Surgeons General: Sequestration Could Have Lasting Impact

By Terri Moon Cronk
DoD News, Defense Media Activity

WASHINGTON, March 25, 2015 – The services' three surgeons general told a Senate defense subcommittee today that military medical excellence must be maintained for readiness, and a return to sequestration would have a lasting impact.

Surgeons general Army Lt. Gen. Patricia D. Horoho, Navy Vice Adm. (Dr.) Matthew L. Nathan and Air Force (Dr.) Lt. Gen. Thomas W. Travis testified on the defense health program in the President's Budget for fiscal year 2016.

"Army medicine provides certainty in an uncertain world," Horoho said in her prepared testimony. "We have always been a leader in health care and health, contributing enormously to solving military, national and global health concerns."

Sequestration is a provision of current budget law that mandates major across-the-board spending cuts in fiscal 2016, which begins Oct. 1.

But still stinging from the fiscal 2013 sequestration, she said, the Army Medical Command continues with an 1,800-civilian employee shortfall, and a second round of cuts could bring another 3,000-employee loss and reduce MEDCOM's military end-strength.

Civilian Employees Vital to Mission

Civilian employees, she said, comprise 60 percent of the MEDCOM workforce. "They are the backbone, stability and glue of our system," she said, adding that the Army lost many employees to agencies not affected by the fiscal 2013 sequestration, such as the Veterans Affairs Department.

While patient safety would not be compromised in a sequestration, the Army could be forced to close some clinics and hospitals, and cut training resources and other programs, Horoho said.

"This would severely impact our ability to support the health readiness of our soldiers, impact the readiness of our providers, and break trust with [patients] by forcing them to the TRICARE network," she said.

The medical progress of the last 13 years of conflict also would be jeopardized, "given an unstable funding environment and the detrimental second- and third-order effects of sequestration," Horoho said.

Even though the fiscal challenges that loom ahead are daunting, "We will continue to support the Army in any austere environment at home or abroad," she said. "These are times of great uncertainty and opportunity, and while there will be many challenges, anything less than our top performance will cost lives."

Navy Concerned About Fiscal Challenges

Sound fiscal stewardship of Navy medicine's resources is critical to its capability to provide outstanding care to military beneficiaries, Nathan said in prepared testimony.

"The president's budget adequately funds Navy medicine to meet its medical mission for the Navy and Marine Corps," he said, adding, "We remain concerned about the uncertainties and associated challenges with any sequestration impacts."

The Navy supports the budget's proposals to modernize and simplify TRICARE, adjust cost-sharing requirements and mail-order pharmacy incentives to help sustain an equitable health-care benefit, he said.

A Shift in Focus Ahead

All three services plan future medical care plans that will focus more on "health" than "health care," the surgeons general reported.

For example, the Air Force will emphasize human performance, "which is clearly connected … to assure optimum performance of airmen," Travis said from prepared testimony.

As the Air Force plans to provide customized prevention, access and care for patients, and recognize stresses associated with career specialties, Travis said, the service also wants to avoid physical or mental injuries when possible. For those that are unavoidable, airmen will have rapid access to care and recovery to reach full performance, he added.

"As a result, mission effectiveness and quality of life should improve, and long-term injuries or illnesses should be mitigated to provide for a healthier, more active life, long after separation or retirement," Travis said.

And long-term health care costs and disability compensation should also decrease, he added.

New Challenges Call for Funding

Future challenges for all three medical services will include service members' exposure to infectious diseases as the U.S. military shifts its focus to the Asia-Pacific region, Horoho said.

The endemic infectious diseases include malaria and dengue fever, and other "emerging disease threats," she said.

And infectious diseases are responsible for more U.S casualties than enemy fire, Horoho emphasized.

"Continued progress to address these emerging threats requires ongoing commitment to funding to respond," she said.