During a Senate Armed Services Committee hearing held before the Congressional recess, Sen. Jeanne Shaheen (D-NH) questioned experts about defense healthcare services funding.
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NewsTranscript
00:00Senator Shaheed. Thank you all very much for being here today. Dr. Robb, you
00:07discussed the impact of declining budgets on the Defense Health Agency. As
00:13a former director, can you talk about how late budgets and operating under
00:18continuing resolutions, continued budget uncertainty affects the readiness of the
00:23military health system? When I look back at, in fact I'll go back in
00:32history because I was part of that, when we initially stood up the Defense Health
00:36Agency in response to the perception that we had a 10% of the
00:41DOD's overall budget and then we moved and then I fast
00:45forward to 12 years later and now we're actually less than 10%. And I look at
00:49we were meeting most of our, not quite, but most of our demands back then. But as
00:54I watch, we've had increasing combatant command requirements with a decreasing
00:59defense health program. And what that has forced us to do is we've seen a
01:04couple of challenges and there are multiple things going on, but the
01:08military departments have, their end strength has gone down. And the way we
01:13man those hospitals is with a certain percentage of military members. And as
01:19Dr. Friedrich said, you just can't buy health care professionals off the
01:23streets. And so what, of course, when we cut the end strength, okay, then
01:29we portion this care downtown and then that increased tri-care budget,
01:34but then we have to pay with bag one money, which is direct care money, to pay
01:38direct care. So now we actually have an internal shrinking of our budget. So it
01:42has been challenging for the Defense Health Agency to manage a set of
01:47military treatment facilities with that to be the current business process.
01:51And is it fair to say that budget uncertainty exacerbates that problem?
01:57Continued resolutions exacerbate that problem? Absolutely, yes ma'am.
02:00Yes ma'am. Thank you. Dr. Friedrichs, you mentioned the National Guard. And one of
02:06the things that I know then, the National Guard, as we all know, is assuming a
02:10greater role in actual deployments and picking up work for the regular military.
02:20I could probably say that more eloquently, but they're taking on a much
02:26bigger role than they did 30 years ago. And yet the National Guard doesn't have
02:35the same coverage for health care that our regular military does, despite the
02:39challenges that you all have identified. It's even a greater problem for the
02:43National Guard. Can you speak to what we ought to be thinking about as we're
02:48thinking about how do we ensure that the Guard actually has the health care they
02:52need so that they're ready to go if they're called to deploy or called into
02:57combat? Thank you, Senator Shaheen. And I'll start, if I may, first with your
03:02premise that there's an increasing demand signal. The decision to take down
03:07the United States Agency for International Development and most of
03:10its capabilities is almost unquestionably going to drive more demand
03:14on the Department of Defense. USAID provided countless services for
03:20disaster response and for work with allies and partners around the world. And
03:24for global health. And for global health and for biosurveillance and many other
03:29roles. In the absence of USAID, we either agree that when Americans are caught in
03:34a disaster, they're on their own, or we're going to turn to the only other
03:38organization that has those kind of capabilities and that's DOD. So we should,
03:41I'm afraid, expect to see more demand on DOD as a result of those changes. To your
03:47point about health care preparedness, when we look back at why people shortly
03:51after deployment have to be pulled off the line, interestingly it's dental care,
03:55primarily among the Guard and Reserve, who don't have ready access to that. I
03:59think if we are serious about a smaller force that must be ready on a moment's
04:05notice, we are going to have to address how to ensure that force is ready when
04:10needed to go forward. And that's medically ready as well as ready and
04:14proficient with whatever their assigned task is. And we're learning a lot of
04:19lessons on the on our industrial base side from the war in Ukraine right now.
04:24And a lot of lessons about the conduct of war today. Are we learning anything
04:31about the health care system and what we ought to be thinking about from what's
04:35happening in the war in Ukraine? Anybody? If I may, I'll just quickly say having
04:42just been with the Ukrainian search in general, absolutely. So what they have
04:46found first and foremost is they're in the kind of conflict we will likely be
04:51in. In the absence of air superiority, contested logistics, you must have a
04:56functioning system that's integrated. And this gets back to Senator Fischer's
04:59question about the National Disaster Medical System. They're also learning the
05:03importance of supply chains. When we looked at this at the Joint Staff, we
05:06found that a significant percentage of the pharmaceuticals in our deployable
05:11assemblages actually rely on ingredients from countries that may or may not be
05:15willing to continue to provide those in the next conflict. Same song next verse
05:19with medical equipment. I urge you, as I said in my written statement, to require
05:23the department to give you an accounting for our vulnerabilities in that area and
05:27a plan to address them. There are ways to do that. We need a strong push, I would
05:33submit, to actually accomplish that. Thank you very much. Thank you all.
05:38Thank you, Senator Shaheen.