{ "id": "IN11115", "type": "CRS Insight", "typeId": "INSIGHTS", "number": "IN11115", "active": true, "source": "EveryCRSReport.com", "versions": [ { "source": "EveryCRSReport.com", "id": 598158, "date": "2019-05-10", "retrieved": "2019-05-14T22:18:36.560603", "title": "DOD\u2019s Proposal to Reduce Military Medical End Strength", "summary": "In accordance with 10 U.S.C. \u00a7115, Congress annually authorizes the end strength for active duty and reserve component personnel. End strength is the maximum number of personnel permitted in each military service (e.g., Army, Marine Corps, Navy, Air Force) as of September 30, the last day of the fiscal year. For fiscal year (FY) 2019, Congress authorized a total end strength of 1,338,100 active duty personnel and 824,700 reserve component personnel, including subtotals by force. Each military service then decides how to organize, train, and equip the people who compose its authorized end strength in order to meet combatant commander or service-specific requirements. \nThis decision includes determining the number of military medical personnel required in each service. The size of each service\u2019s medical force is often dependent on total end strength levels authorized by Congress, demands for medical capabilities in military operations, and the priority of those demands compared to other nonmedical capabilities. As major combat operations decreased over the past decade, DOD gradually reduced the active duty military medical end strength at an average annual rate of 1% (815 personnel). However, for FY2020, DOD proposes to reduce its active duty medical force by 13% (14,707 personnel). \nMilitary Medical Force\nDOD\u2019s total medical force includes military (active duty and reserve component), civil service, and contract personnel. Currently, the active duty medical force is comprised of 116,154 personnel from the Army, Navy, and Air Force\u2013approximately 65% of the total medical force. This includes uniformed physicians, nurses, medics, and other health care professionals. Most of the active duty medical force (71%) is assigned to the Military Health System (MHS). The MHS provides health care worldwide to approximately 9.6 million beneficiaries (i.e., servicemembers, retirees, family members) in military hospitals and clinics and through civilian health care providers participating in TRICARE. The remaining active duty medical force (29%) is generally assigned to health service support positions in deployable or warfighting units, military service headquarters, or combatant commands. \nDOD\u2019s Proposal to Reduce Military Medical End Strength\nDOD\u2019s budget request for FY2020 proposes an overall active duty end strength of 1,339,500 personnel. If authorized by Congress, this would be a 0.1% increase from FY2019 end strength levels. Budget documents detailing this request indicate that DOD plans to reduce its active duty medical force by 13% (14,707 personnel) in order to \u201csupport the National Defense Strategy.\u201d Compared to FY2019 levels, the Army would have the largest reduction in medical forces (-16%), followed by the Air Force (-15%), and the Navy (-7%). \nTable 1. Active Duty Medical Force, FY2019 vs. FY2020\n\nFY2019 (estimated)\nFY2020 (proposed)\nProposed Change (#)\nProposed Change (%)\n\nArmy\n44,643\n37,550\n-7,093\n-16%\n\nNavy\n39,600\n36,764\n-2,836\n-7%\n\nAir Force\n31,911\n27,133\n-4,778\n-15%\n\nTotal\n116,154\n101,447\n-14,707\n-13%\n\nSource: Department of Defense (DOD), \u201cDefense Health Program Fiscal Year (FY) 2020 Budget Estimates,\u201d March 2019; DOD, \u201cDefense Health Program Fiscal Year (FY) 2019 Budget Estimates,\u201d February 2018.\nFigure 1. Active Duty Medical Force, FY2011-FY2020\n/\nSource: Department of Defense (DOD), \u201cDefense Health Program Fiscal Year (FY) 2020 Budget Estimates,\u201d March 2019; DOD, \u201cDefense Health Program Fiscal Year (FY) 2019 Budget Estimates,\u201d February 2018; DOD, \u201cDefense Health Program Fiscal Year (FY) 2018 Budget Estimates,\u201d May 2017; DOD, \u201cDefense Health Program Fiscal Year (FY) 2017 Budget Estimates,\u201d February 2016; DOD, \u201cDefense Health Program Fiscal Year (FY) 2016 Budget Estimates,\u201d February 2015; DOD, \u201cDefense Health Program Fiscal Year (FY) 2015 Budget Estimates,\u201d March 2014; DOD, \u201cDefense Health Program Fiscal Year (FY) 2014 Budget Estimates,\u201d April 2013; DOD, \u201cDefense Health Program Fiscal Year (FY) 2013 Budget Estimates,\u201d February 2012; DOD, \u201cDefense Health Program Fiscal Year (FY) 2012 Budget Estimates,\u201d February 2011.\nNotes: Reserve component personnel are not reflected above.\nThe proposed reductions stem from several medical workforce assessments and reforms directed by the National Defense Authorization Act for FY2017 (P.L. 114-328). These mandates require DOD to\nestablish and report to Congress a process to define military medical and dental personnel requirements (by position) necessary to meet \u201coperational medical force readiness requirements;\u201d (\u00a7721)\nconvert certain military medical and dental positions to civilian medical and dental positions; (\u00a7721)\ndevelop measures to maintain critical wartime medical readiness skills; (\u00a7725)\nimplement a \u201cperformance-based, strategic sourcing acquisition strategy for health care professional staff.\u201d (\u00a7727)\nDOD\u2019s initial plan to implement these reductions include: (1) transferring positions (also known as billets) from the MHS to new health service support positions in deployable or warfighting units, military service headquarters, or combatant commands; (2) transferring billets from the MHS to the military departments for repurposing as nonmedical assets; and (3) converting certain military billets to civilian billets.\nConsiderations for Congress\nIn the coming months, Congress will consider the National Defense Authorization Act for FY2020 and annual defense appropriations. The following possible questions may be of interest to Members of Congress seeking further clarification on DOD\u2019s proposal to reduce its active duty medical force and conducting congressional oversight of the MHS. \nCosts\nWhat are the estimated cost-savings and opportunity costs (e.g., increased private sector care costs, reduced military medical capabilities and surge capacity, narrowed recruitment and training pipelines) from reducing military medical personnel numbers over the fiscal year defense program (FYDP)? \nHow might reductions in personnel affect costs for the TRICARE program?\nImpact to Military Operations\nWhat are the benefits or risks to military operations posed by reducing the medical force? \nHow might a smaller medical force affect military readiness?\nImplementation\nHow do the military services plan to implement a reduction of military medical personnel?\nHow might reductions in military medical personnel affect access to health care by servicemembers, family members, or retirees? \nRecruitment and Retention\nHow might proposed changes impact recruitment and retention of military medical personnel, particularly those with critically short wartime skills?\nAre current recruitment and retention tools (e.g., special pays, accession/retention bonuses, graduate medical education opportunities) adequate to meet military medical end strength requirements?", "type": "CRS Insight", "typeId": "INSIGHTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/IN11115", "sha1": "9929cb9d6676f4a6ba1dd56778129e86f3fa8fa3", "filename": "files/20190510_IN11115_9929cb9d6676f4a6ba1dd56778129e86f3fa8fa3.html", "images": { "/products/Getimages/?directory=IN/ASPX/IN11115_files&id=/0.png": "files/20190510_IN11115_images_1ef535f4926d0a06da3131de6cae8ef613d37c3e.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/IN11115", "sha1": "bbe0c2e3b5f85d712fd092bccccc7037e78da835", "filename": "files/20190510_IN11115_bbe0c2e3b5f85d712fd092bccccc7037e78da835.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4872, "name": "Military Personnel, Compensation, & Health Care" } ] } ], "topics": [ "Appropriations", "CRS Insights", "National Defense" ] }