Senator Collins Pushes for Expanded Health Coverage for National Guard Members, Improved Mental Health Services

Press Release

At a Defense Appropriations Subcommittee hearing reviewing the Pentagon's health care programs, U.S. Senator Susan Collins, a senior member of the Subcommittee, pushed to expand eligibility of the Tricare Reserve Select program to members of the National Guard at no-cost. She also requested an explanation for the decline in soldiers' visits with mental health care providers between Fiscal Years 2020 and 2021 even as the rates of suicide and mental health challenges within the military population remain alarmingly high.

Senator Collins began by focusing on the need to ensure that Maine Guard members have access to health care. Given that National Guard members need to maintain medical deployability requirements, ensuring consistent and reliable health care for National Guard members is critical to readiness.

"Maine National Guard members have told me that there is a need to extend Tricare Reserve Select at no cost to the Guard members who do not currently qualify for premium-free Tricare," Senator Collins told Dr. David J. Smith, the acting Assistant Secretary of Defense for Health Affairs. "One of the concerns that has been raised is that service members have to change health care plans when individual duty status or orders change, and that affects continuity of care. As an example of that, we're soon going to see a large group of Maine Army National Guard members deployed to Poland."

Dr. Smith acknowledged that extending Tricare eligibility for Guard members would improve medical readiness.

"I clearly would think having Tricare Reserve Select…should facilitate medical readiness," said Dr. Smith. "On the con side would be there is a substantial cost associated with expanding the Tricare benefit to the National Guard. Also, we have to be cognizant of…how that may affect the ability to recruit and retain active duty versus reserve and guard, as we sort of equalize the benefits that are accrued with that employment as another potential side effect of expanding the program to the entire National Guard over."

Senator Collins requested that Dr. Smith provide cost estimates for an expansion of no-cost Tricare Reserve Select.

Directing her next question to Lieutenant General R. Scott Dingle, the Surgeon General of the Army, Senator Collins asked about the rate of suicides and other mental health challenges among service members.

"I was surprised to see that the number of behavioral health encounters actually fell from 2.05 million in fiscal year 2020 to 1.68 million in fiscal year 2021," said Senator Collins. "And yet, suicide numbers remain very consistently high. So I'd like to ask you, General, to elaborate on the factors so that I can better evaluate this declining statistic, because it does not seem to be correlating with a substantial, a similarly substantial, decline in suicides, for example."

"[T]hat is a great question that I do not know the exact answer to," LTG Dingle responded. "As we look at it across the board and across the United States Army, one of the things that we're trying to get across is one to remove the stigma, so that our soldiers will in fact seek behavioral mental health, that it is okay. And so we implemented several programs at the strategic, operational, and tactical level to get after that."

LTG Dingle elaborated on several of the initiatives the Army has launched to encourage soldiers to utilize mental health resources, such as one base's initiative called Operation Victory Wellness, which requires every soldier to see a mental behavioral health specialist once a year. He also noted that there are regional differences that need to be addressed. For instance, despite the skyrocketing use of telehealth for many services, virtual behavioral health visits in Alaska have actually decreased. LTG Dingle attributed this trend to service members and their family members in Alaska preferring in-person visits. He said that the Department of Defense is working to raise awareness about the benefits of the virtual platform while soldiers wait for an in-person appointment.

"I'm really interested…in what you just said about telehealth because our experience in Maine has been exactly the opposite," Senator Collins observed. "What we've found is that telehealth counseling reduces the stigma. And as one hospital administrator told me, when they moved all of their behavioral health sessions to telemedicine during the pandemic, their no show rate went to zero."

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