An army may march on its stomach, but deployed soldiers will stay focused in the field when they know their families are being cared for at home.
When it comes to the front-line warfighters stationed on forward-deployed U.S. military bases and ships, concerns about financial and family health issues can be a subtle, but systemic, threat to force readiness.
Those strains can manifest in many ways, from suicides, such as the seven enlisted men aboard the aircraft carrier USS George Washington between April 2021 and April 2022, to poor dependent access and inadequate health care on military bases that can cause distractions in the field and shortfalls in retaining high-performing leaders.
During a March 7 hearing before the Senate Appropriations Committee’s Defense Subcommittee on the Defense Health Agency’s (DHA) FY24 spending needs, senators heard from the Department of Defense (DoD), the agency’s director, and chief medical officers of the three military branches how such strains can affect operational readiness.
In 2018, the Pentagon completed a seven-year transition that established the DHA as a joint, integrated combat support agency rather than each military branch having its own. Its fiscal 2023 budget was $773 million, and the fiscal 2024 request is nearly $800 million of the Biden administration’s $6.9 trillion spending plan’s $885 billion military budget.
March and April are usually when military command officers and Veterans Affairs (VA) officials testify before congressional panels about their spending proposals during the annual budget cycle leading up to Oct. 1, the official start of the federal fiscal year.
Thus far, unit and regional commanders, DoD chiefs, and VA officials have discussed in hearings an array of topics and undefined—until Biden’s budget announcement—spending needs. There were 16 hearings on Capitol Hill related to military and veterans’ affairs issues between March 6 and March 10.
‘Lighten the Load’
During the March 7 hearing before the Senate defense appropriations panel, Assistant Secretary of Defense for Health Affairs Dr. Lester Martínez-López said the military is paying more attention to mental health and dependents’ access to medical services to enhance overall force readiness, especially in addressing the “ongoing cases of suicide by serving members and family members.”The Pentagon must “reverse the heartbreaking trends we have witnessed,” he said, pointing out that while suicide is a national scourge reflected within the military community, in the armed services, it’s a symptom of those serving on active duty facing operational stresses who are unable, or in some cases, fearful, of seeking mental health counseling.
Sen. Dick Durbin (D-Ill.) said mental health counseling “is so important for all of us—all of us—but especially in the military” but in the past, there was a “stigma attached” to doing so.
“There’s movement in the bullpen on that” but it will take time, Martínez-López said.
“Mental health is health. Now we can put it on the table.”
Once “on the table,” he said, most of the time the person isn’t really dealing with a mental health issue but a stress issue related to other matters.
“We need to lighten the load on military members,” he said, and alleviate financial crises and concerns about dependents’ quality of life in military housing, or it can degrade force readiness.
Sen. Susan Collins (R-Maine) noted that among issues identified in providing expanded mental health services for active-duty military and their families is that it takes the DHA a year and a half to hire psychiatrists and a year to hire psychologists. And when it does issue a job offer, it’s often turned down because the applicant found a position elsewhere.
‘Arctic Warrior’ Stresses
Sen. Lisa Murkowski (R-Alaska) said suicide is an issue among active duty personnel and their families at the Fort Wainwright U.S. Army and Eielson Air Force bases.No wonder, she said, noting that for some Wainwright soldiers, it’s a three-mile trek from their barracks to a “WWII-Era dining facility,” which can be an arduous and depressing way to live, especially in the winter.
The situation at Wainwright was identified by the military in its report, which called for replacing old buildings on base.
“We know we’ve got to do something. Doing the studies doesn’t necessarily change lives,” Murkowski said, noting that a proposed “Arctic Warrior” bill would provide those stationed in Alaska an additional stipend and allow them to be reimbursed for the cost of a flight home.
These are “financial stressors” that decrease force readiness, she said.
“They need $2,000 to $3,000 for a flight home,” which many can’t afford.
Also, Murkowski said, outdated technologies plague many commands, especially those that are forward-deployed, with active-duty warfighters “not being paid on time.”
She has fielded complaints of some “waiting up to seven months” to resolve paycheck issues.
“That kind of financial stress on service members ... isn’t right.”
In Japan, a Force Diminisher
Biden’s fiscal 2024 budget request states that “military families are key to the readiness and well-being of the All-Volunteer Force, and therefore are critical to national security.”But the lack of medical facilities on bases in Japan is forcing military families to wait for extended periods for appointments and Defense Department civilians to seek “host nation providers” to tend to routine and chronic care issues.
Subcommittee Chair Sen. John Tester (R-Mont.), in addressing the situation in Japan, began his remarks by saying, “I want to talk about China.”
He said the United States has “troops in Japan and in other places” facing off against Chinese forces that require vigilance, which can be imperiled by instability on their bases, such as “a lack of health care for dependents and DoD civilians.”
In October, the DHA announced that the military’s civilian employees in the Indo-Pacific region—which spans from the U.S. West Coast to the Arabian Sea—must receive routine medical care from a “local host nation provider” because military hospitals lack the capacity to service them, beginning Jan. 1.
That policy came down after an assessment of forward-deployed bases determined more space within existing medical facilities needed to be accorded and upgraded to treat active-duty casualties in, for example, a war with China.
The USFJ would be a pivotal component—and target—in the event of a war. It has approximately 54,000 active-duty military and 45,000 dependents dispersed among 84 installations primarily on Honshu, Kyushu, and Okinawa islands.
USFJ includes the headquarters of the 7th Fleet and the 5th Air Force on Honshu in the Tokyo area and the 3rd Marine Expeditionary Force on Okinawa.
The restricted access is most acutely an issue for the 8,000 USFJ civilian employees working on bases on mainland Japan, especially on Yokota Air Force Base, Naval Hospital Yokosuka, and Camp Zama, the headquarters of U.S. Army Japan.
Many DoD civilian workers are key weapons systems technicians and technology consultants, and without access to on-base care, Tester said that it “is going to end up being an incredible recruitment challenge.”
Base commanders have been lobbying for expanded medical facilities for a while, he said, but now “these reports are ... repeatedly delivered with a sense of urgency from military leaders in Japan.”
“The impact on our military readiness is alarming.”
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