Today and we welcome them. Lieutenant dingell, rear admiral bruce gillingham, surgeon of the u. S. Navy. Lieutenant general dorothy hogg, Surgeon General of the United States air force. Mr. Mccaffrey, assistant secretary of defense for Health Affairs and lieutenant ronald j. Pace director of Health Agency and mr. Bill tinston Program Executive officer of Defense Health care and management systems. Today we have serious questions on how medical reforms have been accounted for in the president s budget for fiscal year 2021. We will have members coming in and out. We are getting briefings on covid19 as we speak and theres a few other meetings going on. Your full testimony is available and i know members had it like i did last night to read through it. Well get start. Across is the spectrum of the military health care to benefit care in many cases the budget justifications lacks adequate detail for the subcommittee to make informed decisions. We hope the Witnesses Today can address the subcommittees questions and concerns. Out of particular interest we look forward to hearing about the role of the department in addressing or assisting other federal agencies dealing with the epidemic or pandemic possible outbreaks such as covid19. The departments study on reducing and eliminating Certain HealthCare Services at many military Treatment Facilities and an update on the departments Electronic Health care records system msa genesis. We look forward to hearing about these topics and more and with that i want to thank you for appearing before the subcommittee and now i want to recognize our distinguished Ranking Member mr. Calvert for his comments. Thank you, madam chairman. I want to thank you referring to this horrible disease as covid19. Im from corona, california, we want to make sure we call the disease what it is. I did it for you. I appreciate that very much. I want to welcome our distinguished panel. This is a critical year for the military Health Care System with a lot at stake, trying to keeps the covid19 virus from impacting readiness and going through significant structural changes to the system. These changes include transitioning military Treatment Facilities from the services the Defense Health agency and consolidating facilities and shifting medical specialties to focus more on operational readiness all while continuing to implement a new Electronic Health records system. Currently you have a lot on your plate. Given these issues will impact a broad population, to include military personnel, dependents and retirees, i cant overstate the importance of keeping us apprised of your progress and informing us when you need help. We must ensure that health and safety are not adversely impacted as a result of these structural changes. During my time ill ask you to address some of these issues starting with your preparedness and resourcing for covid19, we all know the impact it has globally and ill be interested in your plans to mitigate its effect on the force. In addition ill ask about your views on the structural changeses to the military Health Care System and their potential impact on readiness. Finally i look forward to hearing about the progress on implementing the new lec trop nick Health Record. Thank you for your service. I look forward to your testimony. I yield back. Thank you. They are hoping to be joining us and break for any statements they wish to make when they arrive. As i said earlier your full written testimony will be placed in the record and members have copies at their seats and i told some of you i was riveted reading last night. We have it and we thank you for it. In the interest of time, however, im going to strongly encourage each one of you to keep your summarized statement to three minutes or less and i will let you know when youre at three minutes. I will do so gently and then it might get louder with the gavel. Lieutenant general dingle will you lead us off with a threeminute remark. Thank you, vice chairman. Ranking member calvert and distinguished members it is an honor to speak before you today. The mission of Army Medicine is to conserves the fighting strength. As armsy is called upon, we accomplish this not independent lit but as part of a joint force that is represented before you today. The chief of staff of the army says people first and winning matters because there is no second place in combat. Like general mcconville i and everyone in Army Medicine recognize the strength of our army lies in our people, soldiers, their families, our civilians and soldiers for life. They are our greatest strength and most important asset. My vision for Army Medicine is to ensure we remain ready, reformed, reorganized, responsive and relevant in this area of global complexity, change and uncertainty. In support of multidomain operations, large scale combat operations. As the army undergoes modernization to support the battlefield, we will lead through change. And reorganize to remain responsive to the war fighter. However our unwavering commitment to save lives will never change. In tomorrows multidomain battlefield our adversaries may possess area denial capabilities that will test our ability to provide prolonged field care. Consequently our medics will have