[Senate Hearing 118-625, Part 6]
[From the U.S. Government Publishing Office]




                                ------                                
                                                  S.  Hrg. 118-625, Pt. 6
 
                  DEPARTMENT OF DEFENSE AUTHORIZATION 
 REQUEST FOR APPROPRIATIONS FOR FISCAL YEAR 2024 AND THE FUTURE YEARS 
                            DEFENSE PROGRAM

=======================================================================

                                HEARING

                               before the

                      COMMITTEE ON ARMED SERVICES
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                                   ON

                                S. 2226

     TO AUTHORIZE APPROPRIATIONS FOR FISCAL YEAR 2024 FOR MILITARY 
ACTIVITIES OF THE DEPARTMENT OF DEFENSE, FOR MILITARY CONSTRUCTION, AND 
   FOR DEFENDSE ACTIVITIES OF THE DEPARTMENT OF ENERGY. TO PRESCRIBE 
   MILITARY PERSONNEL STRENGTHS FOR SUCH FISCAL YEAR, AND FOR OTHER 
                                PURPOSES

                               ----------                              

                                 PART 6

                               PERSONNEL

                               ----------                              

                             MARCH 15, 2023
                             
      GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT
                       


         Printed for the use of the Committee on Armed Services
         
         
         
         
         
         

  DEPARTMENT OF DEFENSE AUTHORIZATION REQUEST FOR APPROPRIATIONS FOR 
     FISCAL YEAR 2024 AND THE FUTURE YEARS DEFENSE PROGRAM--Part 6
     

                               PERSONNEL
                               
                               
                               




                                 ______



                                                 S. Hrg. 118-625, Pt. 6

                  DEPARTMENT OF DEFENSE AUTHORIZATION 
 REQUEST FOR APPROPRIATIONS FOR FISCAL YEAR 2024 AND THE FUTURE YEARS 
                            DEFENSE PROGRAM

=======================================================================

                                HEARING

                               before the

                      COMMITTEE ON ARMED SERVICES
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                                   ON

                                S. 2226

     TO AUTHORIZE APPROPRIATIONS FOR FISCAL YEAR 2024 FOR MILITARY 
ACTIVITIES OF THE DEPARTMENT OF DEFENSE, FOR MILITARY CONSTRUCTION, AND 
   FOR DEFENDSE ACTIVITIES OF THE DEPARTMENT OF ENERGY. TO PRESCRIBE 
   MILITARY PERSONNEL STRENGTHS FOR SUCH FISCAL YEAR, AND FOR OTHER 
                                PURPOSES

                               __________

                                 PART 6

                               PERSONNEL

                               __________

                             MARCH 15, 2023

                               __________

         Printed for the use of the Committee on Armed Services


                 Available via: http://www.govinfo.gov
                 
                 
                      ______

             U.S. GOVERNMENT PUBLISHING OFFICE 
 60-099          WASHINGTON : 2025 
            



                      COMMITTEE ON ARMED SERVICES

JACK REED, Rhode Island, Chairman    ROGER F. WICKER, Mississippi
JEANNE SHAHEEN, New Hampshire        DEB FISCHER, Nebraska
KIRSTEN E. GILLIBRAND, New York      TOM COTTON, Arkansas
RICHARD BLUMENTHAL, Connecticut      MIKE ROUNDS, South Dakota
MAZIE K. HIRONO, Hawaii              JONI ERNST, Iowa
TIM KAINE, Virginia                  DAN SULLIVAN, Alaska
ANGUS S. KING, Jr., Maine            KEVIN CRAMER, North Dakota
ELIZABETH WARREN, Massachusetts     RICK SCOTT, Florida
GARY C. PETERS, Michigan            TOMMY TUBERVILLE, Alabama
JOE MANCHIN III, West Virginia      MARKWAYNE MULLIN, Oklahoma
TAMMY DUCKWORTH, Illinois           TED BUDD, North Carolina
JACKY ROSEN, Nevada                 ERIC SCHMITT, Missouri
MARK KELLY, Arizona                  
                                     
    
                                     
                                     
                                     

 Elizabeth L. King, Staff Director
  John P. Keast, Minority Staff 
             Director


                       Subcommittee on Personnel

 ELIZABETH WARREN, Massachusetts, RICK SCOTT, Florida
               Chair               MIKE ROUNDS, South Dakota
RICHARD BLUMENTHAL, Connecticut   DAN SULLIVAN, Alaska
MAZIE K. HIRONO, Hawaii           TED     BUDD, North Carolina
TIM KAINE, Virginia
                            
TAMMY DUCKWORTH, Illinois            
                                     
                                    
                                     
                                  (ii)

  


                         C O N T E N T S



                             march 15, 2023

                                                                   Page

Military and Civilian Personnel Programs in the Department of         1
  Defense.

                           Member Statements

Statement of Senator Elizabeth Warren............................     1

Statement of Senator Rick Scott..................................     3

                           Witness Statements

Cisneros, Hon. Gilbert R., Jr., Under Secretary of Defense for        7
  Personnel and Readiness Accommodated by Hon. Lester Martinez-
  Lopez Assistant Secretary of Defense for Health Affairs; Hon. 
  Shawn G. Skelly, Assistant Secretary of Defense for Readiness; 
  Mr. Thomas A. Constable, Performing to Duties of the Assistant 
  Secretary of Defense for Manpower and Reserve Affairs; Ms. 
  Elizabeth B. Foster, Executive Director of Force Resiliency.

Schaefer, Hon. Agnes G., Assistant Secretary of the Army for         44
  Manpower and Reserve Affairs.

Parker, Hon. Franklin R., Assistant Secretary of the Navy for        50
  Manpower and Reserve Affairs.

Wagner, Alex, Assistant Secretary of the Air Force for Manpower      55
  and Reserve Affairs.

Questions for the Record.........................................    68

                                 (iii)


  DEPARTMENT OF DEFENSE AUTHORIZATION REQUEST FOR APPROPRIATIONS FOR 
         FISCAL YEAR 2024 AND THE FUTURE YEARS DEFENSE PROGRAM

                              ----------                              


                       WEDNESDAY, MARCH 15, 2023

                      United States Senate,
                         Subcommittee on Personnel,
                               Committee on Armed Services,
                                                    Washington, DC.

 MILITARY AND CIVILIAN PERSONNEL PROGRAMS IN THE DEPARTMENT OF DEFENSE

    The Subcommittee met, pursuant to notice, at 2:58 p.m., in 
room 222, Russell Senate Office Building, Senator Elizabeth 
Warren (Chairman of the Subcommittee) presiding.
    Subcommittee Members present: Senators Warren, Blumenthal, 
Hirono, Kaine, Duckworth, Kelly, Scott, Sullivan, Budd, and 
Wicker.

         OPENING STATEMENT OF SENATOR ELIZABETH WARREN

    Senator Warren. Good afternoon, and welcome to the first 
Personnel Subcommittee hearing of the 118th Congress. I am 
pleased to welcome all of you here to this hearing to receive 
testimony on the military and civilian personnel programs at 
the Department of Defense (DOD) and the Military Services in 
review of the Administration's defense authorization request 
for fiscal year 2024.
    All three of my brothers served in the military, so 
supporting the military and military families means a lot to 
me, and I am particularly pleased to be chairing my first 
hearing as an Armed Services Subcommittee Chair.
    I am honored to chair this Subcommittee and I look forward 
to continuing its long history of bipartisanship and working as 
a partner with Ranking Member Scott and with all of our Members 
on both sides of the aisle to improve the lives of our 
servicemembers, of retirees, military families, and the 
civilian workforce.
    Our annual posture hearing provides the Department the 
opportunity to discuss their personnel policy priorities for 
the coming year. This year marks the 50th anniversary of the 
All-Volunteer Force.
    In today's hearing, I would like to focus on how we welcome 
young people into the military, how we support families who 
continue to serve, and how the military contributes to our 
communities.
    The Administration's National Defense Strategy gets it 
exactly right in prioritizing servicemembers. We must do this 
to address one of the military's greatest challenges, the 
ongoing struggle to meet its recruiting goals.
    Today, only the Marine Corps and the Space Force are 
meeting their recruiting targets. Meanwhile, the Army is set to 
miss its target by tens of thousands of soldiers, and the Navy 
has recently lowered its requirements and standards for many 
ratings in order to address anticipated shortfalls.
    The most direct way to address this shortfall is by making 
sure that we are taking care of military personnel and their 
families. This is just as much a readiness issue as our supply 
of tanks and missiles and material to fight on land and at sea. 
So, where to start?
    Well, I have a lot of work that I want to propose for this 
Subcommittee, including protecting and enhancing health care, 
continuing to build on Senator Gillibrand's leadership in 
addressing sexual assault, and combating the corrosive impact 
of the revolving door between senior Pentagon officials and 
defense contractors, and foreign governments.
    I also look forward to working with the Readiness 
Subcommittee to be certain that U.S. military families are not 
living in unsafe and unsanitary housing conditions. I have done 
extensive investigative work here, and I have worked with other 
Committee Members on bipartisan legislation.
    For today's hearing, I have picked three items to begin 
with, access to childcare, medical debt, and the Junior Reserve 
Officers Training Corps, or JROTC. First, childcare. Accessing 
childcare remains a problem for all families, military and 
civilian.
    We must modernize and improve the way the DOD ensures that 
servicemembers and their families have access to childcare, and 
I am happy to work with any Member of the Committee, Democrat 
or Republican, who has good, smart, creative ideas on how to do 
that.
    Second, I want to take a good, hard look at medical debt 
and how it affects both members of the military and civilians. 
I want to ask specifically about implementation of my 
amendments, along with Joaquin Castro, to the 2021 National 
Defense Authorization Act to provide DOD the authority to waive 
civilian debts for military hospitals, a bill that was intended 
to keep our doctors sharp without sticking patients with big 
private bills.
    I won't get to cover it today, but I am also concerned 
about servicemembers who have TRICARE but who still get stuck 
with medical bills they are expected to pay on their own, and 
finally, I have questions about the Junior Reserve Officers 
Training Corps, or JROTC, particularly about reports of sexual 
assault of our children.
    We have much to do to better support military families. I 
look forward to getting to work on these issues and many more, 
and I will now turn to Ranking Member Scott for his comments to 
open this hearing. Thank you. Ranking Member Scott.

                STATEMENT OF SENATOR RICK SCOTT

    Senator Scott. Thank you, Chair Warren. As this is the 
first meeting of the Personnel Subcommittee this Congress, let 
me begin by saying that I am very much looking forward to 
working with Senator Warren as we continue the bipartisan 
tradition of the Armed Services Committee in developing the 
National Defense Authorization Act.
    I am on four committees, and this is my first subcommittee 
to be the Ranking Member, and I want to say that the Armed 
Services Committee is the one committee that actually works 
well together. I think we are going to continue to do a great 
job with the National Defense Authorization Act again this 
year.
    Every Member here is united in supporting our men and women 
in uniform and their families. This Subcommittee has a long 
history of prioritizing the well-being and morale of our 
servicemembers. I am eager to be continuing that work as the 
new Ranking Member. Today, the military faces, as we all know, 
a recruiting crisis.
    If current trends continue, the Army, Navy, and Air Force 
will fail to achieve their recruiting missions this year. The 
Army and Navy look like they will miss the mark by over 10,000 
recruits each. Well, this could be only the third time in 
history the Air Force has failed to meet its recruiting 
mission.
    This situation is unprecedented in the 50-year history of 
the All-Volunteer Force, and this Subcommittee must make it our 
top priority to do whatever we can to fix it. I am concerned 
that in the midst of this challenging recruiting environment, 
the Navy has decided to lower enlistment standards.
    We have seen this approach tried before. It had disastrous 
results. I am a Navy veteran myself. I joined at the age of 18. 
I probably did more swabbing the decks and cleaning the 
latrines than I did being a radarman. I am also the son of a 
World War II veteran who fought--who was one of 3,000 people 
that did all full combat and jumps with the 82d Airborne.
    Also fought in the Battle of the Bulge. I know that no job 
in military is easy or unimportant. When ships catch fire or in 
collision, as has happened repeatedly in the recent past, every 
sailor must know how to respond to save lives.
    When enlistment standards drop below certain levels, we 
have seen increased morale and discipline problems, which are 
accompanied by lower unit readiness. These are not acceptable 
outcomes.
    I hope to use this hearing to learn more about what the 
Navy is doing to avoid the mistakes of the past in this area. 
The good news is that as difficult as recruiting is right now, 
retention levels are generally quite high. That means once 
people join the military, they tend to like it and want to 
stay.
    Military families in particular have higher retention rates 
than single servicemembers. This is supported by DOD surveys 
that report married servicemembers with children have the 
highest levels of satisfaction with the military way of life. 
So, we need to ask ourselves why is there such a disconnect 
between recruiting struggles and retention successes, and what 
can we do to bridge that gap.
    As we continue working to ensure servicemembers and their 
families enjoy high quality of life in the military, we need to 
do more to share their inspiring stories with the rest of the 
country. Effective use of marketing and advertising must be a 
priority right now and we need to resource it accordingly.
    The Department of Defense should also be an advocate for 
the many benefits that come with military service. For example, 
we know that veterans have lower unemployment rates and higher 
rates of homeownership, marriage, educational achievement.
    Military service sets young men and women on the path to a 
great life and we need more people to know that. So, we have 
major issues facing our military, and this Subcommittee stands 
ready to tackle them.
    That is why I was excited to take the position as Ranking 
Member, because there are real issues like housing, childcare, 
recruitment, and health care that demand our attention. These 
aren't Republican or Democrat issues. There are things that 
this Committee has and must continue to work on, on a 
bipartisan basis, to fix so our military members and their 
families are taken care of.
    This Committee did this last Congress to better protect 
against and prevent sexual assault. Working together on these 
issues--important issues allow us to best serve those who serve 
and protect our Nation.
    That is why I was incredibly disappointed when I finally 
received Secretary Cisneros prepared statement, of several 
witnesses last night at 10 p.m., and found that a major focus 
of the Pentagon, I am sure probably at the urging of the White 
House, was prioritizing DEI [diversity, equity and inclusion], 
virtually cultural war issues.
    I have run big companies. I know the importance of ensuring 
that we have a workplace, whether in the military or elsewhere, 
where people can come to their jobs without the threat of being 
disrespected or discriminated against. But when it comes to our 
armed forces, the top question should be, is every person who 
wants to join solely focused on the mission of intimidating the 
hell out of our enemies and defeating them if necessary.
    It is not about hitting diversity quotas. It is about being 
the most lethal military fighting force on the planet because 
the folks who wear the uniform are warfighters, 
unapologetically devoted to protecting American values, putting 
that above all else.
    Our Commanders know this, and I am gravely concerned that 
this Administration is forcing them to move away from that to 
achieve some diversity metric that isn't based on enhancing the 
lethal fighting capabilities of the American military.
    We are creating nice talking points for the Administration 
to tout race and gender instead of fighting power and strength. 
Do I believe that our military should reflect America and be 
made up of fighters as diverse as places like my home State of 
Florida, you better believe it.
    But to assert that diversity quotas and pronoun training 
are more important than the basic needs of recruitment and 
retention or caring for the needs of our current force by 
ensuring proper access to childcare, good housing, health care 
is outrageous, and I think everybody in this room knows that.
    I look forward to getting to the real issues, solving 
problems, taking care of our members and their families. That 
will be my focus as Ranking Member of this Subcommittee. Thank 
you to each of the witnesses for appearing before the 
Subcommittee today, and I look forward to your testimony.
    Senator Hirono. Senator Wicker, I understand you wish to 
make a statement.
    Senator Wicker. Yes, ma'am, I do, and I appreciate that. I 
had intended to attend this Subcommittee hearing to talk solely 
about Junior ROTC [Reserve Officer Training Corps]. But I do 
have to address the matter that the distinguished Ranking 
Member of the Subcommittee just raised, and that is the 
submitted statement by the Undersecretary of Defense for 
Personnel and Readiness.
    I do hope that this statement is not a reflection of the 
Department's priorities, because if it is, I am very concerned. 
We have a military recruiting problem, as the Chair mentioned, 
as the Ranking Member mentioned. It should be at the top of our 
list.
    Yet this statement of some 26 pages, let me make sure I 
have got it right, some 26 pages does not get to recruiting 
until page 20 of the statement. Instead, topics like abortion 
and diversity, equity and inclusion are addressed in those 
first 20 pages.
    I don't understand why the Department feels that is 
necessary to change the culture of the military by, 
``inculcating diversity, equity, inclusion, and accessibility, 
DEIA, principals across the Department efforts.''
    As a veteran, as a ROTC commissioned officer, as a former 
member of the Air Force Reserve, I can tell you the United 
States military has been decades ahead of the rest of our 
society in inclusion.
    I have said publicly many times, the United States military 
is the greatest civil rights program in the history of the 
world, and I am proud that they have been ahead of our society 
on that.
    When some of my colleagues criticize the Department for 
misplaced priorities, Mr. Secretary, I think that is what--this 
concern that I have, and the Ranking Member has, are what they 
are talking about.
    Now, with regard to Junior ROTC, in my home State of 
Mississippi, the program is a pillar in the development of 
future leaders. Over the years, I have passed legislation to 
expand the number of JROTC units as a part of the National 
Defense Authorization Act (NDAA), increased funding for the 
program, and grow the population of veterans who are eligible 
to be Junior ROTC instructors.
    Junior ROTC helps our Nation's high schoolers reach more of 
their full potential to become successful citizens. A RAND 
Report, A RAND Corporation report found, and I quote, ``there 
is consensus that JROTC participation has both academic and 
nonacademic benefits for students.''
    According to this very comprehensive and scholarly report, 
most of these benefits go to economically disadvantaged schools 
and the students of those schools. In addition to these 
benefits, the report noted that JROTC provides, ``volunteer 
opportunities that allow students to benefit the larger 
community.''
    In my conversations with superintendents, principals, and 
parents, when I ask, if you would like to have Junior ROTC in 
your school, I have never run into a superintendent or a 
principal that said other than, yes, I very much am glad we 
have Junior ROTC or I would like to have a Junior ROTC program.
    This moment presents us with an opportunity to address a 
claim in recent news articles about JROTC. This reporting 
suggests that JROTC instructors commit sexual misconduct at 
much higher rates than civilian teachers. I very much doubt 
that assertion. There is simply no data available to support 
that.
    Sexual misconduct toward students is never acceptable, and 
the JROTC program understands this, and every instance of 
misconduct involving JROTC, the military immediately suspended 
the instructor. But I will also say this to my fellow Senators, 
Junior ROTC makes an easy target in this area because the 
Department of Defense is a central repository of information 
and is subject to strict oversight.
    So, there is a lot of information about JROTC. On the other 
hand, the information in public school systems is diffuse since 
the systems are large, sprawling, and decentralized. We know 
school districts often do not publicly disclose cases of 
teacher sexual misconduct. It is just a fact. It is such a 
problem that last year the Department of Education released a 
report on the issue and found only 20 states have laws on the 
books that prohibit suppressing information regarding school 
employee sexual misconduct.
    We don't get all the facts, but no one would suggest that 
we do away with public schools simply because there is some 
misconduct on the part of a very few members of the faculty. If 
anything, there is every reason to believe that Junior ROTC is 
a safer environment than others for our future leaders.
    Junior ROTC instructors receive twice the screening, twice 
the screening, of a normal teacher before they enter the 
classroom, both from the military and the school district. 
Given this extra scrutiny, I am highly skeptical of the idea 
that JROTC instructors are more likely to commit misconduct.
    Congress should be mindful of the highly positive, highly 
positive impact of Junior ROTC. In fact, it is celebrated on 
both sides of the aisle on this Committee. My colleague from 
Massachusetts, Senator Warren, is to be thanked for raising 
this issue and has taken a substantive and helpful interest in 
JROTC.
    As she reenters the room, I thank her for that. I will 
carry our shared work forward by introducing additional 
legislation this year that would further expand Junior ROTC to 
the hundreds of schools currently on the waiting list for a 
program.
    I hope to have many partners in this effort, and I look 
forward to working with Senator Warren and the Ranking Member, 
Senator Scott, as we approach this year's NDAA. Thank you, 
Madam Chair.
    Senator Warren. Thank you, and do you have a statement you 
would like to make, Senator? All right, good. So, to our 
witnesses, thank you for appearing. We have two panels today. 
The first panel consists of officials from the Office of the 
Secretary of Defense who will cover the full range of military 
and civilian personnel programs.
    The Honorable Gil Cisneros, Undersecretary of Defense for 
Personnel and Readiness. Dr. Lester Martinez Lopez, Assistant 
Secretary of Defense for Health Affairs. Ms. Shawn Skelly, 
Assistant Secretary of Defense for Readiness. Mr. Tom 
Constable, Acting Assistant Secretary of Defense for Manpower 
and Reserve Affairs, and Ms. Elizabeth Foster, Executive 
Director, Office of Force Resiliency.
    Welcome to all of you. Appreciate your being here. The 
second panel will consist of the Assistant Secretaries of the 
military departments for Manpower and Reserve Affairs. We will 
have Ms. Agnes Schaefer, Assistant Secretary of the Army. Mr. 
Franklyn Parker, Assistant Secretary of the Navy, and Mr. Alex 
Wagner, Assistant Secretary of the Air Force.
    Again, thank you all for appearing here. Undersecretary 
Cisneros, I understand that you are going to deliver an opening 
statement on behalf of the first panel, is that right? Then you 
are recognized for 5 minutes.

