service member, so that each has a
different reason to be paid out, and so we really support that
that be eliminated.
Mrs. Davis. Thank you.
Mr. Wilson.
Mr. Wilson. Thank you very much, and again thank all of you
for being here and I appreciate the individual testimony and I
have never seen such brevity; so thank you very much.
For any of you, I would like to ask--it has been mentioned
in the testimony that there are redundancies in military family
programs and some programs don't meet the needs of today's
military families. Are there any programs existing today that
in your opinion should be terminated? If so, what are they?
Mrs. Moakler. Well, I think we need to look at the myriad
of services that are provided by each of the services, and
especially in the area of information and referral. It seems
like people are starting up new programs to collect information
from community sources and get them out there for military
families. But there are so many areas to choose from that it
gets confusing. So if there could be one list, the National
Resource Directory is a good start, that it be a Purple list.
We are all about having Purple programs for families. And not
that they would lose their individual alternate but sometimes
too many resources can be confusing.
Mr. Wilson. And the Internet can be a real resource to help
get through so you can find it for a particular community.
Mrs. Moakler. Yes. You could put in your zip code and find
out where those resources are.
Mr. Wilson. Again, to me, it is exciting that they are so
available technologically for families.
Another recommendation has been to establish a unified
joint medical command structure within DOD. Can you explain how
this would be helpful?
Dr. Cohoon. That would be me on this particular one. I
handle health care for our organization. What we have talked
about is right now what we are dealing with--the funding
happens under three different services rather than as far as it
being joint, and we are looking at what is happening with the
National Capital region and how that is rolling out. And as we
are looking at programs that are rolling out, sometimes the
best practices aren't necessarily shared across services. And
as we stand up at the National Capital region where you have
Army and Navy working together, and down in San Antonio you
have Air Force and Army working together, the ability to be
able to share resources so you are purchasing the same
equipment, you are teaching your staff as far as utilizing the
same policies would go a long way as far as keeping down costs
but also improving the quality of care through efficiencies but
also as far as patient safety.
Mr. Wilson. Another example would be the Uniform Services
University, which is a joint service university and since one
of my sons is a graduate, I know it is a great institution. So
I hope we can possibly look into what you suggest.
Dr. Cohoon. We look forward to working with you on that.
Mr. Wilson. That would be great.
Then again for anyone who would like to answer, it has been
suggested that the system of multilayered case managers for
wounded service members and their families may be aggravating
the delivery of necessary services to the families. How would
you streamline the process to make it more effective?
Dr. Cohoon. What we are seeing, again, is all the services
are rolling out their own programs and their own level of case
managers. The Department of Veterans Affairs (VA) is doing the
same thing. Also we have DOD doing the same thing. And our
families are getting confused as far as who do you go to for
what and when. So we have been asking for basically maybe a
report to take a look, and I knew the GAO was looking at the
federal recovery coordinators to see how effective they are
being. But also we need to look at recovery care coordinators
and everyone else.
What we are finding is that the families sometimes aren't
aware that certain case managers are available that they could
utilize, i.e. the federal recovery coordinators, or that they
are in the VA and that now they could be using the VA case
managers, and instead, they are still utilizing the services on
top of that.
So there is a lot of great programs, but we want to make
sure that we take a look that we haven't added so many on that
it is getting confusing for the families.
Mr. Wilson. Well, your organization serves such a vital
function as a safety net and as a means of providing assistance
to families. So I hope you all continue that effort, and I am
particularly concerned about a person's going from DOD care to
VA care, that that be as seamless as possible and without a
hiccup so that people receive services with nobody to fall
between the cracks. So thank you very much for your time.
Mrs. Davis. Thank you.
Ms. Bordallo.
Ms. Bordallo. Thank you, Madam Chairman and Ranking Member
Wilson. And I do want to thank you ladies for your testimony,
and it looks as if services for military families is in very
good shape from what I have heard.
You know, it is an old adage that it is not just the man or
the woman in uniform that serves but the entire family, and I
truly believe in that. In recognition for your role, our
chairman recently, Mr. Ike Skelton, worked to have this year
designated as the year of the military family, and while
Congress has done much, there is still a lot more to be done.
Now, the National Military Family Association has been a strong
supporter of the reporting requirements in the 2010 National
Defense Authorization bill, and as you know, this bill requires
the Secretary of Defense to examine the housing standards used
to distinguish between grades when setting housing allowance
rates. Some complaints surrounding the notion that junior
enlisted members and their families can be housed in apartments
while town homes are adequate for mid-grade noncommissioned
officers. Opponents of the standard believe all families should
be housed in separate housing units, which is the general
standard for the United States.
