Expanding Dental and Vision Benefits for Active Duty Family Members

On April 11, 2002, the Director of Defense Capabilities and Management testified before the Senate Armed Forced subcommittee on Personnel, “A significant body of research by the military services shows that family satisfaction with military life can significantly influence a service members decision to stay in the military or leave.”[1]

Impact of post-9/11 Foreign Policy on U.S. Armed Forces

·         Since September 11, 2001, the Department of Defense has reported more than 68,000 wounded and 4,443 killed in Iraq or Afghanistan.  The Department of Veterans Affairs, however, has reported treating nearly 300,000 Iraq and Afghanistan war veterans, including 95,000 for mental health conditions (38,000 of whom have been diagnosed with PTSD).[2]

·        Between 2001 and 2005, the Army saw the divorce rate for its officers nearly triple and nearly double for its enlisted soldiers.[3]

·         The suicide rate in the Army is the highest in 27years, with 121 soldiers committing suicide in 2007 (a 20% increase from 2006).  Moreover, attempted suicides and other self-inflicted wounds rose from 350 in 2002 to 2,100 in 2006.[4]

·         Since 9/11, more than 1.5 million soldiers have been deployed to Iraq and Afghanistan.  As a result of the continued demand on our Armed Forces, Secretary of Defense Gates announced in April 2007 that Army tours in Iraq would be extended from 12 months to 15 months.  (Tours will not be reduced to 12 months until August 2008 and then only for orders issued after August 1st.) 

·         Junior officers and NCOs are leaving the service at the highest rates in 30 years[6] and the propensity to serve is the lowest it has been in 20 years.[7]

·         To maintain the necessary number of service members, the Army has resorted to raising the maximum age, lowering the education standards, increasing cash bonuses, and, most alarming, issuing “moral” waivers for criminal convictions.  Almost 12 percent of

new Army recruits in 2007 have received these waivers for criminal convictions.[8]  Since 2003, 125,000 recruits have received waivers for felonies including crimes such as assault and robbery.[9] 

What Can Be Done?

While we cannot alleviate our nation’s need for a large, well-trained, and voluntary armed force (even with pre-9/11 needs, the U.S. military recruited 196,000 new service members in 2001[10]), we can take steps to improve military life by decreasing some of the hardships associated with military service.  One of the greatest hardships upon the service member is maintaining his or her marriage and tending to the needs of his or her family, particularly after 9/11.  

To preserve manpower and protect the integrity of the overall force, the military should not be relying so heavily upon lowered recruitment standards and ever-increasing financial bonuses.    General Pace recently testified before the U.S. Senate the family satisfaction and support played a key role in soldier morale and retention. [11]  Congress needs to designate and allocate a larger percentage of defense funds to enhance family member benefits and improve family support services.

An investment in the military family IS an investment in the military service member.  If the family is not taken care of sufficiently, it is HIGHLY unlikely that the service member will remain in the service once he or she has an opportunity to leave. 

"(Military families) are serving this country," General Pace said. "And when a service member comes home and their family tells that service member they're proud of them for what they're doing, they support what they're doing, they're willing to continue to support them in the future, that makes all the difference in the world."[12]

Further illustrating the point, a soon-to-be Captain shared his thoughts on what will be the biggest influence on him when he has to make the decision whether to stay in the Army (or leave): 

"It doesn't matter what I think.  It only matters what my wife thinks," he said.[13]

The military can do many things, large and small, to support the service member and his/her family, from providing lawn care on post to allowing the GI Bill to be transferable to a spouse or child to expanding dental and vision benefits (the emphasis of this particular proposal).  Supporting the family IS supporting the service member.   A failure to provide for the family is a failure to provide for the service member and the problems we see today with morale and retention are very much a reflection of the military’s inability to effectively meet the needs of the service member as well as his or her family.

Current Dental and Vision Needs of Military Families

Contrary to Army’s recruiting website, which states, “[a]s a Soldier, you and your family are automatically covered by a comprehensive HMO-type health care plan called TRICARE that provides medical and dental care at little or no cost,”[14] military families are actually responsible for a large portion of their dental costs.       

United Concordia is the dental service provider for the U.S. military.  In order to be covered, we pay $29 a month for a cost-share dental plan under which the only services that are covered 100 percent are x-rays and teeth cleanings.  Basic restorative work, endodontic, dental consultations, and post surgical visits are 80 percent covered.  Oral surgery, endodontic, periodontic work is covered by 70 percent.[15]  Implant services and prosthodontic are 50 percent covered, etc.  However, Tricare will only pay up to $1,200 per year per person for whatever needs to be done.  As a result, military families have had to take out “Emergency Relief” loans or resort to use high interest credit cards to pay for dental work that MUST be done (as dental conditions are progressive and become more severe and painful and their treatments become increasingly expensive and invasive if left untreated). 

Vision care is nearly non-existent for military families.  Tricare currently pays for one eye exam per family member per year and nothing more.  Consider the experience of the Van Riper family (active duty Army) currently stationed in Virginia:

“This year my daughter, age 4, was diagnosed as ‘legally blind.’  Tricare paid for one visit to the eye doctor.  She has required two follow up appointments this year that I must pay for out of pocket.  In addition, I must pay for lenses and frames.  Because her vision is so poor, we have had to "ease" her into her full prescription.  With two lens changes this year, and more on the way, this has become very expensive for my family.  It is sad that if my daughter's medical issues were with any other part of her body, that she would have coverage.  But because it is with her eyes, we have to pay for it ourselves.”