  STATEMENT OF THE HONORABLE GILBERT R. CISNEROS, JR., UNDER 
 SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS ACCOMMODATED 
 BY THE HONORABLE LESTER MARTINEZ-LOPEZ ASSISTANT SECRETARY OF 
  DEFENSE FOR HEALTH AFFAIRS; THE HONORABLE SHAWN G. SKELLY, 
  ASSISTANT SECRETARY OF DEFENSE FOR READINESS; MR. THOMAS A. 
 CONSTABLE, PERFORMING TO DUTIES OF THE ASSISTANT SECRETARY OF 
  DEFENSE FOR MANPOWER AND RESERVE AFFAIRS; MS. ELIZABETH B. 
         FOSTER, EXECUTIVE DIRECTOR OF FORCE RESILIENCY

    Mr. Cisneros. Thank you. Chairwoman Warren, Ranking Member 
Scott, Distinguished Members of the Subcommittee, thank you for 
the opportunity to discuss the Department of Defense's greatest 
strength, our people.
    On behalf of the entire team, I think the Committee for 
your support of the 2.3 million Active and Reserve component 
servicemembers, and over 900,000 civilians who defend our 
Nation and the families who serve alongside them.
    This year is an especially momentous year as the Department 
celebrates the 75th anniversary of President Truman's order to 
integrate the armed forces, as well as the 50th anniversary of 
the All-Volunteer Force.
    Both of these events are responsible for creating the most 
unrivaled fighting force in history. Near the beginning of his 
tenure, Secretary Austin laid out three priorities to ensure 
our military is capable of meeting any current and future 
threats, defending the Nation, taking care of our people, and 
succeed through teamwork.
    I have established four overarching priorities that are 
foundational to all the P&R's efforts, change the culture, 
promote the health, well-being, and safety of the force and 
families, cultivate talent management, and advance strategic 
readiness.
    In changing the culture, the Department understands the 
trust is key to the preserving our All-Volunteer Force. We 
thank Congress for its support to providing the full amount of 
the Department's fiscal year 2023 budget requests in support of 
the recommendations of the independent review commission on 
sexual assault in the military.
    We are making progress toward implementing--implementation 
of all approved IRC recommendations, and your support for 
fiscal year 2024 budget request would ensure we complete this 
historic reforms to the military justice, field a specialized 
prevention workforce, train and equip response personnel, and 
empower survivors to recovery.
    We are also ensuring diversity, equity, and inclusion 
accessibility principles are applied across the Department's 
efforts. We want to leverage the strength of all of our people, 
advance opportunity, remove barriers, and ensure everyone 
within the Department of Defense is treated with dignity and 
respect.
    With regard to promoting the health, well-being, and safety 
of the force and families, we know the global pandemic economic 
pressures such as inflation and operational tempo make it more 
important than ever to focus on training and taking care of our 
people.
    Thanks to Congress's support, our servicemembers and 
civilians received a 4.6 basic pay raise at the beginning of 
this year, and the Fiscal Year 2023 President's Budget includes 
a 5.2 percent pay raise for 2024.
    These pay raises are critical to recruiting and retaining 
the all-volunteer force. Secretary Austin directed the creation 
of the Suicide Prevention and Response Independent Review 
Committee to conduct a comprehensive review. This Committee's 
report was published in late February and the Department is 
carefully reviewing the recommendations.
    Every death by suicide is a tragedy and weighs heavily on 
the military community. We are tackling these issues with 
focused attention and dedication. With regard to cultivating 
talent management, recruiting challenges will persist, but we 
are looking for ways to galvanize our future servicemembers on 
the values of military service.
    The Department is implementing a comprehensive outreach 
strategy that includes partnerships with other agencies such as 
the Peace Corps, AmeriCorps, and Selective Service that touts 
the benefits of public service to our Nation and our 
communities. We are also working on efforts to dispel 
inaccuracies and educate both our youth and their influencers 
through a national military advertising campaign.
    We ask for your support in the Fiscal Year 2024 
Presidential Budget requests, which includes $40 million for 
our joint marketing campaign. With P&R's fourth priority, 
advancing strategic readiness, we are ensuring we can build, 
maintain, and balance warfighting capabilities and competitive 
advantage to achieve strategic objectives across threat and 
time horizons. This includes updating our professional military 
and education to make it more effective and relevant to the 
National Defense Strategy.
    As we look to the future, it is imperative that we do not 
take for granted what makes our U.S. military unparalleled and 
unmatched. It is our people, the Active Reserve, National 
Guard, DOD civilians, and all of their families who are willing 
to serve this country. They are the bedrock of our national 
security.
    Thank you for your continued support of our servicemembers, 
their families, and we look forward to your questions.