I would like to focus on this matter with reference to the
Marine buildup. I am the representative from the territory of
Guam. And the current plan involves significant acquisition of
our land in Guam in order to house the 8,600 additional Marines
and their families. Due to the significant concern regarding
the draft environmental impact statement, I have offered some
proposed alternatives to the main bed-down location of the
Marines. I have proposed using less land by housing Marines in
vertical structures such as condominiums.
I understand that we would all like to have a home and a
yard but, in some cases, this is just not possible. So with
that in mind, and I know--I don't know which one of you is a
military housing expert, but with that in mind, could you
comment on any concerns that you would have about building more
vertical structures on Guam to house our Marine families? Could
anybody give us some idea?
Ms. Savant. Ma'am, I wouldn't consider myself an expert,
but I can certainly try to answer that question for you. I
definitely think that we need to look at the area where the
housing is going to be, whether it is in Guam, whether it is in
Japan, Hawaii, and we need to have standards that meet the
standards of that community. If that is vertical housing in
Guam, then that is the standards of that community. Certainly
military families do like to have homes, but that is not always
available in certain areas. In city dwellings there are high-
rise apartments, and I think as long as the dwellings are
meeting the standards of the community and have all the safety
features that are required, then those are reasonable standards
to have.
Ms. Bordallo. So as an association, if the standards are up
to par, you wouldn't have any objection. Is that pretty much--
--
Ms. Savant. Yes.
Ms. Bordallo. All right. Thank you.
Now one more question. I would like to get everyone's take
on the implementation across this nation of home station
mobilization and demobilization for our National Guard and
Reserves. I am concerned that this is not occurring as Congress
intended. I am wondering what your thoughts are on this process
and what more we can do to make this a reality. As you all know
it significantly degrades military readiness when we force
families to travel to active duty locations far from their
homes. So we need to maintain the readiness of our families by
fully implementing a home station mobilization and
demobilization.
Mrs. Wheeler. Ma'am, we couldn't agree with you more.
Ms. Bordallo. Mrs. Wheeler.
Mrs. Wheeler. Yes, I am Candace Wheeler. And we agree,
making sure that family has all the support that they have and
not necessarily having them move during that period of time and
giving them all the support. We see a lot of our Guard and
Reserve actually serving as individual augmentees as well. So
we need to make certain that those families have the support
they need also. But, yes, we would support that.
Ms. Bordallo. Thank you very much and I thank you for your
service. It is very important the work you are doing.
Mrs. Wheeler. Thank you.
Mrs. Davis. Thank you.
Mr. Loebsack.
Mr. Loebsack. Thank you, Madam Chair and Ranking Member
Wilson for having this important hearing. I thank all of you on
the panel for everything you are doing.
It is often said that there are a lot of divisions in this
Congress on party lines, and there are. I think it is fair to
say that Congressman Wilson and I probably don't agree on very
much of anything when it comes to policy issues out there, but
we actually both have very close personal family members who
are serving at the moment, and that brings us together
certainly on these issues. I think that is fair to say, and I
think the Congressman would agree with that. So I want to thank
you for what you are doing here.
In Iowa, we have a lot of National Guard members, not
unlike Madam Bordallo in Guam, and we come together on issues
all the time to work as hard as we can for those Guard and
Reserve----
Ms. Bordallo. I have the most per capita.
Mr. Loebsack. That is right.
Reclaiming my time, at any rate, I am happy to hear, Mrs.
Wheeler, in particular some of the things that are happening
with respect to the Guard and Reserve. In the State of Iowa, we
have 3,500 Guard members who are getting ready to deploy to
Afghanistan and a number of them have had a number of
deployments already, and a lot of us are very concerned, of
course, about the families, about the children and about the
spouses. In the State of Iowa the legislature and the Governor
are trying to do some things with respect to spouses and
employment, to try to deal with these multiple deployments and
just a multitude of issues that come up with the Guard and
Reserve. Again, active duty folks, they have certain specific
issues. Everyone has the same issues--similar issues,
obviously. General Orr, who is our adjutant general, he really
is trying to place a lot of emphasis on readiness centers and
armories as focal points for families for services and what
have you. Health care, obviously another issue as well.