to sustain life in austere locations. This requires training in our doctor and training solutions. To remain relevant Army Medicine must leverage 21st Century Digital technology along with research and development to remain proficient. Similar to hiv and the ebola responses Army Medicine is working with leading agencies and institutions to combat covid19. Army medicines ability to prevent and detect and treat diseases depends on the armys Research Development and Public Health capabilities that enable a medical ready force and a force that is medically ready. I want to thank the committee for allowing my colleagues and i to speak before you this morning. America entrusts the military Health System, Army Medicine and the services with this most precious resources our sons and daughters. It is imperative that we get it right and we will. Your commitment and continued support assures the joint force when a wounded soldier cries out medic in combat we will be there ready to respond because Army Medicine is armstrong. I look forward to answering your questions. That was delivered with precision timing. Thank you. Rear admiral gillingham your statement please. Good morning. Madam chairwoman mccullum, Ranking Member calvert, distinguished members of the subcommittee on behalf of the over 60,000 of men who comprise the navy ready mission team im pleased to be here and grateful for the trust you place in us. The mission of Navy Medicine is linked to those we sieve. The United States navy and marine corps. Their ability depends on their medical readiness and our capability to enhance their survivalal in a highend fight. Survivability is Navy Medicines contribution to lethality. Our priorities of people, platforms, performance and power are strategically aligned to meet these imperatives. Welltrained people working as cohesive teams on optimized platforms demonstrating high velocity performance that will project medical power in support of naval superiority. I can tell you these priorities are rapidly taking hold. On any given day Navy Medicine personnel are deployed and operating forward in a full range of diverse Missions Including damage control resuscitation and surgery teams, trauma care at the nato role 3 multinational medical unit in kandahar, afghanistan, humanitarian assistance aboard our hospital ships and Expeditionary HealthService Support around the world. There is no doubt that people are the epicenter of everything we do, dedicated active and reserve personnel, Navy Civilians serving around the world in support of our mission. To meet current and future challenges we must recruit and retain talented medical and civilian workforce. Navy medicine continues to focus on several key areas, both our officer enlisted communities including critical war time and operational specialties as well as Mental Health care providers. Importantly we are now embedding 29 of our uniformed Mental Health providers directly with fleet, Fleet Marine Force and training commands to improve access to care and to help reduce stigma. All of us have a responsibility to do Everything Possible to reduce the incidents of suicide. Its important its impact is devastating and affects family, ship mates and commands. Collectively, substantive military Health System reforms directed by congress fiscal years 2017 and 2019 National Defense authorization acts represents an important Inflection Point for military medicine, catalyzed our efforts to strengthen our system of readiness and health. Navy and marine corps leadership recognize the tremendous opportunity we have to refocus our efforts on medical readiness while transitioning Health Care Benefit administration to the Defense Health agency. You would expect from a transformation of this scale, mhs reform presents both challenges and opportunities in point to progress made to date however all of us recognize there is much work ahead. In summary, nation depends on our unique expeditionary medical expertise to prepare and support our naval forces. It is a privilege to care for our sailors, marines and families. Thank you for your leadership and i look forward to your questions. Thank you. Lieutenant general hogg, please. Vice chairwoman mccullum, representative calvert and distinguished members of the subcommittee it is my distinct honor to testify on behalf of the 64,600 active duty guard reserve and civilian airmen who comprise the air force medical service. At home and abroad, air force medics answer the call across a Broad Spectrum of operational, humanitarian and Disaster Response missions. From the clinic to the battlefield and even the back of an airplane, our ability to deliver lifesustaining care is the most in the most challenging environments ensures our warriors return home to their families. The air force medical Services Corp competency of Aerospace Medicine and evacuation focuses on the needs of air and Space Operators and maintainers. Since september 11, air force air medical evacuation crews have conducted more than 340,000 Global Patient movements including 13,500 Critical Care missions. In the deployed environment, roughly 30 of downrange care is trauma related and the remaining 70 is disease nonbattle injuries. These injuries range from