WASHINGTON—The President asked for $47.4 billion to meet the Department of Defense’s health care needs for FY 2010. A top DoD official told a subcommittee last month that the budget request fully funds the agency’s health care programs. “All of the requirements of both the service medical departments and the Tricare Management Activity were funded by the Secretary. We do not anticipate any additional requirements at this time,” Allen Middleton, acting principal deputy assistant secretary defense for Health Affairs, told the House Armed Services Committee’s Military Personnel Subcommittee.

The requested amount for the budget will cover the defense health program; wounded, ill and injured care and rehabilitation; military personnel; military construction; and Medicare-eligible retiree health care.

Absent from the 2010 budget request was a proposal to increase Tricare fees. During the last three years of the Bush administration, the White House had unsuccessfully tried to convince Congress that it was necessary to raise Tricare fees and pharmacy copays to counter rising health care costs in the agency. “This budget does not include any benefit reform savings,” Middleton told the subcommittee.

Budgeting For Health

Subcommittee Chairwoman Susan Davis said she was pleased that the budget request did not propose raising fees for beneficiaries. “The increases proposed in previous years would have provided large savings for the department, but most of the savings would have been the result of raising fees so high that large numbers of beneficiaries would choose to leave the system,” she said.

She expressed concern, however, about how the proposed budget would address improving AHLTA, DoD’s electronic medical record system. In March, DoD officials had told the subcommittee that they were working on a comprehensive plan to overhaul the system and address issues of slowness and stability raised by users. Rep. Davis said that she couldn’t “find any mention of any of the promises” made during the March hearing on fixing AHLTA in the FY 2010 budget request.

Charles Campbell, chief information officer for MHS, explained that officials are now in discussions about how to implement the plan they have developed to address AHLTA problems using the current FY 2009 budget. He said that they have already begun to address problems related to the electronic medical record system with the current budget. “One of the key components that the Services and others have mentioned to us is maintaining the stability of the system,” he told the subcommittee. “The key to that stability is our one central data repository that we have where all of the information is stored. If for some reason that goes down and is not working, then everyone goes into a ‘fail mode.’ So we are focusing efforts in the last two months on stabilizing the central data repository.”

During the March hearing on the electronic medical record system Army Surgeon General Lt. Gen. Eric Schoomaker, MC, USA, said that there did not seem to be a comprehensive strategy to address the issues hampering the system. Since that hearing he told the subcommittee that the office of the Assistant Secretary of Defense for Health Affairs has “redoubled” its efforts to bring the Services “inside the building of a comprehensive strategy rather than to piecemeal a plan that just mandates over problems.”

Mental Health Concerns

Members of the subcommittee also had questions regarding how the military is addressing mental health issues among its population. Subcommittee Ranking Republican Joe Wilson, R-SC, wanted to know what was being done in terms of prescreening service-members for mental health issues. The Surgeons General testified that the military is conducting appropriate screenings for mental health. “I believe that our prescreening and our preassessment brings us good individuals willing and able to do our nation’s work, and our job is to assure that we continue to support them in that endeavor and have the right capabilities to assist them if such assistance should be required,” said Air Force Surgeon Lt. Gen. Roudebush, USAF, MC.

Dr. Schoomaker agreed. “Given the state of science right now and given our understanding of predictors of difficulty, I think that we have appropriate screening,” he said. Dr. Schoomaker said that rather than establish arbitrary screenings, the Army is looking to build the resilience of those who are in uniform.

Navy Surgeon General Vice Adm. Adam Robinson, MC, USN, said that he also believes that current screening is adequate, but that servicemembers are being stressed by the war. “Everything that we are doing has to be looked through the lens of a very long and a very hard war,” he said.

He said that a large part of the stress of personnel is that they are repeatedly put in a war situation, which“exacerbates whatever people had at the beginning that would not necessarily come to the surface if they hadn’t been stressed to a certain level.”

Members also wanted to know how much dwell time—time between deployments—is optimal for the troops. Dr. Schoomaker said that the Mental Health Advisory Team, which is conducting an assessment of mental health in Iraq and Afghanistan, will provide data that will help the Army determine that. “I think that the current Mental Health Advisory team, which has just gotten back from Iraq and Afghanistan, will give us some of our best data,” he said.