I want to give you an opportunity, Mrs. Wheeler, just to
elaborate a little bit with the time remaining on some of the
things that you have been working on. I know you folks were
wonderful in being very brief at the outset here, but I would
just like to give you some more time to talk about what you are
doing and what you think needs to be done for the National
Guard families.
Mrs. Wheeler. Thank you. I appreciate the time. We have
seen a lot of support for our National Guard families in recent
years, and we do appreciate Congress especially and the
services stepping forward to help our Guard and Reserve
families, whose challenges are different than our active duty
families. We are seeing some innovative ways of helping. I
mentioned a few in my opening. But there are some other things
as well. There is something called Fort Rochester, which is a
virtual community that is being stood up and I think it is a
way of being able to support families. This is under the Army
program. And I think that is very helpful to not only think
that it has to be brick and mortar, that how do we get to our
Reserve Component families? They do not necessarily live in the
same geographic area. Like I said, many of them live in rural
areas as well.
So thinking in more in terms of how do we support them.
There is been a lot of things in recent times. Some of the
things have been in like the joint family support program,
assistance program, the JFSAP. That has been very helpful as
well.
We have also seen the Joint Services Support, which is
something you can go to online. A lot of these things are
Internet based, but we need to remember we need to have touch
points with families. It can't all be through the Internet, and
we need to make certain that we are giving them that type of
care. Military OneSource has been tremendously helpful to be
able to have time for families to be able to talk with one
another and to reach out and have that behavioral health
support that they need, especially for our children. We are
seeing that with our Guard and Reserve children that they are--
with our RAND study that we went through we are seeing that
they are experiencing the same types of things, but it is very
important for them to understand that they are a military
family also.
And in the beginning of this war, many of our Reserve
Component families did not feel like military families. They do
now. And we need to make certain that we are supporting our
children and the caregiver. We have also realized that when the
caregiver has the support they need, then the family does
better, not only during the deployment but during the
reintegration period as well.
Mr. Loebsack. Thank you.
And just to finish up, I couldn't agree more with what you
are saying, and certainly as the Guard and Reserve become an
increasing operational force, they are part of the military in
that sense, very much a part of the military. So thank you very
much. I appreciate that. Thanks to all of you.
Thank you, Madam Chair. And I yield back.
Mrs. Davis. Thank you, Mr. Loebsack.
I want to turn to the behavioral health issues a little
bit, and I know Dr. Cohoon--I think all of you have referenced
that in some way. But one of the concerns that you have
expressed is that while families see that their loved one in
theater may be getting some support that the families, when
they are trying to get appointments or trying to access some
care, are having some difficulty. Is there a way that you can
perhaps--if you want to clarify some of those concerns and what
you would suggest. I think you have mentioned the fact that we
have a lot of family members who might like to develop the
skills to be part of the force of behavioral health specialists
that are serving the military.
But short of bringing those people into the fields right
away, what do you think that we need to be focusing on?
Compassion fatigue, you have mentioned, creating burnout. What
is it that we should be focusing on? I might also ask you as
you answer that question, whether you think that we have done
as good a job as we should be in integrating with Veterans
Affairs as well? I think there is a real lack there in terms of
transition care.
And I will be perfectly honest, I am not sure that we do as
good a job just here in Congress in terms of integrating some
of those discussions, but I also feel like there could be
something more that you might suggest in how we can better work
with the Veterans Administration to answer the needs of many of
our families in transition.
Dr. Cohoon. Thank you, Chairman Davis. In the beginning of
the war, we really didn't have that large of a robust network,
especially for mental health providers. What were in the
military treatment facilities (MTFs) actually would forward
deploy and then that left a gap that was in the MTF, but we
really didn't have that large of a network in our civilian
option. Plus there is also a general shortage of mental health
providers across the country. Now that there has been added
funding both for DOD and VA, they have been able to bring more
providers on board as far as in the direct care system, but
sometimes they don't necessarily understand our culture. It
takes a little while for them to learn about military life.
That happens too in our civilian network the same way.
As the network becomes more robust, we need to make sure
that the mental health providers that our families are exposed
to actually understand our population and our culture, and that
would make things a lot easier with them. Those that are
forward deployed, our mental health providers, we need to make
sure that we are taking care of them also, that they have time,
dwell time, so that when they do come back from theater they
actually have time with their families to reintegrate, and then
when they come back as far as to help us that they are ready to
help us so that the provider themselves has the opportunity as
far as to recharge their batteries, and a lot of times we are
not seeing that.