Joint Prepared Statement by The Honorable Gilbert R. Cisneros, Jr., The 
Honorable Lester Martinez Lopez, The Honorable Shawn Skelly, Mr. Thomas 
                     Constable, and Ms. Beth Foster
    Chairwoman Warren, Ranking Member Scott, and Members of the 
Personnel Subcommittee, thank you for the opportunity to testify before 
you, along with the other leaders of the Office of the Under Secretary 
of Defense for Personnel & Readiness (OUSD(P&R)), to discuss the 
Department of Defense's greatest strength and achievement--our people. 
We are proud to represent the 2.3 million Active and Reserve component 
servicemembers and over 900,000 DOD civilians who defend our Nation 
every day, and the families, caregivers, and survivors who serve 
alongside them. And 2023 is a very significant year for the Department 
of Defense as we celebrate the 75th anniversary of President Truman's 
order to racially desegregate and congressional action to allow women 
to serve in the Armed Forces as well as the 50th anniversary of the 
All-Volunteer Force. These significant events were directly responsible 
for creating the most unrivaled fighting force in history.
    In order for us to succeed in an ever changing landscape of threats 
and challenges, both international and domestic, Secretary Austin laid 
out three priorities for the Department--Defend the Nation, Take Care 
of Our People, and Succeed Through Teamwork. Understanding that our 
people are at the core of Secretary Austin's priorities, P&R 
established four overarching priorities that are foundational to P&R's 
efforts: Change the Culture; Promote the Health, Well-being, and Safety 
of the Force and Families; Cultivate Talent Management; and Advance 
Strategic Readiness.
                           change the culture
    Trust in the military is crucial to preserving the legacy and 
effectiveness of our All-Volunteer Force. In order to gain the trust of 
servicemembers, their families, civilian employees, and the public, the 
Department focuses on supporting our forces' ability to accomplish 
their mission by decreasing the prevalence of sexual assault, sexual 
harassment and other destructive behavior, inculcating diversity, 
equity, inclusion, and accessibility (DEIA) principles across all 
Department efforts, and ensuring servicemembers and families, and 
civilian employees are protected against bias and discrimination. 
Addressing these issues is critical to our values, maintaining cohesive 
and strong units, and ensuring our overall military readiness and 
leadership on the global stage.
Countering Sexual Assault and Sexual Harassment
    Sexual assault and sexual harassment are not only a threat to our 
readiness, but contrary to everything we stand for. It has a 
devastating impact on the whole military community and erodes the trust 
of our All-Volunteer Force. In order to bring about change, the 
Department is making significant investments to properly and 
effectively counter sexual assault and sexual harassment in the 
military.
    Secretary Austin made countering sexual assault a priority on his 
first day on the job as it is one of the most challenging issues we 
face. The entire Department continues to work collaboratively--across 
Office of the Secretary of Defense (OSD) Components, Military 
Departments, and the National Guard Bureau to operationalize the 
Secretary's implementation guidance for recommendations from the 
Independent Review Commission on Sexual Assault in the Military (IRC).
    We are making progress toward implementation of all approved IRC 
recommendations. This past year, we began implementing the most 
significant changes to the military justice system in decades when the 
Army, Navy, Marine Corps, and the Department of the Air Force achieved 
initial operational capability in standing up their respective Offices 
of Special Trial Counsel (OSTC). Each OSTC is led by a Senate-confirmed 
one-star Lead Special Trial Counsel supervised directly by the Military 
Department's Secretary, without intervening authority. The OSTCs are on 
track to reach full operational capability by December 2023. These 
changes place prosecution decisions for sexual assault, domestic 
violence, and other named offenses in the hands of trained, 
experienced, and independent military attorneys who report outside the 
command structure, and only to the civilian Secretaries of the Military 
Departments. Implementation also includes building a career track for 
military justice for judge advocates in each of the Services, to enable 
the development of a sustained cadre of these specialized prosecutors 
across the Force. In 2025, these Special Trial Counsel will importantly 
also assume jurisdiction over sexual harassment.
    We are also making progress in fielding a new full-time and 
specialized prevention workforce to avert these crimes before they 
occur. We have established guidance and infrastructure, and hiring for 
the 2,000-plus workforce continues, prioritizing on the highest risk 
locations and positions that will establish policy and processes for 
the workforce. Additionally, we have trained 1,200 collateral-duty 
prevention personnel. The Department is also working to professionalize 
the sexual assault response workforce to provide them with enhanced 
skills and the independence required to better assist victim recovery. 
We are revising policy and training to provide Sexual Assault Response 
Coordinators and Sexual Assault Prevention Response Victim Advocates 
with greater independence and expertise to foster support and provide 
victim care. We are also working to identify supportive services and 
victim advocacy for victims of sexual harassment, as the IRC also 
recommended, recognizing the corrosive impacts of sexual harassment on 
unit climate, cohesion and morale in addition to the harms experienced 
by individual victims, including the significant increased risk for 
sexual assault within units that have high rates of sexual harassment. 
Further, we are working to strengthen accountability, prevention and 
victim support for cyberharassment across the force.
    We continue to use On-Site Installation Evaluations (OSIEs) to 
support leaders in improving their command climate through data-driven 
changes that help eliminate harmful behaviors in the military, protect 
our people, and support readiness. Locations for the 2023 OSIEs were 
selected using a multi-pronged risk index, including data from the 
Defense Organizational Climate Survey and other data involving risk for 
harmful behaviors. OSIEs expand the Department's efforts on integrated 
prevention of harmful behaviors and heighten the visibility of risk and 
protective factors impacting our installations and improve our chances 
of detecting and correcting harmful behaviors before tragic incidents 
occur.
    Although we are making progress with the IRC recommendations, we 
know there is still much work to be done. We believe our efforts will 
restore the trust and faith of people, assist victims with recovery, 
and hold offenders appropriately accountable. We owe nothing less to 
our servicemembers. We thank Congress for authorizing and appropriating 
the full amount of the Department's fiscal year 2023 request in support 
of the IRC recommendations. Your support of the fiscal year 2024 DOD 
budget request would ensure we have the continued resources to 
aggressively combat this issue, and complete the historic changes to 
reform military justice, field the specialized prevention workforce, 
train and equip response personnel, and empower survivors. These 
efforts not only reflect our values, but they have a direct impact on 
ensuring the unit cohesion necessary for success on the battlefield.
Diversity, Equity, Inclusion, and Accessibility
    Our diversity, equity, inclusion, and accessibility (DEIA) efforts 
recognize that even one instance of inappropriate discrimination or 
other problematic behaviors can destroy unit cohesion and trust, which 
are necessary for the good order and discipline that underpins our 
Armed Forces and our ability to deter and defeat adversaries. 
Additionally, our approach to DEIA recognizes that we must do more to 
draw upon the varied backgrounds, skills, talents, and unique strengths 
from all members of our Total Force. Taking these actions helps support 
all of our people, and ensures we maintain our readiness and unique 
strategic advantages as a diverse nation.
    Enhancing DEIA across our Department also maximizes our ability to 
recruit and retain top talent, and DOD strives to ensure that the wide-
ranging benefits of DEIA also helps drive every aspect of our approach 
to talent management. Inculcating DEIA principles ensures we are 
leveraging the strengths of all our people, advancing opportunity, 
addressing potential barriers and discrepancies, and fundamentally 
ensuring people are treated with dignity and respect--all of which 
directly enhance our ability to accomplish the Department's mission to 
provide the military forces needed to deter war and ensure the Nation's 
security.
    DOD continues to take steps to improve and increase DEIA, and the 
Department is working to further understand root causes in areas where 
we lack diversity, develop initiatives that have measurable outcome 
metrics, maintain appropriate data to inform and target efforts, ensure 
environments are inclusive of all who serve, and foster a strong 
governance structure to oversee these efforts.
    This past year, the Department published its 2022--2023 DEIA 
Strategic Plan. To advance progress on DEIA issues, we continue to 
aggressively address a broad range of topics, including the need for 
additional efforts to more fully capitalize on the significant benefits 
that DEIA brings to the Department's mission. With partners across the 
Department, we continue to address efforts to increase diversity within 
talent pathways; expand DEIA data collection, analysis, and management; 
and integrate diversity and inclusion curriculum into leadership 
development training.
    The DOD is focused on creating long-term changes by supporting 
racial, ethnic, and gender diversity and inclusion in the military--as 
well as diversity and inclusion for varied backgrounds, strengths, 
skills, and talents--and eliminating any causal factors that prevent 
diversity or lead to discriminatory practices. We are taking steps to 
ensure our servicemembers and DOD civilian employees have opportunities 
to achieve their professional goals based on merit, remove any barriers 
that prevent equal opportunity, and ensure a cohesive and ready force 
that reflects the diversity of our Nation. Doing so will help the 
Department attract and retain the best talent for our wide-ranging 
needs, while supporting strong and resilient teams.
Junior Reserve Officers' Training Corps (JROTC) Program
    Proper oversight of the operation, administration, and 
effectiveness of the overall JROTC program is paramount as a program to 
highlight the importance and merits of public service, and bridge the 
ever widening civil-military divide in our country. Following 
allegations of JROTC instructor misconduct, P&R has taken action to 
address concerns. P&R issued a memorandum to the Military Departments 
on March 10, detailing the continued collaboration in developing and 
codifying policy to ensure we have effective oversight and 
administration of the JROTC program. P&R is working on an expedited 
Department of Defense Instruction (DODI) that will direct the Military 
Departments to implement seven policy directives: 1) Standardize 
background investigations--Tier 1 with Child Care Investigation for 
Non-Sensitive Positions; 2) Achieve a maximum headquarter to school 
oversight ratio of 1:30; 3) Standardize Memorandums of Agreement; 4) 
Implement JROTC Instructor Prohibited Activities Acknowledgement; 5) 
Implement Student and Instructor Responsibilities Acknowledgement; 6) 
Title IX Compliance Course for all JROTC instructors; and 7) 
Notification of Allegations Against a JROTC Instructor.
    The fiscal year 2024 Defense budget requests $12.98 million to 
support increased oversight and evaluation of the operation, 
administration, and effectiveness of the overall JROTC program. 
Congress' support for these funds would allow the Department to achieve 
a 1:30 oversight ratio, directly support annual, in-person program 
evaluations, and expand the capacity for processing Tier 1 with Child 
Care Investigation for Non-Sensitive Positions which would contribute 
to the safety of all program participants.
  promote the health, well-being, and safety of the force and families
    Our people are the foundation of our military readiness and 
national security and it is not just the servicemembers who serve, but 
their entire family. Current events--recovery from a global pandemic, 
economic pressures such as inflation, declining trust in institutions, 
and two decades of accelerated operational tempo--make it more 
important than ever to focus the Department's policies and resources on 
taking care of our people.
Safety and Occupational Health
    To preserve our enduring advantages, we must ensure the safety and 
health of our greatest asset, the Department's military and civilian 
personnel, and protect our resources and capabilities. We are elevating 
safety governance through the Department's senior safety governance 
forum, the Defense Safety Oversight Council (DSOC), as well as the 
congressionally mandated, operationally focused Joint Safety Council. 
We are undergoing a Department-wide effort to establish, implement, 
validate, and analyze consistent safety data collection standards and 
processes, based on the 2020 National Commission on Military Aviation 
Safety recommendations. Standardized safety data will be integrated and 
analyzed with readiness, training, maintenance, medical, and other 
information to identify risk mitigations and support resource 
decisions. Our governance guides DOD-wide cross-cutting efforts to 
achieve and promote a safety culture, reduce mishaps, manage safety 
hazards, and ensure actionable enterprise safety data is accessible to 
support DOD's business processes for managing safety and minimizing 
risk in the workplace.
Economic Security
    Ensuring that we are appropriately compensating our workforce and 
increasing the overall economic security of servicemembers and military 
families is integral to the competition for talent that supports 
mission readiness. While we believe the current military compensation 
package is fair, in order to remain competitive, we must keep pace with 
private-sector wage growth and inflation to ensure we can recruit and 
retain the force we need. Due to Congress' support, on January 1, 2023, 
servicemembers and civilian employees received a 4.6 percent basic pay 
raise, the largest since 2003. This was coupled with an average 12.1 
percent increase in the basic allowance for housing and an 11.2 percent 
increase in the basic allowance for subsistence. The President's Fiscal 
Year 2024 Budget request provides a 5.2 percent pay raise for military 
and civilian personnel in Calendar Year 2024 assuring fair and 
equitable compensation needed for recruitment and retention of skilled 
talent. These have been impactful increases, we recognize there is 
still work to be done and will continue to implement change as we 
evaluate the effectiveness of these increases.
    Food insecurity is also a complex issue that requires collaboration 
across the Department, as well as with other Federal agencies, 
community partners, and military service organizations. Through a 
coordinated effort, the DOD is working to ensure military families have 
the resources, support, and knowledge necessary to address and avoid 
food insecurity, especially when they are most vulnerable. In addition 
to executing the Department's Strengthening Food Security in the Force: 
Strategy and Roadmap, the DOD also implemented a Basic Needs Allowance 
in January 2023 to ensure servicemembers' household income is at least 
130 percent of the Federal poverty guideline. The fiscal year 2023 NDAA 
increases this level from 130 percent to 150 percent by January 2024.
    These increases in pay and allowances will have a real, positive 
impact on the economic well-being of the Force and our families. The 
14th Quadrennial Review of Military Compensation (QRMC) has begun its 
work, and we 8look forward to reviewing its progress. As directed by 
President Biden, the QRMC will thoroughly look at the military 
compensation system and how it can ensure economic security and better 
attract and retain servicemembers and their families, including through 
a first-ever review of childcare access and cost, and consideration of 
additional factors such as the challenge of military spouse 
unemployment, frequent military moves, periods of geographic separation 
between servicemembers and their spouses (including dual military 
couples).
Taking Care of Our People
    To advance Taking Care of People as one of his three priorities, 
Secretary Austin issued a memorandum on November 17, 2021, 
``Strengthening Economic Security in the Force,'' which directed 12 
specific initiatives in three categories: Provide Immediate Relief; 
Increase Stability for servicemembers and families; and Expand 
Financial Readiness Resources. Less than 1 year later, on September 22, 
2022, the Secretary issued a second memorandum: ``Taking Care of Our 
Servicemembers and Families.'' It directed 13 specific initiatives in 
four categories: Securing Affordable Basic Needs; Making Moves Easier; 
Further Strengthening our Support to Families; and Expanding Spousal 
Employment. These initiatives took measurable action to tackle pressing 
problems facing servicemembers and their families such as economic pain 
occasioned by this inflationary period, a persistent unemployment rate 
of 21 percent for military spouses, difficulty finding child care, and 
mitigating the hardships military families face due to frequent moves. 
Moving forward, the Department will leverage previous actions and 
continue to aggressively pursue programs and initiatives to make sure 
we are taking care of our people.
Military Spouse Employment
    No spouse should be forced to choose between supporting their 
servicemember and pursuing their own meaningful career. On January 5, 
2023, the President signed into law Congress' amendment to the 
Servicemembers Civil Relief Act to require portability of most 
professional licenses for servicemembers and their spouses. This law is 
intended to ease the ability of military spouses to find meaningful 
employment as they advance their careers while relocating alongside 
their servicemember. The Defense State Liaison Office will continue its 
work with State legislators in all 50 states to improve and enhance 
State laws governing occupational license portability and reciprocity 
to reduce barriers to portable, sustainable careers.
    The Department also continues to increase employment opportunities 
through the broadening of the Military Spouse Employment Partnership 
(MSEP), with a focus on critical employment sectors such as information 
technology, education, and small businesses. This past October, the 
MSEP welcomed 70 new employer partners, bringing the total number of 
MSEP partners to more than 600. Since its inception in 2011, the MSEP 
employer partners have hired more than 250,000 spouses.
    The Department has also launched a 12-week paid fellowship program 
to expand employment opportunities for eligible military spouses and 
connect employers with a diverse, highly skilled, and educated 
workforce. The Military Spouse Career Accelerator Pilot (MSCAP) program 
provides spouses of currently serving members of the U.S. Army, Navy, 
Marine Corps, Air Force and Space Force, to include Active, Reserve and 
National Guard components, with paid fellowships at civilian employers 
across various industries and locations. This is being done in 
partnership with best-in-class non-profit programming that has a proven 
record of military spouse employment and empowerment.
    Understanding that military spouses are usually transitory based on 
their servicemember's duty location, we are addressing the ongoing 
challenge of ensuring they are aware of available resources and support 
to assist them. Ensuring awareness and increasing utilization of 
resources across the force, and across the spectrum of service, is 
crucial to retaining our servicemembers and their families.
Military Parental Leave Program
    At the beginning of this year, the Department published its 
expanded parental leave policy that builds on the Department's support 
of military families by streamlining and enhancing leave for 
servicemembers who become parents of a new child. The fiscal year 2022 
NDAA expanded parental leave to 12 weeks for eligible birth and non-
