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Govern Reserve Health Care by Risk, not Status, Leader Says

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Dec. 1, 1999 – An Air Force Reserve technical sergeant was called to active duty in Kosovo. Before the call-up, he, his wife and their three children got their medical care from a civilian dentist through his employer's medical insurance plan. The plan didn't cover them, however, once he left for active duty.

He walked into his military health care office to enroll his family for dental care. The clerk asked to see his orders, which stated, "You are hereby called to active duty for a period not to exceed 270 days."

"We're sorry," the personnel clerk said. "We can't put your family into the military dental care program, because you need two years of obligated active duty in order to enroll."

Charles Cragin, assistant defense secretary for reserve affairs, related this true story as an example of how reserve component members often don't get the same level of care as their active duty counterparts, even when they perform the same duties.

"Duty status shouldn't determine the level of health care reservists and their families get," he said. Instead, according to a new entitlement study, their care should be based on the reservists' exposure to risk or harm.

The report Defense Secretary William S. Cohen sent to Congress in mid-November recommends sweeping changes to the statutes and policies covering health care benefits and entitlements for Guard and Reserve members. Cragin called the study vitally important because of the number of "disconnects" created by America's increased reliance on the Guard and Reserve to meet worldwide mission requirements.

"There are guardsmen and reservists serving on active duty someplace, somewhere, every day," he said. "They may only serve for two months, but they're serving. So we had to get away from the issue of status determining the level of health care they get."

The study recommends 14 changes to the health entitlements of reservists and their families and force health protection. Several of the recommendations have already been adopted in the fiscal 2000 Defense Authorization Act.

One provision under the act allows DoD to place a reserve component member on active duty while he's treated or is recovering from an injury, illness or disease incurred while performing inactive duty training. More far reaching are the act's provisions expanding dental care to cover reservists' families and giving the defense secretary authority to waive or reduce TRICARE Standard's annual $300 deductible per family when reservists are ordered to active duty for less than one year to support a contingency operation.

Recommendations Congress still must consider include identifying non-DoD resources for accomplishing such readiness requirements as annual physicals and immunizations. These could come from the Department of Veterans Affairs, Public Health Service, civilian contractors and private practitioners, Cragin said. The study also recommends creating a dental exam and classification form that any licensed dentist could complete and that would satisfy the DoD annual dental examination and classification requirement.

"These folks don't serve on active duty 365 days a year," Cragin said. "Therefore, we want to maximize the utility of time we have with them. If we can develop this certification form that they can take to their civilian dentist, for example, we'll save the time of having to go through that on a drill weekend.

"It's the same with physicals. We're looking to expand the universe that can be used to meet the physical, dental and medical assessment requirements for evaluating guardsmen and reservists."

Dental care also will get a boost with the already approved merger of the Reserve Member Dental Program and the TRICARE Family Member Dental Program, which currently covers only active duty families. After the merger, families of reservists will, for the first time, be able to receive dental care at reduced costs.

The recommendations sent to Congress include a proposal for a long-term study to look at the overall medical readiness of reserve forces. The study would help DoD identify potential health risks and ways to better assess reserve component health, Cragin said.

He said the changes incorporated in the 2000 defense budget and the recommendations sent to Congress continue Cohen's policy of total force integration. "We need to identify and eliminate any cultural or structural barriers that stand in the way of the seamless integration of this force," he said.

Cragin said he believes Congress will act positively on the proposals and expects the changes to come about incrementally.

"I'm not sure that everything that we suggest needs to be changed tomorrow will, in fact, be changed tomorrow, but we're going to work with Congress on this," he said. "Members of Congress have indicated a keen interest in health care issues as they relate to members of the Guard and Reserve. We're really looking forward to working with them on these issues."

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