With the mental health integration between DOD and VA, that
is what keeps me up at night. That is what scares me the most.
Because basically when the military service member decides to
leave the military--Admiral Mullen has talked about assessing
the service member to make sure they are ready. We need to
assess the family too to see how they are doing because once a
service member transitions over to the VA status, depending
upon what is going on, the family may not qualify for a lot of
different services. They can buy COBRA so they could keep
TRICARE for 36 months. They can use the Vet centers.
But for the most part, a lot of opportunities for them and
access to care goes away. When we are looking at funding for
both DOD and VA, we are maybe taking providers from the state
health agencies which is maybe where families end up going
because they no longer have health care coverage; so we need to
make sure that all the systems are working together because we
are not fighting over the same resources since we have a
shortage.
Mrs. Davis. I believe that we are supposed to be looking at
that as a result of the last bill that went through, and I am
just wondering whether--have you had any sense that that is
moving along at all, in the VA? I think there was an
authorization to look at these issues further than what we have
done in the past; is that----
Dr. Cohoon. Right. We appreciate any time that we are going
to take a look at a program to see how well it is working or
not working, and the VA is stepping up to the plate as far as
wanting to bring in service members and their family when they
are still active duty. We call it upstream. Then when they come
in, then they are being assessed at that particular point and
able to provide them services during that time. So that allows
the family then to be introduced to the VA and to what sort of
system of care is available and obviously we have seen the
network increase tremendously as far as within the DOD TRICARE
system.
Mrs. Davis. Is there any sense that families would resist
filling out surveys? We know that even the men and women who
serve have some difficulty initially in wanting to be part of
that for fear of not being able to go home or issues of stigma
that seem to prevail. Have you heard anything? Are families
really asking that they are surveyed and that there are forms
that they could respond to that would suggest the level of
their need?
Dr. Cohoon. Stigma does exist even with our families for
lots of different reasons. It is present in society as a whole,
and so you are trying to break that particular cultural barrier
on top of all of it. We really have been asking our families to
be evaluated the same way that the service member is
predeployment, during the deployment, and post-deployment just
to see how they are doing. They were included in the Cohort
Millennium Study, and we are looking forward to seeing what
type of information we get from there. But we are really not
getting the pulse of really how our families are doing.
Our study did--had wonderful findings, but we are just
scratching the surfaces and when the longitudinal pieces come
out, we will be able to find out more and more information. But
we have been asking that we start assessing how our families
are doing. And even when the war winds down, we are also
wanting to make sure that we have programs in place that we
continue to, as far as we can, to bring more mental health
providers on board and we keep surveying them on how they are
doing.
Mrs. Davis. What do you think is the best mechanism for
doing that, then? I know we have telephone mental health where
service members and perhaps you can tell me if their families
as well would have the opportunity to access someone anywhere
in the country who is there to be able to listen and to
recommend some strategy, some treatment for them? Is that an
important vehicle for that? How can we best assess----
Dr. Cohoon. Well, telephone mental health is great because
it helps Candace's population, which is the Guard and Reserve.
If it is nonmedical care, then it doesn't make any difference
as far as where you sit as far as physically and where you are
providing care where that individual sitting. But if it is
medical care, we are looking at geographical barriers as far as
licensing, as far as being able to provide the medical care,
and we have been asking for that to be looked at to see if
there are ways in which we can open that particular door up.
There are some wonderful programs coming out.
There needs to be some better education to our families as
far as what the programs do, why they should be utilized. And
especially the TRIAP program, there are some great
opportunities there, but our families, I think a little bit
with stigma, but also as far as not really understanding this
new concept, that they haven't really embraced it as much as we
would like to see done.
Mrs. Davis. Thank you.
Mr. Wilson.
Mr. Wilson. Thank you, Madam Chairwoman. Again, thank all
of you for what you are doing. And, Mrs. Wheeler, as a National
Guard family ourselves, I had the privilege and opportunity of
conducting premobilization legal counseling armory to armory
for about 25 years, and as I look back, we were helpful but
gosh, what is being done now and your organization has helped
make it so much more meaningful and the family members truly
understand now that their husbands or wives could be deployed
overseas, not just in my state for hurricane recovery and
relief. So thank you for what you do.
Another issue that I am concerned about, the widows tax,
the SBP-DIC offset. I am really concerned that a lot of people
in our country do not know about this, and so if you all could
explain how this is such a problem because I know it is, and
any way that you can help us on legislation that is pending
would be helpful too.