birth parents. This includes adoptive parents and foster parents in 
cases of long-term foster placements. For birth mothers, the 12 weeks 
of parental leave is in addition to and following authorized medical 
convalescent leave necessary to recover from childbirth. The expanded 
parental leave policy is competitive with the parental leave offered by 
Federal agencies and other leading employers. By strengthening military 
families, we strengthen our force and our Nation.
Child Care
    Child care is a workforce enabler and a critical component of the 
readiness, efficiency, and retention of the Total Force. Affordable, 
quality child care continues to be a challenge facing many DOD families 
and the Nation in general. Child care is among the lowest paid 
occupations in the Nation, and child care professionals with a similar 
education earn less than those working in different fields, which 
contributes to the persistent challenge of recruiting and retaining the 
workforce needed to meet the child care needs of our families.
    To best support the child care needs of our servicemembers and 
civilian workforce, the Department will continue to work in 
collaboration with the Military Services on the development and 
implementation of initiatives aimed at improving child care 
availability, addressing child care staffing challenges, and expanding 
access to community-based fee assistance programs.
    In October 2022, the Department increased the fee assistance 
provider rate cap from $1,500 to $1,700 per child, per month, providing 
more fee assistance to families. The DOD will also continue its pilot 
program of providing servicemembers financial assistance to offset the 
cost of in-home child care, and expand The Military Child Care in Your 
Neighborhood PLUS program which utilizes the States Quality Rating and 
Improvement Systems as an indicator of provider quality, in lieu of 
national accreditation, broadening the pool of providers eligible to 
receive fee assistance on behalf of military families. The Department 
is in the process of establishing a pilot program to contract non-
profit child development centers in areas of high cost, low 
availability, and high need through non-profit organizations.
    We have expanded Military OneSource offerings for no-cost access to 
a web-based subscription service of providers offering child care 
services. The DOD has also established a DOD Child Care Compensation 
Task Force that is currently conducting a bottom-up review of child 
care compensation, recruitment, and retention.
    Addressing child care access is another critical element to 
building an enduring advantage, and the right thing to do to take care 
of our people.
Commissaries
    Access to grocery products worldwide remains a top-priority of the 
Defense Commissary Agency (DeCA). Understanding that Defense 
Commissaries are DOD's first line of defense for families in need, we 
were able to achieve an average of 23 percent savings at our 
Commissaries by the end of fiscal year 2022, even with historic 
inflation. More recently, in the last quarter, those savings increased 
to 25.3 percent, exceeding the goal set out by Secretary Austin. 
Additionally, online shopping is available at all commissaries. DeCA's 
primary purpose is to provide a benefit that enhances quality of life 
and readiness for military servicemembers, their families, retirees, 
Medal of Honor recipients, their authorized family members, all 
veterans with a service-connected disability, and individuals approved 
and designated as the primary family caregivers of eligible veterans.
Reproductive Health Care
    In the wake of the Dobbs Supreme Court decision last spring, it is 
estimated that 40 percent of Active Duty servicewomen have no or 
severely restricted access to abortion services where they are 
stationed. Additionally, 39 percent of the U.S. population has no or 
limited nearby access to Assisted Reproductive Technology services such 
as invitro fertilization or IVF. The Department has heard directly from 
our servicemembers who have expressed their concerns about access to 
reproductive health care for themselves and their family members, and 
the impacts on readiness, retention and recruitment were verified by 
independent experts.
    In October 2022, Secretary Austin issued his ``Ensuring Access to 
Reproductive Health'' memorandum to ensure that servicemembers and 
their dependents can access the non-covered reproductive health care 
they need, regardless of where they are stationed. On February 16, the 
Department published three important new policies to help 
servicemembers access essential reproductive health care, and on 
February 27, the Military Departments published guidance to implement 
the policies.
    The first policy establishes a standard timeline for command 
notification of pregnancy. Under this new policy, servicemembers are 
allowed up to 20 weeks of gestation to notify their commanders of 
pregnancy with a few exceptions. This policy is intended to allow the 
servicemember time to make private, personal health care and family 
decisions while accounting for commanders' responsibilities to meet 
operational requirements and protect the well-being of servicemembers 
in their command. The policy includes limited exceptions for requiring 
notification before 20 weeks such as specific military duties, 
occupational health hazards, and medical conditions. servicemembers are 
also encouraged to access prenatal care as soon as they learn of their 
pregnancy to promote the health and well-being of themselves and their 
pregnancy. When a servicemember chooses to delay command notification, 
a DOD health care provider will place the pregnant servicemember in a 
medical temporary non-deployable status and limited-duty or light-duty 
status without reference to the servicemember's pregnancy status.
    The second policy allows for administrative absence for non-covered 
reproductive health care. Military medical providers may perform--and 
TRICARE pays for--abortions in limited circumstances: when the life of 
the mother would be endangered if the fetus is carried to term, or when 
the pregnancy is the result of rape or incest. Other abortions are not 
covered and are paid for by the individual. Also, except in very 
limited circumstances, TRICARE does not pay for Assisted Reproductive 
Technology. In limited circumstances, severely ill or injured 
servicemembers may receive Assisted Reproductive Technology through the 
Supplemental Health Care Program, however, most beneficiaries seeking 
such services do so at their own expense.
    The new policy grants servicemembers an administrative absence, 
with approval, from their normal duty station to access non-covered 
reproductive health care, including non-covered abortion and Assisted 
Reproductive Technology, without loss of pay or being charged leave. 
Servicemembers may also be granted an administrative absence to 
accompany a dual-military spouse or dependent to access non-covered 
reproductive health care.
    The third policy authorizes travel allowances for non-covered 
reproductive health care when timely access to such care is not 
available within the local area of the duty station. These are standard 
allowances under the Department of Defense Joint Travel Regulation. 
Travel allowances--which include transportation, lodging, and meals--
will be available for servicemembers or an eligible dependent, and for 
an attendant or escort if the individual is not capable of traveling 
alone. As before, the non-covered reproductive health care procedure 
itself is at the expense of the patient.
    In addition to these policies, the Department standardized walk-in 
contraception services at military medical treatment facilities to 
promote easy, timely access to care, and support the family planning 
goals of servicemembers and their families. One hundred and thirty 
facilities now offer same-day access to comprehensive contraceptive 
counseling, including the full scope of non-surgical contraceptive 
methods, without a need for a referral or appointment.
    Nothing is more important than taking care of our people, and these 
policies are necessary to ensure the health and well-being of our force 
and families, and create a diverse and inclusive force. Beyond being 
the right thing to do, the policies promote recruitment and retention 
of servicemembers when our personnel and their families may have 
serious concerns about whether they will effectively lose access to 
reproductive health services if they are required to move to a 
jurisdiction where this essential health care is not available.
Deterrence of Drug Use
    The use of illicit drugs and misuse of prescription drugs are 
inconsistent with DOD policy and the Uniform Code of Military Justice, 
and have a substantial negative impact on performance in the inherently 
hazardous conditions of combat, and degrade safety and security for all 
personnel within the Department. To deter the use of illicit drugs, the 
Department is implementing an outreach strategy to inform 
servicemembers and their families on the facts and risks related to 
drug use including the impact on career and overall well-being, and 
promote and destigmatize substance use disorder. This initiative will 
utilize multiple communication touchpoints, including digital media, to 
amplify messaging and augment current service-level prevention, 
education, and outreach initiatives. This effort will establish 
communication platforms that can widely disseminate information about 
drugs to include new and emerging drug threats, with the goal of 
reaching servicemembers across multiple social and digital media 
platforms.
Suicide Prevention
    Every death by suicide is a tragedy and weighs heavily on the 
military community. The Department is steadfast in its commitment to 
suicide prevention, and the overall well-being of our servicemembers, 
their families, caregivers, and survivors. Suicide results from a 
complex interaction of psychological, biological, and environmental 
factors that vary among individuals. Because no two individuals are 
identical, our suicide-prevention efforts seek to enhance protective 
factors and address a range of risk factors.
    We have a responsibility to care for our people and are committed 
to addressing this issue not only because of its impacts to those who 
serve our Nation, but also because it affects our missions. Our public 
health approach focuses on reducing suicide risk for all servicemembers 
and their families by targeting the various underlying risk factors 
(such as relationship, financial, and behavioral health stressors), 
recognizing the heightened risk for suicide among servicemembers who 
experience sexual assault and sexual harassment, while also enhancing 
protective factors (such as social connections, coping skills, and 
safety in one's environment).
    We are working to enhance holistic, data-driven suicide prevention; 
non-clinical policy and programming, oversight, and engagement that 
address prevention across populations; and also clinical suicide 
prevention efforts with behavioral health services. The Department's 
approach to suicide prevention is focused on four key areas: fostering 
quality of life for servicemembers and their families; addressing 
stigma as a barrier to seeking help; improving clinical services; and 
promoting a culture of lethal-means safety.
    Pursuant to the FY2022 NDAA, Secretary Austin directed the creation 
of the Suicide Prevention and Response Independent Review Committee 
(SPRIRC) on March 22, 2022, and he further directed the committee to 
develop recommendations that could be implemented enterprise-wide. The 
SPRIRC conducted a comprehensive review of suicide prevention and 
response programs, visiting 11 installations both in and out of the 
continental U.S. and meeting with over 2,000 servicemembers and 600 
civilians. In late February, it released its report to the public.
    The report revealed four key themes to effectively reduce military 
suicide. First, restructuring suicide prevention training is required 
to standardize content and better resonate with servicemembers, in line 
with principles of Integrated Primary Prevention. Second, additional 
resources are needed to help servicemembers navigate and effectively 
access existing behavioral health and other support services. Third, we 
must ensure that servicemembers are safely storing personally owned 
firearms through focused training and accessible storage options. Last, 
we must emphasize leader stewardship through taking care of people and 
addressing servicemember needs before problems become crises.
    The SPRIRC report contains 127 recommendations with the vast 
majority aligning with the four pillars of the National Strategy for 
Suicide Prevention, and a small number reflecting the unique needs of 
military environments. The Department is diligently reviewing and 
preparing to implement applicable recommendations of the SPRIRC to 
enhance suicide prevention response efforts of the Department; to 
include efforts that can be taken swiftly and those that will require 
more persistent efforts to implement.
    The Department has the responsibility to support and protect those 
who defend the United States and their families, and we must do 
everything possible to prevent suicide in our military community. 
Toward this goal, we seek to encourage help-seeking behaviors, 
eliminate stigma, and enable access to behavioral health clinical 
services for our servicemembers and their families.
Military Health System
    The fiscal year 2017 NDAA enacted sweeping reforms to the 
organization and management of military medicine. The expanded 
responsibilities of the Defense Health Agency (DHA) are now largely 
complete. The DHA exercises authority, direction, and control over all 
Military Treatment Facilities (MTF) worldwide. The fiscal year 2017 
NDAA also directed DOD to restructure or realign MTFs to support the 
Department's readiness requirements. However, the fiscal year 2023 NDAA 
placed a 1-year moratorium on any changes to the configuration of our 
MTFs. As requested, we are preparing an update to Congress on our way 
forward in the coming month.
    The fiscal year 2023 NDAA also included a 5-year moratorium on 
further military medical personnel reductions. Together with the Joint 
Staff, we are updating our medical requirements as combatant command 
operational plans are also updated. We are also conducting a 
comprehensive, internal review--with our OSD colleagues and the 
Military Departments--on the best configuration of medical 
infrastructure and personnel for the long-term. We are resolute in our 
commitment to ensure combatant commanders have the medical resources 
necessary to protect, treat and provide long-term medical services to 
our men and women in uniform.
    We are also committing resources and attention to the ongoing 
challenge of suicide, to include addressing the shortage of mental 
health providers for both uniformed servicemembers and family members. 
We recently received the recommendations from the Suicide Prevention 
and Response Independent Review Committee, and are continuing to 
implement strategies that can help reverse the heart-breaking trends we 
have witnessed--both in DOD and in the Nation.
    The Department remains grateful for the long-term support from this 
Committee for our military medical research program. In those areas of 
most pressing need and relevance to today's emerging threats that 
include infectious disease, combat casualty care and other areas of 
critical importance to our warfighters, Congress' support is critical 
to our success.
    In 2022 and into 2023, the DHA has been able to focus its resources 
to supporting operational requirements of the Department, while 
continuing to manage the COVID-19 pandemic. There were a number of 
important milestones achieved by the DHA in the past year that will 
continue to influence operations in 2023 and into 2024. One of DHA's 
achievements was migrating 75 percent of MTFs to the new Electronic 
Health Record (EHR), known as MHS GENESIS. In a few weeks, we will 
deploy this system in the National Capital Region. This modern EHR 
platform will provide the Department with a powerful tool to support 
our readiness mission, improve interoperability and record sharing with 
care delivered in the private sector, and allow our patients to engage 
more directly with their providers in managing their care.
    Another major milestone is the use of virtual health. The COVID-19 
pandemic accelerated the Department's use of virtual health, and for 
the coming year, we will build on what we have learned and how our 
providers and patients effectively used technology throughout this 
public health emergency. DHA is creating a new digital health strategy 
that will expand our use of technology in ways that improve our 
training, preparedness, access, and quality of care. We intend to work 
with our military medical leaders and industry partners to focus on 
what can be achieved now, and build on our successes over time.
    In late 2022, after a multi-year process, the DHA awarded the next 
generation of TRICARE contracts at a value of over $135 billion over 
the next 8 years. These contracts will deliver high-value, patient-
centric care that integrates military and private sector care. In 
January, protests were filed that will slightly delay this transition. 
We are working closely with GAO and will ensure this process is carried 
out in a fair and timely way.
    For the current fiscal year, our mid-year review is underway. As in 
past years, the Military Health System continues its sustained decade-
long track record in responsibly managing health care costs--which 
remain below the National Health Expenditures per capita rate. Our 
fiscal year 2024 budget request presents a balanced, comprehensive 
strategy that aligns with the Secretary's priorities. We look forward 
to working with you over the coming months to further refine and 
articulate our requirements.
Transition from the Military
    We must provide the best support possible to our servicemembers who 
defend our country and keep it secure, especially as they prepare to 
transition into civilian life. In exchange for their dedicated service 
to our Nation, servicemembers should return to civilian life at the end 
of their commitment more competitive in the labor marketplace. This is 
the social contract that the Department makes with our servicemembers. 
When the DOD lives up to it, through programs like tuition assistance, 
credentialing, and Skillbridge, American society reaps the benefits. 
About 200,000 servicemembers transition out of the military each year. 
The transition from military to civilian life--especially the 365 days 
prior to and the 365 days post separation--is widely recognized as a 
challenging and stressful time for servicemembers and their families. 
To assist in the transition, the DOD partners with agencies across the 
Federal Government and with the private sector to ensure our 
servicemembers thrive once they leave military service.
Tuition Assistance, SkillBridge, and Credentialing
    DOD's Tuition Assistance (TA) program provides servicemembers with 
financial assistance to enhance their academic achievement (for 
example, earn a degree or certificate) during their off-duty time, 
which in turn improves job performance, promotion potential, self-
development, personal quality of life, and overall readiness. While TA 
is not specifically designed in support of the servicemembers' 
transition out of the military, it also provides an ancillary benefit 
as an effective retention tool and supports their potential career 
after their service.
    DOD's Credentialing, Apprenticeships (the United Services Military 
Apprenticeship Program--USMAP) and SkillBridge Employment Training 
programs exist on the spectrum of how military training, experience, 
and skills relate to increased mission readiness and ultimately result 
in successful post Active Duty careers. The demand for credentialing 
from servicemembers and industry continues to grow. Professional 
credentialing is an integral key of the Services' recruiting, in-
service development, promotion, retention, and transition strategies. 
SkillBridge allows servicemembers to deepen, broaden, and tailor the 
competencies that they developed through their military service to 
increase their compatibility and competitiveness in the civilian labor 
market starting up to 6 months before separation.
Transition Assistance Program
    Transition Assistance Program (TAP) delivery is a collaborative 
effort between DOD, Department of Labor, Department of Veterans Affairs 
(VA), and the Small Business Administration; each with a primary area 
of responsibility and focus. However, the program succeeds due to a 
