WASHINGTON, DC—The president’s FY 2011 DoD proposal includes $549 billion for the base budget, which is up 3.4% over last year. In addition, the department is requesting $159 billion in FY 2011 to support overseas contingency operations, primarily in Afghanistan and Iraq, and $33 billion to implement the president’s new approach in Afghanistan.

In support of military health costs, the budget request includes $50.7 billion for the Unified Medical Budget to go towards supporting the Military Health System (MHS), which provides care for 9.5 million eligible beneficiaries.

The budget request includes funding for programs for the wounded, ill, and injured. According to the administration, key initiatives include: achieving a seamless transition for servicemembers leaving DoD and entering the VA system, ensuring a high standard at facilities caring for wounded warriors, enhancing case management of individuals transitioning to civilian life, establishing a better Disability Evaluation System, and working with the VA to create Virtual Lifetime Electronic Records.

Proposed funding will also go towards the treatment, care, and research of TBI and psychological health injuries, and issues such as the development of tools to detect and treat PTSD and enhancements to suicide prevention measures.

Health Care Costs on the Rise

This year’s DoD budget request was not formulated with the assumption that Congress will allow the agency to raise TRICARE fees and deductibles for working age retirees and their families. During the Bush administration, the budget request was based on the assumption that Congress would approve these fee hikes for military retirees under the age of 65. Congress, however, never warmed up to the idea of the fee hikes and did not approve the idea.

At issue has been that DoD health care costs have been increasing substantially over recent years—$19 billion in 2001 to $50.7 billion for FY 2010—while the portion of medical costs paid by under-65 retirees enrolled in TRICARE has not changed since the program began. MHS costs are expected to grow from 6% of the DoD total budget to over 10% in FY 2015.

DoD Secretary Robert Gates emphasized that there is a need to reign in military health care costs. “It’s only going to go up. And it is absorbing an increasing percentage of our budget. We absolutely want to take care of our men and women in uniform and our retirees, but at some point, there has to be some tradeoff between reasonable cost increases or premium increases or co-pays, and the cost of the program,” he said last month.

Congress Examines Budget Request

At a hearing held last month by the Senate Armed Services Committee, members wanted to know how the DoD budget would address mental health issues. “What do we need to improve our treatment of mental illness and how does this budget address that?” asked Sen Daniel Akaka, D-HI.

Gates pointed to the “over $1 billion dollars” in the proposed budget for PTSD and TBI. He also said that all the services “have extensive programs” for dealing with psychological problems. However, Gates also said that there are two problems that the department still struggles with. One is the shortage of mental health providers, and the other is that stigma often prevents servicemembers from seeking mental health care.

Members also voiced concern about injuries caused to troops by IEDs and troops’increased exposure as the number of troops increase inAfghanistan.Akaka wanted to know what Gates intends to do to reduce IED-related injuries there.

Gates said that a task force he appointed to look at how to improve DoD’s response to the problem made recommendations to enhance long-term full-motion videos to watch roads and around military encampments in Afghanistan. In addition, commanders have increased the requirement for mine-resistant ambush protected vehicles.

He also pointed to an effort by the US to curtail the illegal smuggling of the fertilizer component ammonium nitrate into Afghanistan. A high percentage of IEDs in the country are made from ammonium nitrate, which is illegal in the country. “We have a number of initiatives underway to improve the strong work that is already being done because this is absolutely the worst killer and maimer of our troops,” he said.

Concern was also voiced about prescription drug misuse in the military. Sen Claire McCaskill, D-MO, asked that a DoD task force that is examining prescription drug use in the military also specifically examine prescription drug use for pain among service-members. “Not only should we be looking at the antidepressants that I think have become ubiquitous in some instances, but also the prescription drugs for pain,” she said.

McCaskill said that she was particularly concerned about OxyContin, which she categorized as highly addictive. She asked Gates that the prescription drug task force determine how widely available OxyContin is in the military and whether or not its effect has been harmful or positive overall.

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