By Sandra Basu
WASHINGTON – Sustaining patient care functions in the Military Health System in the wake of sequestration “comes at a cost,” Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, warned Congress.
“The department will reduce funding from a wide range of other essential investments,” he told lawmakers at a recent hearing. “This could produce significant negative long-term effects on the Military Health System.”
Woodson made his comments at a hearing last month in which lawmakers wanted to know what the impact of sequestration will be on military programs such as the MHS. While VA programs are exempt from sequestration, DoD stands to sustain billions of dollars in mandatory cuts to defense spending.
Still, even in this cost-cutting environment, Woodson vowed the department “cannot and will not compromise care.”
“Our commitment to quality of care is sacrosanct. We will not allow quality to suffer or place any patient at risk. Period,” he said.
Civilian Employees Bearing Brunt
Military personnel programs were exempted from sequestration by President Barack Obama. When lawmakers failed to avert a March 1st deadline for a solution to sequestration, it became clear that DoD civilian employees, including those in the MHS, could be furloughed. Exactly what impact sequestration would have on DoD and MHS employees became less certain, however, after a continuing resolution was passed by Congress at the end of March.
Hagel said that, as a result of the continuing resolution, DoD would be able to reduce furlough days and delay the start of furloughs. Originally, DoD officials had predicted that furloughs would begin on Apri 26th.
Hagel said that these numbers “were floating,” and were still being worked out, but that this was “good news.”
“That right now looks as though we’ll be able to go from an original estimate of 22 days to 14. That, we think, will save the department anywhere from, I think the original estimates were around $4 billion, and we can probably plan on about $2.5 billion,” he said at a news conference.
At a town hall meeting at the Pentagon last month, Undersecretary of Defense (Comptroller) Robert Hale explained that as part of the process to implement furloughs, DoD must first notify unions about the furloughs.
“The unions in this case don’t have the right to bargain not to do the furloughs. They do have the right to bargain on how they are implemented,” he said.
Once furloughs go forward, employees would receive furlough proposals. DoD would then send formal furlough decision letters to employees. Employees would have the right to appeal their furloughs to the Merit Systems Protection Board, Hale said.
MHS Research Cuts
In the MHS, civilian providers make up nearly 40% of the medical staff in military hospitals and clinics. Prior to the passage of the continuing resolution, which may have lessened the effect of furloughs, Woodson had testified about of the severe impact that sequestration could pose to the MHS.
“We can expect the furlough of medical staff will impact access to care, causing inconvenience and dissatisfaction among those patients accustomed to getting their care in military treatment facilities. Furthermore, patients who formerly received care in a military treatment facility may seek to obtain care in the private sector at an increased cost to the department and the American taxpayer,” Woodson said in his written statement at a congressional hearing.
In addition, Woodson had warned lawmakers that sequestration could affect several other areas of DoD’s medical activities, such as its medical research.
“In order to pay the bills for immediate delivery of care, we are going to have to shift those funds from our investment in research to provision of care. That is going to slow or stop many of these research projects,” he said.
Woodson said the MHS prioritizes wounded warrior research but, in general, the cuts to research would be “deep and steep and delay progress.”
“We’ve already mentioned the impact of furloughs. Many of our researchers are a part of the civilian community, as well. We have collaborators in the civilian sector and the grants will be slowed. This is a real serious issue that has potential long-term negative consequences,” he said.
In addition, Woodson’s written testimony pointed out that the MHS would have to “dramatically reduce” investment in equipment to free funds for day-to-day healthcare operations.
“Existing equipment will be used longer with greater risk for breakdowns and increased maintenance costs,” he wrote. “At some point, equipment becomes obsolete and cannot be repaired any longer. Sequestration forces us to make do with older equipment that becomes obsolete and prone to breakdowns.”