robust interagency collaboration and communications strategy that 
encompasses these four agencies, and three additional agencies--
Department of Homeland Security, Department of Education, and the U.S. 
Office of Personnel Management. Working together, these seven agencies 
and the Services provide consistent messaging and ensure collaboration 
and synchronization in the delivery of the program.
    During TAP, all transitioning servicemembers complete a Military 
Occupational Code (MOC) crosswalk. They compare their military skills 
to civilian career opportunities and identify any gaps in education and 
training that they can address to enhance civilian employability and 
marketability. The MOC crosswalk is set up to help all transitioning 
servicemembers refine their goals. TAP also addresses transition-
related risks and barriers as part of the initial counseling with a 
personal self-assessment administered by the Services. The self-
assessment provides Commanders, TAP Counselors, and servicemembers with 
insights to and information about potential risks and levels of support 
required. This information facilitates development of the 
servicemember's individual transition plan and steps to meet the 
servicemember's individual transition goals. At the end of TAP, during 
the CAPSTONE event, Commanders and TAP Counselors review the efficacy 
of each servicemember's individual transition plan. If the CAPSTONE 
review indicates a need or desire for follow on support, the 
servicemember is connected via a warm handover to the appropriate 
agency or support organization for specialized assistance targeted to 
the servicemember's specific needs.
DOD-VA Collaboration
    The DOD continues to strengthen collaboration and coordination with 
our partners at the Department of Veterans Affairs (VA). With new 
authorities provided recently by Congress (NDAA Fiscal Year 21 and the 
PACT Act), both Departments are further leveraging shared resources and 
interconnected processes, programs, and initiatives to support 
servicemembers, veterans, their families, caregivers, and survivors. 
For fiscal year 2023, VA and DOD renewed our shared commitment to 
support health care collaboration, benefits and service delivery, and 
to enhance the transition process and post-separation experience, 
modernize shared business operations, and strengthen our 
interoperability.
    VA and DOD senior leaders are now more interconnected and aware of 
how their decisions impact one another. As such, the VA-DOD Joint 
Executive Committee uses an intentional decisionmaking process that is 
servicemember-and-veteran centric, results-driven, and forward-looking 
throughout a servicemember's career and transition to a veteran.
    Last year, DOD and VA signed the Joint Data and Analytics Strategy 
in an effort to optimize data, and to coordinate and share analytics. 
This is particularly important as we support the VA with the 
implementation of The Sergeant First Class Heath Robinson Honoring our 
Promise to Address Comprehensive Toxics Act of 2022, or PACT Act. DOD 
and VA are working to ensure the needed exchange of data to provide 
health care and benefits to veterans exposed to burn pits and other 
toxic substances, and to empower both agencies to make better decisions 
directly impacting servicemembers and veterans health care.
    One such example is the creation of a single, common VA-DOD 
Separation Health Assessment (SHA). Both Departments have worked 
closely to coalesce terminology, definitions and develop joint 
questions. The new common form reduces redundancies, saves time, allows 
for comparative analysis between Departments on health effect outcomes, 
and provides servicemembers more flexibility on where they can complete 
their separation health assessment. VA will begin using the OneSHA in 
the third quarter of fiscal year 2023, and the DOD will implement the 
common form in the fourth quarter of fiscal year 2023. Both VA and DOD 
are simultaneously making technological changes to their systems for 
employment of the new form.
                      cultivate talent management
    The Department will maintain its high standards and is committed to 
helping those who desire to serve meet their goals and ambitions. We 
will continue to invest in recruiting and retaining the talented men 
and women who make up our All-Volunteer Force and the civilians who 
support them. With emerging practices and standards in the current 
labor market, the Department must reimagine the DOD workforce to 
recruit, retain, and develop the talent it needs.
Military Recruiting and Retention
    Steady recruit flows are critical to the All-Volunteer Force. Given 
the tight labor market exacerbated by the residual effects of the 
COVID-19 pandemic and an increasing lack of familiarity with military 
service among young people, the Services continue to face a challenging 
recruiting environment. The Services are balancing declining end-
strength with high retention, but the impact of repeatedly missing 
recruitment goals can create long-term challenges. Reinvigorating the 
recruiting pipeline requires senior DOD leader engagement, robust 
solutions to barriers to service, a concerted effort to rebuild public 
trust and inspire service, innovative approaches to messaging, and a 
commitment to consistent and substantial resource investments.
    Recruiting challenges in fiscal year 2022 foreshadowed the 
increasing recruiting challenges faced in fiscal year 2023. Near 
historic lows at the beginning of fiscal year 2023 in the Services' 
Delayed Entry Programs contributed to the ongoing challenges. Market 
conditions continue to impact our recruiting efforts as we are in a 
fierce competition with the private sector for skilled and innovative 
talent. The propensity to serve in the military continues to be an 
issue with our youth as many do not believe military service is 
compatible with aspirational education and career goals. Nearly 50 
percent of youth never considered joining the military, and 58 percent 
believe individuals leaving the military will have difficulty 
readjusting to everyday life.
    It is likely that recruiting challenges will continue to persist 
for the foreseeable future, and there is no one silver bullet or 
specific action that the Department or the Services can quickly take to 
resolve the current recruiting challenges. However, we are looking for 
ways to get to the heart of our citizens and youth, and galvanize our 
future servicemembers on the merit and value of contributing to the 
country's well-being through military service.
    To this end, the Department is designing and implementing a 
comprehensive, broad outreach strategy that tells the DOD story and 
presents the vast opportunities military service brings. This multi-
pronged effort includes campaigning through an interagency partnership 
with Peace Corps, AmeriCorps, and Selective Service that touts the 
personal benefits and the positive outcomes public service has on our 
country and our communities. In addition to cultivating a culture of 
service, a standing interagency collaboration offers a framework for 
prioritizing and coordinating service across Presidential 
administrations.
    A large-scale, sustained National Military Advertising campaign is 
also needed to dispel inaccuracies and educate both youth and their 
influencers about the opportunities in the military. To support this 
initiative, the Department is requesting $40 million in the fiscal year 
2024 Defense Budget for a joint marketing campaign that focuses on 
youth and influencers. This campaign is critical to addressing 
misperceptions and garnering increased support of influencers who may 
help or support a young person's decision to join the military.
    The outreach strategy also includes celebration of the 50th 
Anniversary of the All-Volunteer Force, the 75th Anniversary of 
President Truman's order to racially desegregate the Force and 
congressional action to allow women to serve, and a robust strategic 
messaging campaign through senior leader engagements and community 
outreach initiatives that focus on reconnecting the military with 
America. P&R and the Military Services also continue to partner with 
the Department of Education on efforts to expand access of military 
recruiters to high school students through engagements with Chief State 
School officers, continued advancement of the Armed Services Vocational 
Aptitude Battery (ASVAB), promotion of the Purple Star Program, and the 
expansion of the ASVAB Career Exploration program. Each of these 
efforts expand awareness of our military and the many benefits and 
opportunities that come with military service.
    We would appreciate your support for the Department's fiscal year 
2024 budget request, which will help address some of the recruiting 
issues. The Department is committed to overcoming recruiting challenges 
through strong collaboration and innovative ideas. We will leverage 
every competitive advantage we have in an already crowded labor market. 
Ensuring we have the right number of people--with the right skills and 
talent--has the highest attention of the Department's senior 
leadership. We are committed to not only meeting our military 
recruiting targets, but also finding the most qualified and mission-
ready talent our Nation has to offer.
DOD Civilian Workforce
    The DOD civilian workforce possesses capabilities, expertise, and 
skills that directly impact DOD's worldwide military operational 
capabilities. As critical enablers of our warfighters, DOD civilians 
perform functions in intelligence, research and development, equipment 
maintenance, health care, family support, base operating services, and 
other activities that directly support the military forces and 
readiness. The Department continuously strives to improve its ability 
to recruit, retain, develop, and reward the civilian workforce to 
support the warfighter and encourage innovative best practices 
throughout the armed forces.
    Competition for talent in innovation and cutting-edge fields such 
as science, technology, engineering, and mathematics (STEM), cyber, and 
health care that are in high demand across the public and private 
sectors continues to be one of the biggest challenges for hiring 
civilian talent. Largely due to Congress' support, the Department 
continues to utilize a variety of human capital solutions to better 
compete in the current labor market, including expanded use of direct 
hire authorities, incentives, and special pay where authorized. These 
hiring tools are critical to compete against the private sector by 
reducing our time-to-hire and allowing us to target the talent needed 
in key areas.
    Following last summer's public release of the Defense Business 
Board's report on Civilian Talent Management, the Department took 
immediate action launching the Talent Management Executive Council that 
includes all Functional Community Managers and elevated its talent 
management framework to the highest levels of DOD, aligning talent 
management under the USD P&R with the Deputy Secretary of Defense 
exercising decision authority and oversight. We are also increasing 
outreach and marketing efforts to highlight opportunities through our 
DOD civilian careers web site, social media content, and live in-person 
and virtual events. The Department is also expanding our development 
and use of work roles to better identify what skills we need versus 
what skills we have. These insights will be critical to upskilling and 
reskilling our current workforce and to best address shortfalls in 
critical and high-demand skills.
    Over the past several months, the Department has been researching 
and collecting talent management best practices and developing a Talent 
Management Best Practices Playbook. The playbook shares insights on 
talent management approaches from some of America's most successful 
companies, as well as successful practices from other Federal agencies. 
We have also established a working group to look at designing a hiring 
model that will reduce the time of ``contact to contract.'' The 
Department is in a fierce competition for talent and a critical 
component of this competition is the ability to hire talented people in 
a timely manner.
    Additionally, we are in the process of hiring our inaugural Chief 
Talent Management Officer who will lead the development of DOD's talent 
management strategy. The CTMO will report directly to the USD P&R and 
will orchestrate the numerous talent management efforts across the DOD 
to include areas such as recruitment and outreach, and learning and 
development opportunities. These actions, and the many other strategic 
workforce planning and human capital management activities, support the 
Department's need to shape a professional, agile, and ready civilian 
workforce.
                      advance strategic readiness
    Building and maintaining our strategic advantage, as underscored by 
the National Defense Strategy, requires that we remain prepared to 
confront near term challenges while taking steps necessary to be ready 
in the future. Advancing strategic readiness means ensuring our ability 
to build, maintain, and balance warfighting capabilities and 
competitive advantages to achieve strategic objectives across threat 
and time horizons.
Strategic Readiness Framework
    The Deputy Secretary of Defense directed P&R to lead the 
establishment of the strategic readiness framework emphasized in the 
2022 National Defense Strategy. Since then, P&R has convened the 
resources and stakeholder support necessary to integrate the concept of 
strategic readiness throughout the Department to inform a broader 
understanding of the impacts of decisions on readiness. We are 
developing an analytic framework that integrates models across the 
Department to provide greater visibility on the readiness tradeoffs 
incurred by today's decisions and assessments that capture the 
quantifiable, cumulative, and cascading impacts of strategic readiness 
in DOD programs, policies, and strategies. This holistic view of 
readiness is designed to drive decision advantage by integrating 
processes to provide leaders with comprehensive, objective assessments 
of the strategic readiness-related risks and tradeoffs associated with 
our decisions.
    A notable example of the strategic readiness framework is the P&R-
led process to assess the potential strategic readiness impacts of 
providing security assistance to Ukraine. We assess these potential 
impacts against our other known requirements--such as training--and 
account for defense industrial base information, so that we have a 
clear picture of our own supply timeline. This assessment process then 
identifies what actions the Department can take to mitigate readiness 
impacts. The support Congress has provided to the Department through 
supplemental appropriations is critical in allowing us to add 
resilience to our industrial base and replenish our own stocks. In some 
scenarios, we have even been able to accelerate modernization plans as 
a by-product of our support to Ukraine and the data-driven mitigation 
process we have in place. We are already taking the lessons learned 
through the Ukraine security assistance process to inform and refine 
the strategic readiness framework and how we assess, quantify, and 
mitigate potential strategic readiness impacts across our processes.
Professional Military Education (PME)
    The Department is updating PME to make it more effective and 
relevant to the National Defense Strategy (NDS). Our War Colleges and 
Command and Staff Colleges have adjusted the framing of appropriate 
aspects of their core curricula to address the challenges of strategic 
competition with China and Russia. The fiscal year 2024 budget request 
supports the strengthening of the national security workforce, 
consistent with the President's National Security Memorandum (NSM-3), 
Revitalizing America's Foreign Policy and National Security Workforce, 
Institutions, and Partnerships. The PME enterprise, and Joint PME in 
particular, have set a high bar for developing the knowledge and habits 
of mind for the U.S. profession of arms.
    The NDS states that PME will ``foster critical thinking and 
analytical skills, fluency in critical languages, and integration of 
insights from the social and behavioral science.'' P&R is overseeing 
the implementation of these efforts through policy, governance, and 
talent management levers. DODI 1322.35, Volume 1, ``Military Education: 
Program Management and Administration,'' directs the military education 
institutions to design, develop, and deliver outcomes-based military 
education (OBME) programs. Program outcomes form a critical bridge 
between PME and operational performance. The Department is implementing 
this first-ever DOD policy on PME, synchronizing educational and 
operational requirements, and assessing outcomes in order to improve 
talent management and strengthen educational impact.
    We are also adapting manpower and personnel systems to collect and 
utilize performance information to improve talent management. This 
data-informed talent management approach is most evident in our efforts 
to improve management of critical language skills to address 
longstanding issues with the recruitment, training, utilization, and 
retention of cryptologic language analysts and to meet National 
Security Agency and Service requirements for professional level 
proficiency. Language, Regional Expertise, and Culture (LREC) skills 
are critical to the DOD mission and must be managed to optimize their 
accession, development, sustainment, enhancement, and employment. LREC 
skills improve the effectiveness of the total force by enhancing 
linkages with allies and partners, as well as providing direct and 
often immediate insight into potential adversary capability, intention, 
and activity, which is essential for the challenges of near-peer, 
strategic competition.
    We also oversee discrete programs such as the Secretary of Defense 
Strategic Thinkers Program, a highly competitive 10-month master's 
degree program, enrolling a select cohort of Active Duty military 
officers from across the Services in a specialized track within John 
Hopkins University's School of Advanced International Studies (SAIS). 
The Department has also increased the number of international officers 
participating in the U.S. PME system. Relationships built in the 
classroom undergird the hard power of coalition interoperability with 
Allies and partners on the battlefield.
    Developing servicemembers who understand the evolving nature of the 
security environment and how it potentially affects American interests, 
warfare, and the dimensions of strategic competition requires a PME 
system that keeps pace. Strategic readiness involves not only having 
the necessary equipment and technology, but also servicemembers who 
have the training and education to compete in a new era of competition.
Preparing for the Pacing Challenge
    Training is critical to preparing the Joint Force to meet the 
pacing challenge. Rapid technological advancement and threat evolution 
continue to outpace training modernization, widening the gap between 
how the Joint Force trains and how it will conduct multi-domain 
operations in a contested environment. To win the joint, multi-domain 
battles of today and the future, combat forces must have joint 
interoperable training environments robust enough to support large 
numbers of joint and coalition warfighters simultaneously, and advanced 
enough to simulate high-end combat in the all-domain battlespace.
    To answer this foundational challenge, we have chartered a new 
governance body with the Joint Staff, Military Services and Combatant 
Commands to accelerate the pace of change in the training community and 
quickly develop and execute realistic, joint, interoperable, and multi-
domain training capabilities to meet the threats from peer adversaries 
in a contested environment. We are driving pacing threat training into 
the synthetic world, while also increasing the capabilities of large-
scale training areas, to replicate the complex, joint, multi-domain 
fight. Given the key role of Allies and partners in the NDS, we are 
also breaking down barriers in our training programs, exercises, and 
security policies to enable greater ally and partner participation.
                               conclusion
    As we look to the future, it is imperative that we do not take for 
granted what makes our U.S. Military unparalleled and unmatched. It is 
our people--the Active, Reserve, National Guard, DOD Civilians and all 
of their families, caregivers, and survivors who are willing to serve 
this country. They are the bedrock of our national security.
    Thank you for your continued support of our servicemembers and 
their families, we look forward to your questions.