occupational, denl and musculoskeletal injuries. Our training and currency opportunities mirror these scenarios to produce wellrounded, flexible medics who can accomplish any mission under the most unpredictable conditions. As the National Defense strategy shifts focus to global conflict and peer competition, the air forces posture to increase lethality, strengthen alliances and realign resources the air force medical service is evolving in support of these National Defense objectives by investing in our air medical evacuation platforms, surgical teams and broadening every medics skill set, preparing them to deliver care in environments where we may not have the access to functioning airfields or stateoftheart equipment. The story of colleen mitchell, a young medical technician, drives home the criticality of this point. In january airmen mitchell was on her first deployment when al shabaab militants attacked the air fields in kenya killing three americans. Awakened by the chaos she assumed the role of lead medic spending hours triaging and treating patients working with limited personnel and supplies she operated well above her pay grade and outside her comfort zone to save lives. Airmen mitchell demonstrates the qualities that makes our medic reese markble. Leadership, technical skill and unwavering commitment to mission and those whom we serve. As a Surgeon General my responsibility is to prepare every medic to do what airman mitchell did and i do not take this task lightly. They remain our primary readiness platform but sometimes fall short of offering patient volume, diversity and acuity needed to sustain clinical currency, leveraging additional training opportunities through civilian and Government Health organization is paramount and will grow as we rescope the direct care system. Military medicine presents unique challenges that a civilian Health Care System does not encounter. Our medics will continue to rise to those challenges. Thank you for your continued support and i look forward to your questions. Thank you, Lieutenant General please. Vice chairwoman mccullum, calvert, just a few comments to my colleagues. The dhas principle mission is supporting readiness and within that are two distinct responsibilities first to ensure that every person in uniform is medically ready to perform their job anywhere in the world. Second is to ensure our military medical personnel have the cognitive and Technical Skills to support the full range of military operations which our leaders may call on us to perform. The Defense Health agency is accountable to the assistant secretary of defense, the combatant commands and the military departments for same. The dha assumed responsibility for managing all military hospitals and clinics in the United States in october of last year. Working closely with my colleagues, the service Surgeon General and the joint Staff Surgeon we view our medical facilities as readiness platforms where medical professionals from the army, navy and air force obtain and sustain their skills from which these professionals deploy in support of military operations. The d. O. D. s leadership recent assessment of which medical facilities best support this Readiness Mission provides the basis for moving forward and implementing these decisions. We intend to execute this plan there a manner that ensure our patients continue to have timely access to quality medical care. Ill highlight a few points. Active duty family members who are required to transition to civilian Network Providers will incur little to no additional outofpocket costs for their care. Second, all beneficiaries in these locations will still enjoy access to the mtf pharmacy. Finally well implement changes in a deliberate fashion at a pace local Health Care Markets can handle. If market capacity in a location is more constrained than we estimated well reassess our plans and potentially adjust them. The surgeons general and i are assuring the proposed medical personnel is coordinated. This synchronization will be reflected in the personnel Reduction Plan required by the fy 20 nda section 719 as due to the congress in june. The dha is scrutinizing every part of our budget to ensure were using the resources provided by congress in a manner that supports our Readiness Mission. Weve established four Health Care Markets to integrate health care in specific regions of the country and establishing additional markets throughout this year. Local military medical leaders will have the authority and responsibility to allocate resources in a way that improves patient care and our readiness functions. Im grateful for the opportunity to provide further detail on our efforts to standardize military medical support to combat and commands, the departments and to our patients. Thank you to the members of this committee for your commitment to the men and women of our armed forces and the families who support them. Mr. Mccaffrey, please. Vice chairman mccullum, Ranking Member calvert and members of the subcommittee on behalf of the secretary of defense it is an honor to speak before you today representing the dedicated military and civilian professionals the military Health System who support our war fighters in care for the 9.