Mrs. Moakler. Well, I think one of the major areas, as I
mentioned before, retired service members choose to sign up for
the survivor benefit plan and they pay a portion of their
retired pay each month to provide for their spouse upon their
death. So they have paid into that program. They may also be
eligible because of wounds or conditions that they have because
of their service. They may die from service-connected
disabilities. Then their spouse would also be eligible for the
dependency and indemnity compensation. Two different programs
given for two different reasons. And that is why we believe it
is unfair for the DIC to offset the SBP.
Mr. Wilson. For many families we are talking about a
thousand dollars a month?
Mrs. Moakler. Yes.
Mr. Wilson. And most Americans, you may be aware, are not
at all aware, and people do understand what a thousand dollars
means a month, particularly with children. So I hope you all
keep raising the awareness so that good people like Susan Davis
can make a difference.
Also, another issue that I am concerned about is TRICARE.
This is a terrific benefit for active duty, for Guard, and
Reserve, but in some of the material that you all have provided
to us you warn, which I think is correct, that this can be a
hollow benefit and I am so concerned that be there are
circumstances being created that can overwhelm the health care
capabilities of our country. But on TRICARE in particular what
recommendations do you have to make sure that this truly is a
benefit that can be accessed by military families?
Dr. Cohoon. We have been watching the Medicare
reimbursement rate cut closely. As you know the TRICARE is
tied--the payment is tied to the Medicare reimbursement rate,
and as it drops down 21.2 percent we have been hearing from
some providers that we may actually see them decide not to take
our population, and this is not really the best time for us to
be losing providers especially in the mental health field. We
are also looking at our TRICARE contractors may be changing and
we are looking at two out of three may possibly change. Of that
that means that 66 percent of our providers will be up for
renegotiation as far as either deciding to sign on for TRICARE
or not.
So you add that, the reimbursement rate possible cuts, and
then national health care reform on top. We are wondering if
given the reimbursement rate for TRICARE, if the provider will
stay on board or not, and if they won't, especially in rural
areas where there is a limited number of providers that are
available to begin with, then you have a benefit, but then you
are not able to access any doctors because they are not taking
TRICARE. We hear on a regular basis that doctors are taking
TRICARE, especially mental health, but when you call them they
are no longer taking TRICARE patients.
Mr. Wilson. And that is so crucial. I am the former
president of the Mental Health Association; so this has been an
issue that I care about and we have serious problems that need
to be addressed. But we look forward to the suggestions that
all of you have because I was struck by your comment of a
hollow benefit. There are many people concerned about a free
ticket, no show, that you have a card but nowhere to go. And we
should be working together on how this can be beneficial and
particularly in Guard and Reserve in faraway places.
People commute--it is not uncommon--200, 300 miles across
state lines to come to armories. So we have got a challenge.
And I look forward to working with the chairwoman on this.
Thank you.
Mrs. Davis. Thank you, Mr. Wilson. I appreciate your
raising that because I think we really do need to make certain
that the providers are available and TRICARE has been actually
recently successful in attracting physicians, but we remain
concerned about that and the fact that I know that on a number
of bases--I guess it is not necessarily just TRICARE--but where
so many of the physicians are actually in theater who they had
access prior to that and the community physicians have very
much filled in a lot of those gaps. But you are suggesting that
even though they may say they are taking patients, you are
finding that that is not true. I think it would be interesting
for us to know if you have some--I don't know whether it is
necessarily statistics or even anecdotal information about
that, it would be helpful for us to know and to have an
opportunity to follow up as well. I would like to have a better
picture of that.
Dr. Cohoon. We have been using our Facebook as far as
asking some information from those that have been following,
especially with the Medicare cuts, are they hearing providers
that are telling them that they are no longer going to be
taking TRICARE? And I did ask the woman in our office, Bailey,
that handles that, and we have pulled off some quotes as far as
``this isn't good, wonder how it will affect those of us as
reservists.'' ``The civilian doctors don't want to take TRICARE
before the cuts. Now it is going to become a real problem in
certain communities.'' And another wrote, ``so many sacrifices
to ensure your family is being taken care of and now this.'' So
they--as I mentioned in our oral, there are--this has
heightened our concern as far as access. We haven't heard that
providers are actually walking away, but we do hear that when
our families do reach out that even though they are taking
TRICARE patients, they are just full up, or if they go to the
behavioral health provider list, the same thing as far as
calling them and finding that they are just not available.