    Senator Warren. Thank you very much. I appreciate it, 
Secretary Cisneros. I would like to start. I recognize myself 
for opening questions. All across this country, families need 
high quality, affordable childcare in order to show up at their 
jobs or go to school. Military families are no exception on 
this.
    In fact, because of nonstandard work hours, sudden changes, 
significant deployments, the need for childcare among our 
military families can be even greater. That is why our military 
has long recognized that childcare is essential to supporting 
servicemembers' ability to protect our country.
    DOD runs the largest employer sponsored childcare program 
in the United States. Military and nonmilitary families should 
all have access to high quality, reliable care, which is why I 
based my bill for a universal childcare system on the DOD 
model. But the DOD childcare system still faces its own 
challenges, a top one being finding enough workers to care for 
eligible children.
    Secretary Cisneros, workforce shortages have been a major 
problem in the childcare industry for years now, and of course, 
it has been made even worse since the pandemic. Are military 
child development centers facing this issue as well?
    Mr. Cisneros. Well, thank you for that question, Senator, 
and really thank you for your support on the childcare efforts, 
not only in the military but throughout the Nation. You are 
correct in stating that there is a national childcare provider 
shortage in the country and we are feeling that as well.
    Since the pandemic we have had trouble, difficulties trying 
to hire more childcare workers to work in our child development 
centers. Last year we were able to raise the salary, the 
minimum wage for workers----
    Senator Warren. We are going to talk about the money in 
just a minute, but you do have a problem. Let's start there, 
and I just want to make sure I get this on the record, what it 
means for military families when they don't have access to the 
childcare that they need. Can you just say a word about that?
    Mr. Cisneros. Well, ma'am, it does create difficulties. We, 
as you stated, see childcare as part of our readiness. We want 
our servicemembers to be able not to really have to kind of 
think or worry.
    To be able to have the ability to drop their child off at--
for childcare at a child development center or using one of the 
other options that we have available to them. It really kind of 
relieves some stress from them and it allows them to focus on 
their mission and performing their task.
    Senator Warren. So, it is a part of performing your mission 
and being able to concentrate on your tasks. Now, it takes a 
lot to recruit and retain staff for anything. But one 
significant issue is pay, which is where you started a minute 
ago. When was the last time you updated your pay scale for 
childcare workers?
    Mr. Cisneros. Well, last year, ma'am, we were able to 
raise----
    Senator Warren. I am not asking you that. I am saying when 
did you last update the pay scale for childcare workers?
    Mr. Cisneros. Well, raising the salaries of our child 
development workers last year when we raised the minimum wage 
was when we were able to do that, ma'am.
    Senator Warren. You got the minimum up, but I am talking 
about the scale overall. Not everybody is down at minimum. I 
understand that the last time was 30 years ago. Does that sound 
about right?
    Mr. Cisneros. It has probably been a while since we looked 
at it, ma'am.
    Senator Warren. What is the highest level of pay a 
childcare worker in the military system can receive under your 
30-year-old scale?
    Mr. Cisneros. From what I have been told, ma'am, it is--
allow Mr. Constable to answer this question.
    Senator Warren. Mr. Constable, do you want to answer that 
one? I think that was known as a lateral pass.
    Mr. Constable. Chairwoman, thank you very much. The top of 
the skills is approximately $55,000 a year.
    Senator Warren. Yes, $55,000. That is, it. That is the top. 
So, DOD runs a school system for military families called DODEA 
[Department of Defense Education Activity], right? How does the 
pay scale for DODEA teacher compare with DOD childcare pay 
scales for people with similar credentials? Secretary Cisneros. 
Unless you want to call on Mr. Constable.
    Mr. Cisneros. Well, ma'am, they don't really have similar 
credentials.
    Senator Warren. Well, that is--the question I am asking is 
when you have got people with similar credentials--maybe I 
should ask it this way, what is the top pay for DODEA workers?
    Mr. Cisneros. I will allow Mr. Constable to answer that.
    Senator Warren. Mr. Constable?
    Mr. Constable. The top pays approximately $110,000 per 
year.
    Senator Warren. So approximately $110,000. I think we 
understand the difference here, $55,000, $110,000 for the very 
top.
    So, if we had two workers with the same credentials, same 
education, same experience, and one was teaching 4-year-olds at 
a DOD child development center, they would earn only about half 
as much as one teaching 6-year-olds at a DODEA center.
    So, I just have to ask, do you think that makes any sense? 
Are you surprised to find out that you are having trouble 
filling these spots?
    Mr. Cisneros. Ma'am we know that, as you stated, right, we 
are having difficulty hiring these spots. It is a national 
problem. I think being able to pay a competitive salary is part 
of that. That has to be there to get in the solution to 
resolving this problem.
    Senator Warren. So that is why we are here today, to talk 
about this. Look, childcare is infrastructure. We need roads. 
We need bridges to get to work. In the case of our military, 
sometimes you need an aircraft carrier or a cargo jet, but you 
also need a functioning childcare center.
    If the Federal Government is serious about military 
readiness and national security, if it is serious about 
retaining families, then we need to invest more in childcare 
workers, and that means within DOD. It is put money into these 
workers.
    We need to start by updating these pay scales and doing it 
now. Thirty years is too long to go between, and it is a 
statement that we don't care about those people. If we care 
about this system, we will update those pay scales.
    Thank you, and I now call on Senator Scott.
    Senator Scott. Thank you, Chairwoman. All right, Secretary 
Cisneros, you know that we talked about recruiting is not 
hitting the numbers. Tell me what you think of your marketing 
plan and your advertising program, and is it very effective? 
What should you do differently? Is it properly funded?
    Mr. Cisneros. Thank you for that question, Senator. I will 
admit we need to do a better job of telling our story, the 
benefits of military service, what it could provide. Just last 
month I went out to go talk to a group of college students as 
well as a group of high school students about the benefits of 
service and really how it changed my life. Like yourself, sir, 
I joined the military, 18 years old.
    It put me on a different trajectory that I couldn't even 
imagine--that I never would have imagined for myself that I 
would be sitting here. So, there are benefits of that, and I 
think as our Senior Enlisted who were here on the Hill a couple 
of weeks ago testifying is that we do, we agree that we need to 
do a better job of telling our story and marketing ourselves.
    We are working with our public affairs Department to do 
that right now. But, as I said in my opening statement, for OSD 
and the services have their own budget and they can talk about 
that in the next panel.
    But for OSD, we are requesting $40 million, that is in the 
budget, to really help us with a joint marketing campaign that 
will allow us to go out and do the research with JAMRS [Joint 
Advertising Market Research Students] that we have, as well as 
to kind of go out and market to the influencers, whether it be 
teachers, grandparents, parents, to let them know about the 
benefits of military service.
    Senator Scott. So, I am a business, I have spent a lot of 
money on marketing in my companies, and so, we test everything. 
We test all of our marketing plans. We tested what worked, what 
didn't work, and so, talk about how you do that with regard to 
your advertising and how you market the military.
    Mr. Cisneros. Well, we do have a firm, we do have JAMRS, as 
we call it, that we work with to go and to prepare, help us 
prepare the marketing campaign that does the research for it. 
With that, I can turn over to Mr. Constable and go into more 
depth about JAMRS and what it does for us.
    Mr. Constable. Thanks very much, sir. Senator, thanks for 
your question. JAMRS is the Joint Advertising Marketing 
Research Group that does our work. It is very similar to what 
you would find in industry and works closely in fact with 
industry.
    As you probably are aware, is a highly fragmented 
marketplace, so really testing and piloting is key, just as you 
have said. So, to that end, the additional funds requested in 
the President's Budget Request for fiscal year 2024 will not be 
focused on closing deals with servicemembers, the contact to 
contract as the services can speak about.
    What it is really focused on is building the brand, making 
sure there is more public awareness and making sure that when 
the time for a decision comes for a young person to join or to 
not join, they are at least aware that military service or 
public service even is an option to them.
    Then the services can speak about what is in their budget 
separately for then going in and building on that baseline that 
we will provide through JAMRS to actually close the sales with 
each of the contractees.
    Senator Scott. So, first off, if you could send us a copy 
of your research, I would like to see it. Second, if it is not 
successful using the same people, have you changed firms? Are 
you using the same people that got you where you are you are 
way behind?
    Mr. Constable. I would have to get you along with the other 
information, the background on who--with whom we have worked 
over the different iterations of this effort.
    Senator Scott. Has anything changed?
    Mr. Constable. Significantly. Again, what you are going to 
see in the fiscal year 2024-hour request is one of the biggest 
increases that we have put into this because we have our 
investment in that baseline awareness, the marketing targeted 
toward those influencers has waned over the years.
    We saw the need to again, not leave it all to the service 
ads or the service online spots or whatever medium they choose 
do the whole job. Again, what you are seeing now is based on 
the data and understanding that rebuilding the brand and 
getting awareness to all of our target populations is where we 
are going.
    Senator Scott. If you are asking for $40 million, I mean, 
do you have research to suggest that if you got there and if 
you start trying something and it doesn't work, are you going 
to stop?
    Mr. Constable. I think we will have to, you know, see how 
the market responds to the investment like everything else. But 
the intent is to sustain over time that baseline marketing, to 
keep the brand out there, to keep the awareness of public 
service, military service out there.
    I suspect that as the service numbers ebb and flow over 
years and years, they will make larger, smaller investments as 
they need to, to keep their ranks at the right end strengths.
    Senator Scott. Okay. Thank you.
    Senator Warren. Senator Hirono.
    Senator Hirono. Thank you, Madam Chair. Secretary Cisneros, 
and probably for Mr. Constable too, my office has heard from 
our servicemembers in Hawaii that they are deeply concerned 
about imminent cuts to their cost-of-living allowance by around 
50 percent. That is a big potential cut.
    Certainly, I share their concerns. Hawaii has the most 
expensive cost of living of any State in the country. Today, 
the cost of a gallon of gas in Hawaii is $4.85, more than $1.00 
above the national average of $3.46. A gallon of milk in Hawaii 
is about $7.25 compared to the national average of $4.41. The 
cost of housing in Hawaii is higher than any other State. I 
could go on.
    As we continue to combat inflation, the thought of slashing 
the cost-of-living allowance for servicemembers in Hawaii is 
absurd. Secretary Cisneros, does the Department of Defense have 
information suggesting the cost of living has fallen by 50 
percent in Hawaii?
    If not, how does DOD justify cutting the cost-of-living 
allowance for our soldiers, sailors, airmen, guardians, and 
marines in Hawaii? How do you justify this kind of potential 
cuts?
    Mr. Cisneros. Ma'am, the cost-of-living allowance that you 
are referring to is the--well over in Hawaii, they get what we 
call OCOLA, overseas cost of living allowance. It really is 
about trying to bring it in line with what the--to make sure 
that their dollars goes just as far as it does here in the 
United States, in the Continental United States, I should say.
    Senator Hirono. I am glad you know the Continental U.S. 
because Hawaii is a State. Go on.
    Mr. Cisneros. Yes. But the, what we are seeing here, right, 
is that the struggles have really kind of, with inflation--and 
inflation doesn't really play into the COLA analysis and how we 
come up with that. But in order to kind of make it--well, what 
happens as it is evening, things here in the Continental United 
States have grown as well and have gotten more expensive. But I 
will turn it over to Mr. Constable again to kind of go into 
detail on how the formula is figured out there.
    Mr. Constable. Thank you, sir. Thank you, Senator.
    Senator Hirono. Well, first of all, let me just get to, 
because I am running out of time. So, you believe this kind of 
a huge cut for servicemembers in Hawaii is justified? If so, 
could you send me the justification or send this Committee the 
justification?
    Mr. Cisneros. We could provide you with the information, 
ma'am.
    Senator Hirono. Do you consider this kind of cut to be 
justified?
    Mr. Cisneros. I think, the way the COLA is figured out, and 
the system that it is, and the way it is, and it is not just I 
will say, ma'am, it is not just Hawaii, but it is all around 
the----
    Senator Hirono. Alaska? Well, wherever you are making these 
kinds of----
    Mr. Cisneros. Germany, Japan, all these areas are facing 
the same cut because, again, the COLA is meant to bring the pay 
scale or pay in alignment with what it would be here to make 
sure that the dollar, if they were here in the States, that the 
dollar would stretch just as far as they are overseas.
    But as we struggle here, or people are struggling here in 
the Continental United States, it has kind of even the playing 
field out. So, but we can provide you with that information. I 
will turn it over to Mr. Constable.
    Senator Hirono. Well, clearly, I don't think that these 
kinds of cuts are justified for servicemembers in Hawaii. They 
are already having a pretty hard time. I was glad to see the 
President's Budget included multiple investments in our 
servicemembers, like $90 million to expand full day pre-K, $209 
million for suicide prevention efforts, and $637 million for 
continued investment in sexual assault prevention and response.
    Although we have made some changes over time in how the 
military would deal with sexual assault cases, it is still an 
issue. It still continues to be a scourge. So, I am glad that 
this kind of investment is being made to continue to fight the 
scourge. I appreciate the Department of Defense's commitment to 
taking care of its people, but I think there is more to do, 
especially for servicemembers considering their family planning 
options.
    Mr. Secretary Cisneros, what is the importance of the 
Department of Defense's new policies to ensure access to 
reproductive health care for our servicemembers? Also, 
cryopreservation is a fertility tool that servicemembers, men 
and women, could use if they wish to have children of the 
future.
    This is something that the British armed services provides. 
So, could you give me your views on what the cost of 
cryopreservation under TRICARE would be? Could this not be an 
important recruiting and retention tool for the military? All 
of the services are facing those issues.
    Mr. Cisneros. You know, as you stated, Senator, I believe 
family planning is very important and we have done a lot, I 
believe, to kind of help the servicemembers with that. We have 
walk-in hours for contraceptives for our servicemembers at our 
Military Treatment Facilities (MTFs).
    Now that they can go and make sure that they are on a plan 
there. We initiated the policies there to help support 
reproductive health care for our servicemembers as well. Where 
they are denied access to certain types of health care in 
certain states, where we will be able to ensure that they will 
be able to be--travel in order to get that health care. As far 
as what you are asking for, I can turn it over to----
    Senator Hirono. Cryopreservation----
    Mr. Cisneros. Cryopreservation--I can turn over to Dr. 
Martinez. He can go into depth with that.
    Mr. Martinez-Lopez. Senator, thank you for the question. We 
do provide the services to servicemembers that may have had 
trauma or are facing cancer. So, it is very limited and only 
for servicemembers. We are not providing the care for all the 
beneficiaries in the TRICARE system. So--and I don't know why.
    Senator Hirono. You are saying that you provide 
cryopreservation options?
    Mr. Martinez-Lopez. We may provide that in the case of 
trauma or in the case of----
    Senator Hirono. Okay. That is a very limited kind of set of 
circumstances. So, I would ask that you look at what the 
British armed forces is doing in this area and let us know if 
this is something that we should contemplate.
    Mr. Martinez-Lopez. I will do, ma'am.
    Senator Hirono. Obviously, I support going forward with it. 
Thank you, Madam Chair
    Senator Warren. Thank you. Senator Budd.
    Senator Budd. Thank you, Madam Chair, so honored to be on 
the Subcommittee with you. It is good to be with a Member, a 
former Member of the U.S. House, and we served together for a 
few years.
    A couple of questions. I want to draw your attention, and 
this is on the heels of the recruiting conversation, I want to 
draw your attention to an incredible organization called Our 
Community Salutes. It recognizes and honors high school seniors 
who plan to enlist in the military following their graduation. 
They also recognize, the group also recognizes their parents 
and other members of their family.
    Now, this is an incredible way to build and maintain 
support for our military within communities across America. 
Despite senior military leaders speaking at these events, I am 
told that military lawyers have taken issue with official 
communications to inform recruiters and senior leaders of 
opportunities to engage or support Our Community Salutes.
    Mr. Secretary, will you commit to look into this and find 
ways to partner with OCS, Our Community Salutes, and other 
organizations like it. The bottom line is we need all the 
support we can get to get close to our recruiting gap. So, will 
you look into this?
    Mr. Cisneros. Yes, Senator. We could take that for the 
record, and I am not familiar with the organization or as to 
why certain members, senior members have been told possibly not 
to participate. But that is something we could take for the 
record and supply you with an answer.
    Senator Budd. Glad to submit that and look forward to your 
response. Speaking of responses, thank you for getting back on 
my letter I recently submitted. I received this yesterday.
    This is a letter my colleagues and I sent regarding the 
Administration's decision to permit taxpayer funding for and 
authorization of travel to acquire abortions. The bottom line 
is, I just don't think this is an acceptable response.
    Once again, the Department failed to answer the Committee's 
repeated requests for information, and instead we got what 
amounts to a form letter just repeating the new policies. We 
knew the policy, that is why I asked the questions.
    So here is a few of the questions I would like for you to 
answer for the record. First, how many women or military 
families have refused to be stationed in Germany, South Korea, 
or any other country because of those nations' abortion laws?
    Mr. Cisneros. I don't have that information for you, 
Senator.
    Senator Budd. Okay. Well, if it is zero--if it is non-zero, 
would you please send information on that? Would you commit to 
sending information on that?
    Mr. Cisneros. I will commit to looking into that and seeing 
what the information is, if that is available. But that is not 
typically a question----
    Senator Budd. Just please let us know if there is zero 
information, or if there is information, let us know what that 
is. Does the Department have any data on women who felt 
deterred from joining the military for fear of being stationed 
at an installation or base in a State or nation that has 
restricted or restrictive abortion laws?
    Mr. Cisneros. We have had discussions, listening sessions 
with servicemembers who have let everybody know----
    Senator Budd. Secretary, any data on that?
    Mr. Cisneros. We also have a RAND report that they 
published and that the facts that they believe would happen 
from--well, the effects that the Dobbs decision would have on 
recruiting and retention.
    Senator Budd. If you would send that to us, because we have 
repeatedly requested it. It would seem like that would be a 
good report to have.
    Mr. Cisneros. We can share the RAND report.
    Senator Budd. Thank you very much. I appreciate that. What 
actions, if any, would the DOD take against a Commander that 
refused to facilitate the abortion of an unborn child in 
keeping with their sincerely held religious beliefs?
    Mr. Cisneros. Well, Senator, the Commander doesn't really 
know. When the servicemember is making a request, they are 
asking for reproductive health care. Now, reproductive health 
care, that can come in different forms. The Commander should 
not be digging into what the specific reason is why they are 
seeking reproductive health care.
    Senator Budd. The assumption was that it was known and it 
was against their sincerely held religious beliefs. Would the 
DOD take action against such a Commander?
    Mr. Cisneros. Well, again, the Commander should not know. 
They shouldn't be digging into that.
    Senator Budd. In the case that it was.
    Mr. Cisneros. But you now, to the--I would say if the 
Commander feels uncomfortable with kind of approving such a 
request, he can move it up the chain of command. But it is not 
the responsibility of the Commander to put their religious 
beliefs onto servicemembers.
    Senator Budd. Yes, that really wasn't the question. But, 
you know, millions of Americans, myself included, are 
rightfully against the use of taxpayer funds to facilitate 
abortions. So, we will submit some more questions for the 
records. But in our final time here, what is being done to 
ensure that those kicked out of the military due to the vaccine 
mandate are able to rejoin, should they want to continue their 
service?
    Mr. Cisneros. Senator, there--that would be a question that 
could be better answered by the services. They are the ones 
carrying out those tasks.
    But the secretary made it clear in his memorandum that 
servicemembers that put in a request for accommodation, whether 
it be administrative, religious, or medical reasons, that 
those, if a decision had been made, those requests would be 
pulled if it was purely for COVID 19, and that if other members 
that were separated request there is a process for them to 
apply to the board.
    Well, to apply for one of the boards that the services have 
to ask to come back into the service or to have their DD214 
adjusted, their--whether it be their status adjusted as far as 
their discharge status.
    Senator Budd. Okay. Thank you for being here, and I thank 
