Free Health Care for All Troops Is Key Priority, National Guard General Tells Congress

Lack of easy access to mental health services may be compounding the suicide issue in the National Guard, its top officer told lawmakers, pointing out that some troops do not get free health care.

Gen. Daniel Hokanson, chief of the National Guard Bureau, on Tuesday called delivering health care to all Guardsmen his "No. 1 legislative priority."

"If we look at the past year and what we asked them to do, particularly when we didn't know what a COVID environment would be like. … We want the service member and their family to know if anything happens -- if they're sick, before or after duty -- they're going to get the care they need to continue their civilian or military employment," Hokanson said during a Senate Defense Appropriations hearing.

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He also highlighted the rising number of suicides in the National Guard, saying easier access to free care may alleviate some of the problem and urging Congress to step in. His plea to the Senate comes two weeks after he told House members that Guardsmen not having free health care is a serious issue that must be addressed.

"When we look at the number of soldiers and airmen that don't have health care coverage, if they have access to mental health care, or counseling, if that might benefit the number of suicides we have in our organization," he added.

In 2020, there were 118 suicides in the National Guard, up from 90 in 2019, according to Defense Department data. Of that, the Army National Guard saw 102 suicides in 2020 and 76 in 2019, while the Air Guard saw 16 in 2020 and 14 in 2019.

Across the entire military, 571 service members died by suicide in 2020, up from 503 in 2019.

Delivering health insurance to the 441,539-strong National Guard force would be a massive expense for the government, but Congress appears to be in the early stages of looking into it. After Hokanson's comments, Sen. Dianne Feinstein, D-Calif., said she "would be very happy" to work with the Guard on the issue, adding that she "suspects other members would as well."

In their conventional roles, Guard members are entitled to purchase health and dental coverage through Tricare. Deployed service members are able to get care for service-connected issues from the Department of Veterans Affairs.

Getting the Guardsmen closer to pay and benefits parity with their active-duty counterparts has gotten increased attention on Capitol Hill over the past year. But there is no bill on the table to provide free health insurance for Guard troops when they're off duty. So far, most efforts to achieve benefits parity for the Guard have focused on the GI Bill.

Some have argued that bureaucracy and the fine print on how troops are activated on domestic missions can unfairly strip Guardsmen of their benefits.

While on state orders, troops cannot file claims with the VA if injured, do not earn a full housing allowance, or accrue benefits such as the GI Bill. However, if that same mission is federalized under Title 32, which keeps troops under state command but sends the bill to the federal government, Guardsmen earn all benefits and are entitled to the same health care as their active-duty counterparts -- but only after 30 days of service and if the president declares an emergency.

According to Hokanson, switching to the free Tricare coverage they are eligible for during some activations could interfere with troops' civilian health insurance, sometimes forcing them to find a new health care provider.

He said a more streamlined, free and easy-to-understand system is needed to prevent interruptions in care and general confusion over how care works.

-- Steve Beynon can be reached at Steve.Beynon@military.com. Follow him on Twitter @StevenBeynon.

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