When the federal government chooses not to invest in programs that benefit the dependents of the service member, it has actually chosen to impose greater hardships upon that service member.  One cannot divorce the well-being of the family (particularly the economic well-being) from the well-being of the soldier: what benefits one, invariable benefits the other (and vice versa.) 

The failure of the military to meet the dental and vision needs of the military family creates a financial burden for the service member as well as his/her spouse, further exacerbating the hardships of military service and creating yet another disincentive for remaining in, as well as entering, the Armed Forces.  Perhaps, if Congress allocated more funds for family dental and vision benefits, the Army would not have to rely so heavily on lowered educational standards and criminal waivers for new recruits. 

DATA AND COST COMPARISONS

In 2006, the Army and Marine Corps spent 1.03 billion dollars in re-enlistment bonuses.[16]   Bear in mind, this 2006 figure is based upon Army bonuses that ranged from $10,000 to $30,000.  Now Army bonuses are as high as $40,000, so we can safely estimate a multi-million dollar increase in re-enlistment bonus expenditures for 2008 alone.

The Army expects to pay approximately $19,000 per new recruit in FY 2008.  Every year the Army needs to recruit approximately 80,000 new soldiers.  The annual cost FOR ARMY RECRUITMENT ONLY is over a billion and a half dollars ($1,520,000,000).  This expense does not reflect the recruitment costs for the other three branches.[17] 

Consequently, we know that Army and Marine Corps re-enlistment bonuses and Army recruitment bonuses will cost at least 2.5 billion dollars next year. 

Dental Coverage

Tricare should either provide coverage for all non-cosmetic dental care or at least increase its individual annual cap on benefits (from $1,200 to $2,500 per person per year).   A “grateful” nation does not make military families take out personal loans to cover essential dental work while their service member face repeated war-time deployments.    

According to the latest medical expenditure data published by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, many dental needs should be met with the current $1,200 annual cap.  For example, in 2004, nearly 25 percent of children under the age of six received dental care and the average cost incurred was $191.  For children between the ages of 6 and 17, nearly 55 percent received dental care and the average cost was $659.  Meanwhile, approximately 38 percent of the adults (ages 18-44) studied by the Agency had incurred dental expenses and their average expenditure was $496. [18]  

However, during a year in which there is a sudden need for non-cosmetic dental care that exceeds that cap, shouldn’t that family be covered?   Although we have a lot of anecdotal evidence regarding dental care that exceeded the annual cap, we lack official figures to guide us insofar as a possible cost estimate is concerned.  Nonetheless, dental coverage should be considered as an area for additional funding for increased per person coverage because when Congress chooses to cap dental benefits for the family member at $1,200 (per year), all unpaid dental expenses are essentially passed on to the service member. 

Vision Estimate

Fortunately, we can estimate funding for expanded vision coverage.

In 2000, the GAO reported 1.23 million children of active duty service members.[19]   According to the Department of Defense, there were 225,680 officers and 1,135,057 enlisted soldiers in the active duty armed forces in June 2007.  In 2000, the GAO reported that 70 percent of military officers and 50 percent of enlisted soldiers were married.[20]  For purposes of simplification (and the lack of access to more recent data[21]), we assumed that the same percentages of service members are married today, for a total of approximately 725,700 military spouses (158,200 officer spouses plus 567,500 enlisted spouses).

According to the DHHS Agency for Healthcare Research and Quality, 12.5 percent of the children studied incurred vision expenses averaging $183 and 15.5 percent of adults (age 18 to 44) incurred expenses averaging $204.[22]  However, according to the Vision Council of America, approximately 62 percent of the adult American population needs prescription eyewear.  One in four school age children have vision problems (Prevent Blindness America) and it is estimated that 60% of students identified as having learning problems in fact have undiagnosed vision problems (according to the American Optometric Association). 

If 25 percent of military children need vision care, the annual cost should be around $307,500.  Further, assuming that approximately 450,000 spouses need vision care (using the Vision Watch estimate of 62 percent), then that would be $91,800,000 for adult vision care and bringing our grand total to   $92,107,500.

CONCLUSION

Compared to overall military expenditures, expanding vision and dental benefits for active duty dependents is minimal and should received serious budgetary consideration.  For example, in 2002, Congress appropriated 100 billion dollars for military pay and benefits.  When we tried to come up with a worst case scenario cost estimate for this dental and vision expansion, we came up with 1 billion dollars; one percent what was appropriated in 2002.

It is well known that improving family satisfaction with the military increases the likelihood that a service member will remain in the Armed Forces.  Expanding these benefits will not only ease the economic burdens imposed upon the service member by non-coverage, but it will also generate greater goodwill toward the military and greater support for the service member by his or her family when the decision to re-enlist presents itself. 

Because the military is so depleted, the Army has resorted to $20,000 sign up bonuses and $150,000 re-enlistment bonuses while the Marines are offering bonuses of up to $61,000.[23]  Some of these funds could (and should) be diverted to improve family benefits and service member quality of life, thus increasing service member morale and family satisfaction and, correspondingly, decreasing the need for such high bonuses (or more importantly, recruitment tools such as criminal conviction waivers). 

Taking care of troops’ families isn’t just a moral imperative—it is a troop multiplier.