The services plan to cut nearly 13,000 military medical billets using a phased approach through FY 2027, according to a recently released DoD report – a 25% reduction in billet cuts compared with previous proposals.

The report, reflecting MOAA wins from FY 2020 and FY 2021 National Defense Authorization Act (NDAA) legislation, provides the first glimpse at how billet reductions may impact military treatment facilities (MTFs) and uniformed medical providers. It also provides MOAA with insights we can leverage to continue our efforts to halt the billet cuts and ensure continued beneficiary access to care – efforts that continue to be a top priority for the remainder of the FY 2022 NDAA cycle.

MOAA has advocated for enhanced congressional oversight since the medical billet cuts were revealed in the FY 2020 administration budget request. Thanks in large part to efforts from MOAA members who sent thousands of messages to their elected officials, DoD and the services were required to report to Congress on detailed plans and mitigation strategies related to medical billet reductions.

[MOAA IN MILITARY TIMES: New Plan Scales Back Massive Cuts in Military Medical Billets]

MOAA remains concerned about the potential negative impact of medical billet cuts on both operational requirements and beneficiary access to quality care, and will continue to seek a halt to the cuts alongside greater transparency and congressional oversight on mitigation planning.

What’s in the Report

The full report – which includes breakdowns of project cuts by year, installation, occupation code, and service branch – is available online in PDF format. Some details:

• Planned medical billet cuts have been reduced by 25% from 17,005 (submitted in FY 2020) to 12,801.
  
  
• The Army is responsible for the bulk of the adjustment, with the secretary of the Army deciding to adjust medical billet cuts from 6,935 to 2,948 based on additional analysis. The Army accounts for 95% of the overall DoD medical billet cut reductions.
  
  
• The majority of cuts (71%) are enlisted positions. The other 29% are aimed at officer and warrant officer billets, including 779 physicians and 1,081 nurses.
  
  
• Data by occupational code indicate notable reductions in positions related to clinical care including Behavioral Sciences/Mental Health Services, Biomedical Laboratory Services, Dental Care, Family Practice, Medical/Surgical Nurse, Ophthalmology/Optometry, Pediatrics, Pharmacy, and Radiology, among others.
  
  
• Medical billet cuts will impact 220 different units including hospitals, clinics, medical centers, research organizations, and educational facilities. The National Capital Region (NCR) will take the largest portion of the reductions; 1,603 billet cuts are in NCR MTFs because, as the report states, the ability to hire in this area is greater.
  
  
• All the services report a phased approach to billet reductions, with the preponderance planned for FY 2023 and the totals tapering off through FY 2027.
  
  
• The services plan to replace 56% of the uniformed medical billets with civilian hires and “absorb” 26% of the cuts where remaining staff at a location is assumed to be sufficient to cover current and future health care delivery demands. Of the other cuts, 9% are student positions and don’t require mitigation, per DoD, and 1% will be addressed by sending care to the TRICARE network – according to the report, the network optimization strategy was used sparingly based on limited network adequacy information.

What’s Next

While the report provides some details on medical billet cuts, it raises more questions than answers on mitigation planning and the potential impact on the direct care system, including beneficiary access to care.

Without these answers, it’s unlikely to change the minds of many in Congress who have expressed concerns throughout this process that DoD’s proposed cuts go beyond the military health system (MHS) reform directed in the FY 2017 NDAA. At a December 2019 hearing, for instance, Rep. Jackie Speier (D-Calif.) said it appeared the plan “prioritized cost cutting over operational needs and common sense,” and Rep. Trent Kelly (R-Miss.) said DoD “may be viewing this as a cost-savings exercise when the actual purpose is to improve efficiency and health care quality.”

MOAA has continued to raise concerns about medical billet cuts on the Hill and in meetings and letters to senior DoD leadership throughout this legislative cycle. We appreciate the House Armed Services Committee (HASC) responded to our concerns with a provision in its version of the FY 2022 NDAA that would force DoD to delay any planned cuts for a year after the bill’s passage and require a Government Accountability Office (GAO) assessment of the analyses used to support any reduction of military medical manning.

Please stay tuned for a Call to Action supporting this provision as the NDAA process moves ahead.