Mrs. Davis. So it is compounded when there is a shortage of
providers and then a concern, and I think we are all working to
be sure that there are no cuts that the physicians will need to
be anticipating; so that is something that we are working on.
Dr. Cohoon. And we are wanting to make sure that those that
come back from theater have time to be able to regroup so that
when they do come back to take care of us, they are able, they
are full, 100 percent up and running so that they can take care
of us.
Mrs. Davis. Thank you.
One of the issues I think you have raised with respite
care, whether it is child care or it is respite care for a
loved one who is caring for a wounded service member, as we
look at limited budgets across the board, I am just wondering
whether you are hopeful that we can allow for some reasonable
respite care even though in many ways we haven't answered the
initial need for child care itself or for care--for some
compensation for those who are caring for a loved one. How did
we try to balance those needs?
Dr. Cohoon. I will talk about the respite for the wounded
and then I will have Kelly talk about respite as far as for the
child care.
In the National Defense Authorization Act, you included a
service member compensation but there isn't any added respite
care that is in there. Others--there isn't any training that is
in there. And as we are looking at seamless transition of care,
we want to make sure that whatever starts while they are active
duty, as we call upstream, that it is smooth and runs into the
VA. And the VA has some programs, aid and attendance, home
health, those types of things, but our services are keeping our
service members a lot longer than they ever did in the past. So
by the time the service member transitions along with the
caregiver there has been years sometimes as far as going on.
So if the VA is going to set up some types of programs
which the House and Senate have passed which include respite
care, include training and include compensation, we would want
to make sure that these benefits--the caregiver can start
giving those benefits a lot earlier along, so that by the time
they have reached the VA we are not looking at someone that has
been totally burned out. Because they have walked away from
their employment, a lot of them. If it is mom or dad they may
not have health care. They may no longer have a job. That is
why we have been advocating for that particular piece. We
understand that there is limited resources as far as funding.
We are talking a small population that really could benefit
from these services and we really want to make sure that the
benefits we put together are seamless and they start upstream
where the caregiver actually is recognized and starts their job
and continues on without any bumps in the system into the
veteran status.
And I will let Kelly talk about the child care.
Ms. Hruska. There are several available programs for
respite care for caregivers when a service member is deployed.
There are Guard and Reserve programs and programs for active
duty both on the installation and for those who are
geographically dispersed. Those programs are run through the
NACCRRA, the National Association of Child Care Resource and
Referral Agencies. In this year's NDAA, Congress called for a
study to see if the program is adequately funded and if it is
being utilized. We are anxious to see the results of that study
and whether or not we think it is important----
Mrs. Davis. Do you know when that is supposed to be
available?
Ms. Hruska. I know GAO is just starting it; so we are
hoping for it by the end of the fiscal year.
Mrs. Davis. Thank you. Do we need to push a little harder?
Ms. Hruska. That would be helpful. We would appreciate
that. But we are anxious to see the results of the study to
make sure that families know about it, are they utilizing it,
and if there is an increase necessary, where is it required?
Mrs. Davis. Thank you. Also, you mentioned, I think, Ms.
Moakler, the summit on children's issues in May, and I am
wondering what you hope is going to come out of that summit.
Mrs. Moakler. Well, we hope to bring together great minds
and come up with some action items that would pinpoint how we
can take the programs we have and make them work better for
both our caregivers and our children and also to see if we have
missed any program. And we are going to have a two-day summit.
First everyone is going to come together and come up with
some action items. And then we are bringing more people in the
second day to look at those and kind of kibitz and say, well,
have you thought of this, have you thought of this, so that it
is not just a one stop but that we pull as many folks as we can
into the room to discuss this issue.
Mrs. Davis. Is there anything about the RAND study that
actually surprised any of you or that you felt really provided
you with some additional information that you wouldn't have had
otherwise?
Mrs. Moakler. Well, I think around the office we call it
the ``duh'' study. You know, it is something that we have all
known through anecdotal evidence, but when we actually have the
research to back it up that really helps us focus in on what
needs to be done.
Kelly, did you have something?
Ms. Hruska. Well, as Kathy said, I just want to reiterate,
I mean so many times we hear the anecdotal stories, and you
asked us, well, how widespread is this? I think this gives us
that statistical quantitative data to back up those anecdotal
stories and that is very important. I think the longitudinal
information is going to provide us much more information. And
so we are anxious to share that with you when that becomes
available.