the panel. Chair Warren, I yield back.
    Senator Warren. Thank you. Senator Duckworth.
    Senator Duckworth. Thank you, Madam Chairman, and good 
afternoon to our witnesses. Two years ago, gentlemen, I 
introduced legislation that ensured Guard and Reserve members 
receive the same monthly incentive, pay for maintaining the 
same critical skills and taking on the same hazardous duties as 
their counterparts in the Active component.
    Reservists who qualify for these incentive pays work hard 
to maintain the same skills through the same standards as their 
Active Duty counterparts, often on time when they are not 
technically drilling. Yet, they are only currently paid 1/30th 
of the incentive pay that their Active Duty counterparts 
receive.
    So, the situation is, for example, jump pay. You have to do 
three jumps a month as a paratrooper. A reservist goes out, he 
does three jumps in 1 day. An Active Duty troop goes out and 
does three jumps in 1 day. The Active Duty troops get $150. The 
reservist gets $5 bucks for the same three jumps.
    This is an equity issue, and one that I am glad that my 
colleagues in this Committee voted in an overwhelmingly 
bipartisan way to address by including my bill in the Fiscal 
Year 2022 NDAA. Before implementing this section of the NDAA 
though, DOD must submit to Congress a report on its plan for 
providing equal incentive pays along with the certification 
that it will not negatively impact force structure.
    This report was due 6 months ago, in September 30th of last 
year, yet Congress is still waiting for this report. Last 
October, after the deadline passed, I led a bipartisan and 
bicameral letter to Secretary Austin urging the Department to 
expeditiously issue its report and certification to Congress as 
required by law.
    We are still waiting to hear from DOD on this. We are still 
waiting to pay our Reservists equitably for the critical skills 
and risks that they take to contribute to our military. 
Undersecretary Cisneros, how close is the Department to 
completing the report?
    More importantly, how much longer would you like our 
Nation's Reserve component to wait before it is afforded 
incentive pay parity with their counterparts on Active Duty?
    Mr. Cisneros. Senator, thank you for the question there, 
and I know, I was a former tower officer, and then later they 
changed the name to full time support in the United States 
Navy, working with our reservists.
    I know how hard they work and how dedicated they are to 
defending the Nation. You know, for that--but for that, I am 
going to turn over to Mr. Constable, who can----
    Senator Duckworth. Why are you 6 months late?
    Mr. Constable. Senator, this is a conversation that has 
started many, many working groups, really, so we are very much 
aware of the requirement and apologies for the late report. We 
do anticipate meeting with the staff soon to talk through some 
of the impasses that we have reached based primarily on the 
realization in all camps that not all special skills, not all 
special pays are created equally or should be treated the same.
    We just have to find the right mix of places where and we 
seek equal dollars versus equal consideration, and of course, 
all cognizant of creating incentives to draw people from one 
force to the other as one report has warned.
    But we do owe you a report, and we do believe we are 
nearing a solution to propose.
    Senator Duckworth. Can you tell that in ordinary people 
speak as opposed to DOD speak? How--what is nearing, 6 more 
months, a year? I think you guys are slow rolling this because 
you don't want to implement it.
    Mr. Constable. I think--not years, not months, Senator. I 
think the answer is weeks. Obviously faster when I go back than 
before I left the----
    Senator Duckworth. Less than 2 months?
    Mr. Constable. I am going to have to return back----
    Senator Duckworth. I want to know.
    Mr. Constable. Yes----
    Senator Duckworth. All right.
    Mr. Constable. Yes, Senator, we are certainly getting with 
the staff----
    Senator Duckworth. Will you call me back within a week to 
tell me when the report will come?
    Mr. Constable. I think it is ready for staff. I don't 
believe, Senator, it is ready for the Members quite yet.
    Senator Duckworth. When will it be ready for the members? 
When can you commit to?
    Mr. Constable. I can commit to meeting with the staffs in 
weeks or less.
    Senator Duckworth. I will give you 4 weeks.
    Mr. Constable. Senator.
    Senator Duckworth. Well, you need to do this. This idea 
that you can slow roll this, and that you are going to--that 
Active Duty troops is going to leave the Active Duty to go to 
the Reserves because he is going to get $150 bucks extra a 
month for three jobs is an insult to the troops who are on 
Active Duty, and it is still an insult to the troops who do 
those same three jobs every single month in order to make--to 
meet those standards. I am going to move on to my next 
question.
    The military service has faced challenges in meeting their 
recruiting goals, in part due to a historically small pool of 
eligible recruits. This year I am introducing the ENLIST Act. 
This legislation enables the Department of Defense to expand 
its recruiting pool to include individuals like DACA [Deferred 
Action for Childhood Arrivals] recipients and other longtime 
residents of this country who can pass a DOD background check 
and meet the service's high standards for enlistment while 
maintaining the Department's security standards.
    The ENLIST Act will aid the service's recruitment efforts 
by allowing highly skilled and motivate individuals to succeed 
in the military. Undersecretary Cisneros, Mr. Constable, I 
would like to hear from each of you whether you think the 
ENLIST Act's expansion of the pool of possible recruits would 
benefit military recruitment efforts.
    As a follow up for either of you, what other actions has 
the Department undertaken to bolster efforts to recruit diverse 
talents from across the Nation?
    Mr. Cisneros. Ma'am, Senator, we have tried this before, to 
try, so we are in support of trying to diversify our enlistment 
pool in order.
    I know there are a number of kids, young students that have 
grown up here in the United States that consider themselves 
American citizens, that have really done nothing wrong, have 
good lives and have--want to serve.
    So, you know, this is something that we have looked at in 
the past, that we tried to move through in the past, and we 
will continue to try and do it again.
    Senator Duckworth. You didn't answer my question. How about 
Mr. Constable?
    Mr. Constable. Senator, the Department would support any 
effort to expand the recruiting pool, so we look forward to 
reading the details within your bill. In the $40 million that 
we spoke of earlier that is contained in the President's Budget 
Request for JAMRS, in one part is really geared toward getting 
at some--more diverse populations.
    We don't like leaving any money on the table or any 
population unchecked, especially with all the skills that they 
bring us or the opportunity to better reflect the American 
public. So, to that end, you should expect to see and demand to 
see more marketing, more advertising geared toward a broader 
population, and we look forward to your bill. Thank you.
    Senator Duckworth. Okay, Thank you. I am over time.
    Senator Warren. That is fine. Thank you. Senator Sullivan.
    Senator Sullivan. Thank you, Madam Chair. Good to be on the 
committee. I want to thank the witnesses. I am going to follow 
up on Senator Duckworth's line of questioning for Mr. Cisneros, 
Ms. Skelly, and Mr. Constable, and if this has already been 
talked about, I apologize for getting in here late.
    But we have this recruiting problem right now, and I don't 
have to tell you, but the Army's 2022 recruiting goal was 
missed by 25 percent. So far this year, the Army, Navy, and Air 
Force are projected to miss their 2023 targets. I am really 
interested in what you think is going on.
    There are different theories. It is the economy. There is, 
you know, I think there is cultural issues, right. If you tell 
everybody every day in The Washington Post and The New York 
Times that the military is full of extremists, which oh, by the 
way, it isn't, let's just get that one right, you are going to 
have people go, well, geez, I don't want to send my young son 
and daughter there, right.
    The Army deserves some credit developing its soldier prep 
course, which I think has been successful. The Navy seems to be 
taking a different approach, which is dropping its standards to 
as low as they can go. Not really wise, in my view. The Marine 
Corps hasn't missed its recruiting goals, but I don't think 
they are out of the woods yet. So, what do you think is 
happening and how do we need to get on it?
    I do think that the average man and woman, young man or 
woman in America who wants to serve, they want to deploy, they 
want to defend their country, they want to fight, right. So, I 
think we can't lose that aspect of trying to recruit for the 
men and women who want to do it.
    We don't have to go too far afield to say, oh, we are going 
to do all these other appeals. We should appeal to the 
patriotism and desire that has been in this country for 200 
plus years to deploy and fight for their country. I think that 
is how you get good recruiting numbers. But what do you guys 
think?
    Mr. Cisneros. Senator, thanks for the question and again 
for the opportunity to kind of talk about recruiting. We know 
there are some challenges out there right now.
    One of the things that we are seeing in the research that 
we have is that there is definitely a military civilian divide, 
you know, as Senator Duckworth said, right. That the recruiting 
pool is getting less and less, smaller and smaller of those who 
are qualified.
    Senator Sullivan. So, they are not qualified because they 
are overweight. They have a low ASVAB [Armed Service Vocational 
Aptitude Battery] score. What is it?
    Mr. Cisneros. That--well, those are two things right there, 
sir. Right there. It is the--they are not meeting the academic 
standards. They are not meeting the physical fitness standards. 
But then we are also seeing that, you know, 30 years ago, 40 
percent of people between the ages of 16 to 24 knew somebody 
who had served in the military.
    That is only 15 percent right now. They don't know what the 
military is. They don't understand what it is about. That was 
why earlier we talked about, you know, we have got to do a 
better job of going out and telling our story and the benefits 
of military service.
    Senator Sullivan. Yes. Great story.
    Mr. Cisneros. It changed my life. It put me on a different 
trajectory, and I know it has done that for thousands of 
people.
    Senator Sullivan. So, are you viewing the soldier prep 
course as an answer that other services can maybe emulate?
    Mr. Cisneros. I think the--well, the Army would probably 
better talk about that later on, but that is one of the things 
that they saw. They saw there was a need to help students 
academically, to help them get in better shape in order so they 
can meet those standards. From what I understand is the Navy is 
talking about emulating that program as well.
    Senator Sullivan. So, any other thoughts, Mr. Constable and 
Ms. Skelly?
    Mr. Constable. Senator, I want to point out one specific 
initiative we have had, and that is the Medical Assistance 
Review Pilot.
    This is where we are questioning the conventions that have 
constrained us over the years just simply because we know more 
than we used to, especially with electronic health records. 
That is where we used to say, if you have had asthma at any 
point, you are not eligible.
    So, we questioned all of those, working closely, of course, 
with the medical team to define where we can assume a little 
less, looking at the data to where these people would qualify, 
and that has brought thousands more in.
    Senator Sullivan. Good. What about, this is a topic I have 
been--on that topic, on mental health, right. Right now, I know 
for a fact that certain services, and I have been asking this 
question through the Armed Services Committee, but we 
disqualify young men and women, some services, if they have 
seen a psychiatrist or if they have been on medicine for mental 
health.
    Yet we want them to try to improve their mental health, 
right. How are we thinking about that in a way that would not 
just say, oh, you were on medicine for 6 months, you saw a 
psychiatrist, young high school kid, you are disqualified. 
Because then, that is just the wrong message. They are either 
going to lie or they are going to not seek help.
    Mr. Cisneros. There is, as Mr. Constable said, there are a 
lot of things that we have looked to reevaluate that we are 
trying to work with the services to expand that.
    Senator Sullivan. Is that one?
    Mr. Cisneros. I believe it is one. One of the things that 
we are trying to do within the military is destigmatize mental 
health. The Secretary says all the time, mental health is 
health. We want people to come forward when they need--they 
feel they need to talk to somebody or they need to see a 
professional.
    We don't want them to--you know, used to always be if you 
said you had a problem, they would just automatically take your 
security clearance away or ground you from flying the aircraft.
    We don't want that to be the case anymore. We have been 
working hard to change that and to make it so that people will 
come forward and deal with their health issues.
    Senator Warren. Good. Thank you. Senator Blumenthal.
    Senator Blumenthal. Yes. Thank you very much, Madam Chair. 
I want to follow up on exactly that question because frankly, I 
can well envision you would rather have someone who sought help 
than someone who denied the need for it. Said, I am fine, but I 
want to shoot up a classroom or whatever and is not going to 
talk about that when they come to a recruiter.
    So, you say you are working hard. What are you doing and 
what is your timetable for specific steps? I am not here to 
sort of put you on the spot, but I would like a written 
response with specifics as to what you were doing to change 
those qualifications and on what basis for mental health. 
Because I think the question raised by Senator Sullivan is 
absolutely critical.
    Mr. Cisneros. Yes, Senator, we can provide you with that. 
But you know, there are some great programs that the service 
has had, that they implemented. One I always like to talk about 
is the Air Force's True North, where they put in counselors 
within their squadrons to provide individuals to talk to when 
they need the counseling or just to talk about their issues.
    Senator Blumenthal. That is for Active Duty members.
    Mr. Cisneros. Yes.
    Senator Blumenthal. But what about the recruit who will 
come to see the Marine Corps recruiting officer or the Navy 
recruiting officer and say, yes, I had--I went for help. What 
happens to that person?
    Mr. Cisneros. Well, Senator, like I said, we can provide 
you with a written response. I can turn over to Dr. Martinez 
Lopez, who might be able to comment on that. But we are working 
with the services. We are working with them to try and expand. 
We were able to come to agreement on 38 different issues, 
whether it be asthma or whether it be ADHD [Attention Deficit 
Hyperactivity Disorder].
    Senator Blumenthal. Okay. I don't have time in to hear 
about all of that. I want to focus on mental health, because 
mental health, as the Secretary has said, is--should be 
regarded the same as physical health.
    So, if somebody broke a leg and they said, yes, I broke a 
leg, I played football, you know, I was out for 6 months. I am 
fine now. You would take them. If someone says, yes, I had a 
problem, I went to see--I went to see a shrink, and it really 
helped. That is the kind of story that should be regarded in 
the same way.
    But I want to relate this issue to a very specific one, and 
that is the suicides of sailors on the USS George Washington. 
Three sailors died by suicide while that ship was undergoing 
maintenance and repairs. One of them was Xavier Sandor from 
Connecticut.
    His dad has been pummeling the Department of Defense for 
information about what is being done to better the conditions 
of sailors when their ship is not at sea, when it is being 
repaired. He was forced to live on this ship while it was being 
repaired. Like living in an apartment that is being renovated.
    He couldn't sleep. He was in bad shape and he didn't get 
help. The Department of Defense is doing an investigation or an 
inquiry. Do you have the results?
    Mr. Cisneros. Senator, we don't have the results to the 
inquiry or the investigation that the Navy is doing. I believe 
that is still ongoing. I believe that would be a better 
question for the Navy and the second panel as to what they are 
doing and the improvements that they are trying to make for 
those----
    Senator Blumenthal. My understanding is that the work has 
been finished, and that it is under review. Can you tell me why 
it hasn't been made available to the father of the young man 
who lost his life?
    Mr. Cisneros. Senator, I can't do that right now. I don't--
I haven't seen the report myself.
    Senator Blumenthal. Can you look into it?
    Mr. Cisneros. We can see what we can do. We can take that 
for the record. But I believe, again, that would be a better 
question for the Navy as to where they are with that report and 
what are they looking into.
    Senator Blumenthal. They say it is under review. We are 
coming up on the 1-year anniversary of his death, April 15, and 
for all you have said about your paying attention to this issue 
of mental health--by the way, these three sailors are not the 
only ones.
    There have been other suicides on other ships similarly 
situated in home ports for repair or maintenance. This is a 
specific kind of circumstance where you are losing life in real 
time. So, to wait a year for a report makes no sense.
    Mr. Cisneros. Senator, look, any loss of life through 
suicide or any--through any means is a terrible tragedy, and it 
does weigh heavily on our military family. But I am sorry that 
I don't have the answers for you why that report is still under 
review. Again, we can take that for the record and try and get 
you a better answer.
    Senator Blumenthal. Well, my time is over and I just want 
to ask you to commit that you will provide someone to meet with 
John Sander, who lost his son to suicide on the USS Washington 
when he comes down because I am going to invite him down and I 
want him to be able to meet someone from the Department of 
Defense. Will you make someone available?
    Mr. Cisneros. Senator, we will try and see what we can do 
to make some available to meet the individual.
    Senator Blumenthal. Ok. Thank you.
    Senator Warren. Thank you. Senator Kelly.
    Senator Kelly. Thank you, Madam Chair. Secretary Cisneros, 
good to see you. Thank you for being here. Last year, we 
discussed the implementation of section 704 of the NDAA we 
passed in 2021, otherwise known as the Brandon Act, which 
improves the ability of servicemembers to quickly obtain mental 
health care.
    It also reduces stigma and provides needed training. The 
Brandon Act is named for fallen United States Navy Petty 
Officer Third Class Brandon Caserta, of Peoria, Arizona. He was 
a dedicated young sailor. He did all the right things as he was 
trying to deal with his mental health issues.
    He suffered some significant mental health problems. He was 
discouraged and ridiculed, and then tragically took his own 
life. Now, I have been working closely with Brandon's parents, 
Terry and Patrick, on this issue. They were in my office just 
about a week ago, and we share serious concerns about the 
suicide epidemic, as does Senator Blumenthal and Senator 
Sullivan, and I am sure everybody on this Committee.
    We need to use every tool that we have to fight this 
challenge, and one of those tools is the Brandon Act that was 
in the defense bill last year. So now I know we have spoken 
about this before, but I am concerned there haven't been 
visible signs of progress on implementing the Brandon Act.
    I have raised this with you and Service Secretaries in the 
past. Last year I added to the defense bill a requirement for a 
formal progress report on DOD's implementation efforts. That 
was due on March 1st. I think today is the 15th. So, Secretary 
Cisneros, why has the Committee not yet received your 
implementation report as required by the defense bill? Are 
there any updates that you can provide to me today about what 
actions the Department is taking to implement the requirements 
of the Brandon Act?
    Senator Warren. Senator, thank you for that question, and 
as, you know, we stated earlier, any death by suicide is 
definitely a tragedy and it really does weigh heavily on our 
military family. We are trying to make improvements.
    Congress is really kind of given the stability with the 
Suicide Prevention and Independent Review Commission that we 
were able to complete at the end of last year. We can have Ms. 
Foster kind of talk about that a little bit, if you would like, 
but we are making progress on the Brandon Act.
    To do that, and to talk about it I will turn over to Dr. 
Martinez Lopez who can kind of give you an update on that, sir.
    Mr. Martinez-Lopez. Senator, thank you for the question. We 
need to honor Brandon Caserta. There is no question about that, 
and the best way to honor is through you putting into effect 
the law.
    I am new at the job, been there for 3 weeks, but I can tell 
you that the long pole on the tent was the issue of the law 
brought everybody, including the individual ready reserve, that 
have no command and control, so we were trying to figure out 
how to implement the law, including all the servicemembers.
    What I recommended, and I think we are moving forward, what 
we are going to do first is going to break the Active Duty and 
let's go. We move in that axis right away. Then as we come out 
with a solution set for the Reserve components, those have a 
command structure next, and then the IRR [Individual Ready 
Reserve], because there are issues of care and there is a lot 
of--so we are moving, and I guess----
    Senator Kelly. Mr. Secretary, you are talking about how the 
Brandon Act will be implemented.
    Mr. Martinez-Lopez. Yes, sir.
    Senator Kelly. But my first question was, we were supposed 
to get a progress report on the implementation. That certainly 
could be what you said here, could have been in the progress 
report. We were supposed to receive that on March 1st. We are 
now 2 weeks past that. We have not received it. So, when could 
we expect the report on the progress of the implementation?
    Mr. Martinez-Lopez. Senator, we talked--we started talking 
to the staff. Hopefully very soon, in the next month or so you 
are going to see the report coming to you of how we--hopefully 
before that, of how we are implementing the Act. But I just 
gave you the kind of the scope of how we are approaching it.
    Senator Kelly. So, in a month or two, we could expect the 
progress report on the implementation.
    Mr. Martinez-Lopez. Yes, sir.
    Senator Kelly. All right. You talked a little bit about the 
implementation. So, I am interested in seeing that and in 
detail, about what are we doing to make sure that what we 
passed in legislation, how it is going to be implemented. 
Anything else you might need from us, you could add that as 
well.
    Because this is such a serious issue. I mean, it is not 
only in the Navy. I mean in DOD, this is a major problem. It is 
affecting readiness, but that is not the reason to do it. I 
mean, the reason to implement this is it is the right thing to 
do and it will save people's lives. So, thank you.
    Senator Warren. Thank you. Senator Kaine.
    Senator Kaine. Thank you, Madam Chair, Ranking Member 
