Military Update: DOD official wary of healthcare gains for some reservists
Dr. William Winkenwerder, the Defense Department’s top health official, has a task force working to implement healthcare gains for reserve and National Guard forces that Congress approved this month. That includes opening Tricare, on a cost-share basis, to nonmobilized reservists who are unemployed or have no employer-provided health insurance.
But Winkenwerder is wary of how far Congress went this year in boosting reserve health benefits. The changes are costly, he said, and won’t solve the problem of some reservists being physically unfit when mobilized.
“I don’t think those two issues are related,” he said. “The issue that occurred at Fort Stewart and other mobilization sites [involved] command and medical accountability and responsibility. But they’re management issues that have solutions that don’t require benefit changes.”
Congress planned to boost reserve health benefits anyway this year, but that took on added import in October when a UPI wire service story reported that hundreds of reservists and National Guard soldiers, sick or wounded from tours in Iraq or medically unfit for call-up, were in “medical hold” at Fort Stewart, Ga., waiting weeks or months for care while living in rundown barracks. Some reservists reported their morale was sinking.
“There is no question that this was a significant and real problem,” said Winkenwerder.
Members of Congress demanded an investigation. The Army confirmed a shortage of medical staff and adequate housing. Stewart had processed 22,000 reservists for mobilization and 14,000 for demobilization since Sept. 11, 2001. Yet Armywide, they said, fewer than 4,000 of 200,000 soldiers mobilized were nondeployable and placed in medical hold.
The Army ordered extra medical staff to Stewart to relieve a backlog of care. Armywide, officials beefed up medical staff with contract personnel and sent more patients to other service hospitals or VA facilities. At Stewart, $3 million was found to buy air conditioners, improve lighting and spruce up recreation areas for medical hold soldiers.
David Chu, undersecretary of defense for personnel and readiness, revised policy to improve treatment of persons in medical hold across the services. He ordered medical commanders to provide medical hold patients with specialty care within two weeks, half the Tricare standard of 30 days.
If care isn’t available on base, reservists are to be referred promptly to other military, VA or civilian physicians. Also, they are to be billeted in the same quality of housing as active-duty members.
The 2004 defense authorization bill directs four other major improvements in reserve medical coverage. The one that most bothers Winkenwerder will open the Tricare triple option — Prime, Standard and Extra — to about 170,000 inactive reservists, those who are unemployed or have no employer-provided health insurance.
Mobilized reservists deserve active-duty benefits and are getting it, he said. But this change appears to ignore differences “in duty and in sacrifice” between nonmobilized reservists and active duty.
The other significant reserve healthcare changes are:
Transitional military health benefits for reservists will be available for up to 180 days after active duty, for separations that occur after the bill is signed. The current limit is 60 to 120 days. This would end Dec. 31, 2004, too, unless made permanent.
Medical, dental care
The services will be able to screen and provide needed medical and dental to reserve personnel as soon as units are alerted that they will be mobilized. Reservists now need to be on active duty to get military care.
Coverage for reservists and their families could begin up to 90 days before planned mobilization. Tricare coverage now is available only after personnel are on active duty.
Congress ordered the General Accounting Office to prepare a detailed report on reserve health care needs by May 1, 2004, and include GAO’s judgment on the effectiveness of these enhancements.