Mrs. Wheeler. One of the things I thought was striking was
the fact that it is the total time of deployment, time apart
during that period of time, and we are really looking at a
three-year period of time. So our families are finding that the
longer they are separated the more problems they are having.
One of the other things I thought was fascinating was the
reintegration piece for girls. Having raised a daughter myself
and having had her father deployed, I think that was an
interesting thing.
So we have always been looking at deployment. Maybe we need
to be spending a little more time on the reintegration, though
we all know reintegration happens, before the reintegration
happens, so making sure that the family understands what they
might be moving towards, so giving them those types of support
both before deployment and during deployment. That is what we
are seeing with our Yellow Ribbon programs for our Guard and
Reserve families, that that is helping them get ready, that
they're learning skills as they move along.
Dr. Cohoon. I would say looking at the fact that the
caregivers--how their mental health is really affects the well-
being of the whole entire family. And that brings us back to
wanting to make sure that we really are assessing how our
families are doing. You had asked me earlier as far as surveys,
the Army, when I was over in Germany, they actually asked no
matter what you are coming in for a series of questions to see
really how you are doing.
So it could be just as easy as that, that every time you
have made a doctor's appointment, we just ask how you are
doing.
Mrs. Davis. One of the things that I picked up at a session
recently with some of the wives, spouses of our SEALs, and
Special Operations folks is that they had a lot of concern
about additional help with homework and tutoring, and I was
surprised. I was hearing that a lot. And I didn't pick any of
that up on surveys necessarily, that there is such a concern on
the part of the member who is serving that the kids may not be
getting as much help, and obviously if you have several
children, it is very hard for mom or dad, even if it is a
single dad to try to provide that. Do you know whether that
might be part of the focus? And I would really be interested in
knowing if there is anything that we could or should be doing.
I understand that there is a network online for some
homework assistance and help, and I think maybe some of our
families are aware of that. It sounded to me that a lot of them
are not. Is this an area that you have explored with families
and is there anything we can do to help?
Mrs. Wheeler. I would be happy to answer that. One of the
interesting programs that has been out for a while is called
Tutor.com, and it actually is now being offered to all military
families, which is wonderful. It had started with the Army and
now it is being available for our military families. It is a
24/7 program. All of the--actually the tutors are trained and
have certain certification in order to do this. We see this as
a couple wins. Not only is this helpful for families, helpful
for the service member in alleviating that concern; it is also
an opportunity for spouses to look at portable careers. So we
see this as a double edge, being able to actually help take
care of our own which is marvelous. But this is a great program
that has been moving forward. There is another program called
the Scholarships for Outstanding Airman to ROTC (SOAR) program,
which is offered by Military Impacted Schools Association. It
is an online program as well. It is excellent and very, very
helpful to families.
So there are resources out there. I think a lot of it is
making certain that they know they are available. The Tutor.com
is new to all military families, and we have certainly been
publicizing that and will continue to do so. So has the
Department of Defense. And that is being funded for all
families by the Department of Defense. So it is a great step in
the right direction. Thank you.
Mrs. Davis. That is fine. Thank you. I appreciate that. And
just finally, I think Secretary Gates has said that there is a
process looking forward to Don't Ask Don't Tell, that military
families would be consulted. How do you think that would be
helpful and what role do you all see playing in that?
Mrs. Moakler. Well, first, let me state that the National
Military Family Association has no position on Don't Ask Don't
Tell, but we are pleased that the working group that Secretary
Gates has appointed has been charged to look at the true views
and attitudes of our service members and their families, and we
are happy that they are going to look at both the policies that
affect the service members and their families concerning
eligibility for benefits and we hope that they will seek input
from the broader military community, that they don't just focus
on the gay and lesbian community but that they look at families
across the board and our association has long promoted the need
for support of all families during deployments and we feel that
there are some families that are not getting the resources they
need because of fear of disclosure, and so they are having to
suffer in silence.
Mrs. Davis. Thank you. I appreciate that.
Thank you all very much. We are so glad you are out there.
You are making such a great contribution. I know the military
families are pleased that they have such strong advocates and
we certainly want to continue work with you in every way
possible. So stay in touch and let us know when you have some
areas where you think we should give additional time and
attention.
Thank you very much for being with us.
[Whereupon, at 6:37 p.m., the subcommittee was adjourned.]
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