Scott, and to the witnesses for being here. I just want to pick 
up on Senator Kelly's on the Brandon Act, because this occurred 
in Virginia.
    I have also met with the Casertas, and just, you know, to 
put a really fine point on this. They have lost their child 
under unimaginably horrific circumstances. They are turning 
that grief into an effort to try to do something to help 
others. If we pass a law but do not implement it, it is a 
revictimization of a family that doesn't deserve to be 
revictimized.
    They will view that as yet another pain that they are 
suffering at the hands of the United States military. So, this 
needs to be done because we have a significant challenge, and I 
am going to get into another dimension of this. But it also 
needs to be done so that a family that has already suffered 
doesn't suffer more.
    I just echo what Senator Kelly said. We need to see that 
report about implementation. We need to see it soon. We need to 
understand that this is not some box checking thing that people 
are doing just to appease us, but you are doing it to meet a 
need that is a very significant one.
    I have recently had two strings of really difficult 
suicides within the Navy in Hampton Roads, Virginia. So just in 
one community. Sailors aboard the George Washington who trained 
for an MOS [Military Occupational Specialty] and thought they 
would be doing something, but instead because the George 
Washington has been in this limited duty status for so long, 
many of them are there and will have their whole career while 
the ship is getting refurbished, not doing what they thought 
they might do.
    A sense of purposelessness can grow. That can exacerbate 
other challenges. The living situations for folks when their 
ships are in dry dock getting refurb aren't necessarily the 
best. Then we had 4 suicides within a space of 5 weeks, with 
sailors who had been assigned to the Mid-Atlantic Regional 
Maintenance Center in Norfolk.
    This is a center, one of seven or eight in the United 
States that they are kind of like MacGyver. It is a really 
great mission where they take things, off ships and subs that 
are busted. Instead of paying millions to do something new, 
they can figure out a way to fix it and get it back on.
    It is an important mission, but it is very unusual in the 
way it has been composed. Of the 2,500 people who work at MARMC 
[Mid Atlantic Regional Maintenance Center], half are civilians 
who are under contract. They know how long they are going to be 
there. Half are sailors. Of the sailors, half have been 
assigned to the mission, but half were assigned there under a 
limited duty status.
    Maybe they were pregnant, maybe they broke a bone, maybe 
they had a disciplinary issue, and so, they were pulled out of 
the fleet and assigned there. Most of that, nearly 600 people 
in the limited duty status at MARMC, they have no idea when 
they are going back to the fleet. They may be in a med board 
process that is completely opaque and they don't have a sense 
of when it will be over.
    That then builds up some sense of purposelessness when you 
don't know what your next step is and you don't know when you 
will know, you are not only don't know, but you don't know when 
you will know, then that can also contribute to significant 
mental health challenges. That is why, no surprise, those four 
suicides in this workforce of 2,500. It wasn't civilians.
    It wasn't the sailors that were assigned there for a 
traditional tour. It was all people within this limited duty 
population who were living in a world of kind of big question 
mark about what would happen to them.
    So, I guess I would like to ask particularly to being with 
the Navy, when we have members of the armed services who were 
assigned into limited duty status, what can we do to make sure 
that they have the support they need while they are in that 
status?
    Because there were no embedded mental health professionals 
in this workforce of 2,500, even though 600 of them were on a 
limited duty status, each one different from the next, each one 
with a lot of questions about their future. What can we do with 
our limited duty to provide them the services they need?
    Mr. Cisneros. Senator, thank you for that, and again, as 
the Secretary says all the time, mental health is health, and 
we want to ensure that we are taking care of our servicemembers 
that have needs.
    I will turn it over to Dr. Martinez Lopez here. But, any 
servicemember that needs to see a physician can always go and 
talk. It is not just whether it is the people that need to seek 
mental health, right.
    We have counselors for people who are having financial 
problems, if they are having relationship problem, the 
individuals are there for them to go in to talk to. But I will 
turn it over to Dr. Martinez Lopez specifically to talk about 
the mental health and what individuals need to do in order to 
seek help.
    Mr. Martinez-Lopez. Senator, very good question. I think we 
are taking the approach of the public health approach, and you 
are right on target, which is it is not a medical issue, it is 
a poly health. We all play. The Commander plays. There are 
financial issues, social issues. There are medical issues.
    We need to address all of those. Think about it like a 
rucksack that has a lot of stuff that is heavy and we need to 
figure out how to level that rucksack. So, if there is a 
financial thing that we can do to help that sailor, that is one 
thing. If there is a social, family issue that we can help them 
with, let's go and relieve that.
    If it is a legal issue that they are dealing with, let's go 
and try to--and by doing that, we decrease the risk, you know, 
of that sailors, soldiers--sailor, airmen, marine or guardian, 
from--that is part of the equation to this conundrum.
    So, I think we are on the right track in that respect. A 
lot of work to be done, a lot of education. It is a never-
ending process. But I am confident that we need to keep sailing 
in that direction and trying to make head ways.
    Senator Warren. Right. Thank you.
    Senator Kaine. Thank you. Thank you, Madam Chair.
    Senator Warren. Thank you. I think our ranking member has a 
comment.
    Senator Scott. Well, first off, I want to--Senator 
Duckworth. Senator Budd, and I think Senator Kelly, I mean, 
they all asked things--they would like to be more responsive, 
so I hope you guys will do your best to be more responsive. The 
other thing is, we go through the National Defense 
Authorization Act.
    We are just trying to get stuff in there every year, and 
some of it are reports. If you are not going to get a report on 
time, I mean, I think the first thing you probably ought to do 
is tell us, and tell us why. Because we are not doing it 
because we don't care. We are doing it because we care.
    So, I think if you are not going get a report, I would 
like--I mean, I think all of us would like to know it. I think 
this Committee is going to actually work to try to figure out 
how we have--people want to serve. So, and I let me--I went 
through what Senator Kaine was talking about in dry dock.
    I was in dry dock. My ship was in dry dock, and it is 
boring. It is really boring and it seems like there ought to be 
a way to send people to training and do things like that rather 
than just--we just sat around and did nothing. It wasn't like 
the ship was at risk. I mean, we are in a dry dock area.
    Nobody could get there. So, they didn't need us to show up 
and hold a gun every so often. So, but thanks, everybody for--
--
    Senator Warren. So, I agree. I really want to associate 
myself with the remarks. It is very frustrating when we get 
things into NDAA that is something we have all worked on to 
make it happen, and then we don't get answers, that is a real 
problem for all of us.
    So, the commitment specifically that Senator Duckworth has 
extracted and that others have asked for, regard that as 
something the whole Committee is behind and we expect her to 
get her answers in a timely fashion.
    We are going to do a second round with this panel, for 
those of us who want to do a second round of questions, I want 
to do a second round. Are you good?
    Senator Scott. I am good.
    Senator Warren. You are good, you are good, and I think, 
Senator Duckworth. So, we have got two more rounds and then we 
will go to the second panel that we have got here. So, the U.S. 
military should have the best doctors in the entire world.
    In a crisis, these are the medical professionals who are on 
the front lines. But unlike doctors who are at a really busy 
place like Mass General or Boston Medical Center, military 
doctors don't have a constant stream of servicemembers with 
serious injuries coming in the front door.
    Now, it is a good thing that fewer servicemembers are 
suffering serious injury, but it is also a problem for the 
doctors because it means they get less practice stitching 
people up or setting broken bones or doing emergency surgery to 
repair gunshot wounds.
    One of the keyways that military doctors and surgeons 
maintain their skills is by treating civilians at military 
treatment facilities, or MTFs. Now, Dr. Martinez Lopez, how 
does DOD benefit from treating civilian patients?
    Mr. Martinez-Lopez. Thank you very much, Senator. That is 
extremely important to us. A way--you know, from the standpoint 
of readiness, we need to keep all the docs and all nurses. It 
is not just the docs.
    It is a whole team that has to be sharp. By taking care of 
civilians, we do two things. One is the readiness piece, but 
also the good neighbor piece. I mean, like in San Antonio, if 
there is an emergency and they show up in our doorsteps, we 
have the good neighbor responsibility to provide good care to 
them too.
    But so, we need to, as you said, we need to bring about 
more patients, especially trauma patients. San Antonio is a 
perfect place where we do world class burn care and also trauma 
care, and hopefully we never have to use those abroad, but if 
we do, our team will be ready to deploy and do that, right. 
So----
    Senator Warren. Good. So, we want you to be sharp, and we 
want to have the chance to train as a team on an ongoing basis. 
We want you to be able to be designated as trauma centers 
because your level is that high in terms of your practice.
    In other words, treating civilians, for the military to 
treat civilians is supposed to be a win-win. The civilian 
patient gets world class care and military doctors stay up to 
date on their skills. It is not working out so well for 
patients.
    Most of them are dropped off at the MTF in an ambulance 
because they need emergency treatment, and the MTF is the best 
closest option. Two-thirds of civilians who end up at an MTF 
care do not have any insurance. The military treatment facility 
sticks these patients with massive bills.
    If the cost isn't waived, Federal law requires aggressive 
debt collection, including garnishing patients' wages or 
seizing tax refunds, or even taking 15 percent of their Social 
Security checks before it even reaches their pockets. Now, the 
good news is the DOD now has authority to waive these debts.
    Dr. Martinez Lopez, over the last 5 years, military 
treatment facilities treated almost 30,000 civilian emergency 
patients. For how many of those 30,000 patients did DOD 
exercise its authority to waive civilian medical debt, keeping 
in mind two-thirds of these folks do not have insurance.
    Mr. Martinez-Lopez. Ma'am, a very small number. I think 57.
    Senator Warren. Fifty-seven. That is exactly right, 57 
times DOD waived medical debt out of 30,000 people who came in 
and incurred these debts. You know, so DOD is actually waiving 
debt, I tried to work this out, in about 0.2 percent of the 
cases.
    Now, DOD claimed that their number is low because waiver 
authority was too narrow. That the debt could only be waived if 
there was, ``direct and compelling relationship to a priority 
DOD objective,'' not just that someone can't pay. So, to 
address this problem, Representative Castro and I got an 
amendment into the 2021 NDAA, some of you remember this, to 
expand DOD's authority to waive medical bills.
    Our changes clarified that if medical treatment for 
civilians will enhance military medical readiness overall, and 
if the patient is unable to pay, DOD has legal authority just 
to tear up the bill. Dr. Martinez Lopez, how often has DOD 
exercised this expanded authority to waive costs for civilians 
when the treatment will enhance readiness and the patient is 
unable to pay?
    Mr. Martinez-Lopez. Ma'am, I don't know for sure, but I 
don't think we have done many, if any.
    Senator Warren. Yes, so it kind of looks like it is zero 
right now. Look, DOD is dragging its feet on--while these 
patients are toppling into financial ruin. The GAO [Government 
Accountability Office] also found that DOD wasn't telling 
patients that they had an option for relief, as required by 
DOD's own regulations, and they weren't properly tracking 
people when they had or had not paid their bills.
    So, Dr. Martinez Lopez, on this new notion that we are 
really going to start holding people accountable in this 
Committee, can I have your commitment that you are going to 
clean this up, start wiping out medical debts for civilians who 
shouldn't have been hit with those devastating bills to begin 
with, and you are going to get back to me on this?
    Mr. Martinez-Lopez. Senator, I don't want to put more 
burden, and my colleagues are in the same boat, on patients 
that already have been traumatized. That is not what we are in. 
I mean--and worse, they cannot even pay. So why do we want to 
keep adding insult to many of those? So, we thank you for this 
waiver.
    As I understand right now, we are talking to a rulemaking. 
I will try to figure out how can I expedite that rulemaking to 
give the solution set that you want and we want. So, I commit 
that I will work hard to get through the process in DOD and 
start affecting in a nice way the patients that we care for.
    Senator Warren. I understand your heart is in the right 
place. I am not quarreling with your heart. I got to have your 
actions in the right place. So, I am going to ask for the same 
thing that Senator Duckworth asked for.
    Can you get back to me in 4 weeks and at least lay out what 
the plan is to make certain that patients are fully informed 
about the opportunity to have their debts wiped out, and what 
DOD's plan is to implement what we all work to put into the law 
in 2021?
    Mr. Martinez-Lopez. I will get back to you, ma'am.
    Senator Warren. Four weeks, just to tell me what the plan 
is. I am not even asking you for the final report. I am--just 
tell me what the plan is.
    Mr. Martinez-Lopez. I will be glad to talk to your staff or 
yourself in 4 weeks.
    Senator Warren. Okay, we got it. Secretary Duckworth. I am 
sorry, Senator Duckworth.
    [Laughter.]
    Senator Duckworth. Old job, Assistant Secretary of the VA--
old job.
    [Laughter.]
    Senator Duckworth. Thank you, Madam Chair. Gentlemen, 
servicemembers commit their lives to defend our country, and 
they should not struggle to feed their families. Yet in July 
2022, the DOD released an updated report that found that 24 
percent of all Active Duty servicemembers experienced some 
level of food insecurity in 2020 and 2021, with our junior 
enlisted facing the highest risk.
    That is why I introduced a bipartisan Military Family 
Nutrition Access Act last month. This bill eliminates basic 
allowance for housing from income calculations under the SNAP 
program.
    So right now, if you apply for SNAP, they count your BAH 
[Basic Allowance for Housing] as income, even though other 
programs like Medicaid and the IRS [Internal Revenue Service] 
doesn't consider your BAH to be income. By using an already 
established nutrition assistance program and simply updating 
the treatment of BAH so it is in line with other Federal 
assistance programs, we will expand nutrition access to more 
military families so that they can qualify for SNAP benefits.
    Undersecretary Cisneros, Assistant Secretary Skelly, do you 
consider food insecurity and a lack of access to nutrition 
among a significant percentage of military families to be a 
readiness issue? Remember, your own report is at 24 percent.
    Mr. Cisneros. Secretary, I think food insecurity is 
definitely an issue, and it is something that we are working 
hard to help resolve them. You know, the Secretary put out a 
series of memos kind of addressing different things about 
taking care of our people. One of them was around food 
insecurity, and it was about kind of really trying to provide.
    You know, while the research that we have kind of shows 
that where a lot of those happens is when PCS happens, 
servicemembers are--their families that have to move. The 
spouse usually has to give up a job.
    That puts a burden or puts a financial strain on the 
families and kind of makes the food insecurity--or maybe they 
are not getting good quality, healthy food all the time there 
until they are able to get new employment. But this is 
something that we are working on.
    We are working to try and ensure that spouses have access 
to employment, whether it be through just being able to 
transfer, if they have a job within DOD, or other Federal 
Government agencies and being able to remote work or telework 
or partnering with over 600 companies that have made a 
commitment to hiring spouses as well to relieve some of the 
strain.
    But, we definitely see it as an impact and as an issue, 
when families do have struggle to help provide their families 
with healthy meals.
    Senator Duckworth. Would you support increasing greater 
access to SNAP benefits for military families, as would be 
granted by my Act? Basically, that says for when you apply for 
SNAP, SNAP should not consider BAH as income because no other 
part of Federal Government does either.
    Mr. Cisneros. Ma'am, it sounds very interesting, but I 
would have to look at the legislation in your proposal before 
we make any commitment to that.
    Senator Duckworth. Okay. Well, we will get you to that in 
less than 6 months. My next question, Assistant Secretary 
Martinez Lopez, I know that you have only been in your seat for 
a short time. Welcome. I led a CODEL [Congressional Delegation] 
to Japan and Indonesia last month to discuss a wide range of 
issues with our partners, including energy security, economic 
engagement, and people to people academic exchanges. However, 
while I was in Japan, I heard from DOD civilians about the 
struggles that they are now facing accessing health care due to 
a rules change at their local military treatment facilities. 
What is being done by your office to resolve these issues in 
Japan?
    Mr. Martinez-Lopez. Senator, thank you very much. I think 
the health care of not only the servicemembers and their 
families is important, also the civilians that help us is a 
team. I think we have grown that piece of the team larger and 
larger not only overseas but giving more opportunities to 
civilians to help us.
    We have been compensated along. The MTFs are just--the 
force structure is just to take care of the Active dUty and the 
family members. So, what we do is we increase efficiencies of 
those clinics to see--create space available to then see the 
civilians. We haven't changed the policy.
    It is the same policy that has been standing for many 
years. So, what we have done is we increased it--we are working 
hard to increase the efficiency of those clinics, so more space 
available will be for the civilian. But that is just a Band-
Aid.
    Senator Duckworth. Well, but what I heard from them is 
actually the opposite, that they have recently--that they were 
being seen at the facilities and the facilities that actually 
turn around and said, no, we are not going to see you anymore, 
you go on into the economy in Tokyo and find your own doctors.
    Not that they are not great doctors in Tokyo, but frankly, 
with language and capacities, they are now no longer being able 
to access health care.
    Mr. Cisneros. Ma'am, Senator, if I may, I went to Japan 
recently. I did five town halls. I heard both in mainland Japan 
and Okinawa talking about this issue. As Dr. Martinez has 
stated, right, that our policy hasn't changed.
    The civilians and the contractors have always been seen on 
a space available basis. What we had done was we had sent out a 
message through the DHA, the Defense Health Agency, is because 
we were hearing that from our servicemembers and from their 
families is that they were having trouble getting appointments 
and they are our top priority there.
    But what we have done, as Dr. Martinez stated, is we have 
asked the MTFs there in Japan to maximize their efficiencies, 
to open up, make more appointments available so that those that 
are seen on a space available will have more of a chance to go 
and to get that access and to get that health care as well.
    Senator Duckworth. Will you be doing this around the world 
for all of our duty civilians?
    Mr. Cisneros. It is--we are looking at--I think Japan is, 
what we learned, is very unique. The cultural differences there 
is, the way they provide health care as to what we are used for 
is definitely different. The language barrier creates a big--it 
is a big challenge there.
    But it is something that we are looking at. My deputy was 
just recently in Germany, kind of looking at some of the same 
issues. But the space available is everywhere throughout, you 
know--that is everywhere throughout the Department of Defense. 
It is not just specific to Japan.
    But we are working to go and increase, and to see what we 
can do to provide other opportunities, whether it is providing 
like a clinic through AVs that could see patients, or 
partnering with an organization like we do with our defense, 
with our servicemembers.
    Make an organization available that will help them seek the 
health care that they need out in their community like we do 
for our servicemembers when we don't have access to that type 
of health care, and they need a certain type of health care and 
we just can't provide it at that location.
    Senator Duckworth. Could you have your point----
    Senator Warren. We need to wrap this up, if we can. Okay, 
thank you. Thank you. I appreciate all of you being here, Ms. 
Foster, Secretary Skelly, appreciate your being here even 
though any questions didn't come to you. The first panel is 
excused, and we would like to bring up the second panel, 
please.
    Everybody ready? Good. Thank you all for being here. So, 
our second panel consists of Assistant Secretaries of the 
military departments for Manpower and Reserve Affairs. Each of 
our witnesses is going to do a brief opening statement, I 
believe.
    Can I start with you, Ms. Schaefer, Assistant Secretary of 
the Army. Are you ready?
    Dr. Schaefer. I am.
    Senator Warren. Good.

    STATEMENT OF THE HONORABLE AGNES G. SCHAEFER, ASSISTANT 
     SECRETARY OF THE ARMY FOR MANPOWER AND RESERVE AFFAIRS

    Dr. Schaefer. Chairwoman Warren, Ranking Member Scott, 
Distinguished Members of this Subcommittee, thank you for the 
opportunity to appear before you on behalf of the men and women 
of the United States Army.
    At the end of the summer of 2022, the Senate confirmed me 
to be the Assistant Secretary of the Army for Manpower and 
Reserve Affairs, and I joined an amazing Army team that works 
tirelessly every day to improve the lives of our soldiers, 
civilians, and families.
    I bring both deep and broad expertise to my current 
position, as well as a renewed emphasis on leveraging data and 
analysis to assess the effectiveness of our policies and 
programs, to better target our resources in alignment with the 
Secretary of the Army's main six objectives.
    Between my previous position as a Senior Advisor to the 
current Deputy Secretary of Defense, and my 16 years at RAND 
supporting the Department of Defense through research and 
analysis, my focus every day for years has been on improving 
our Army's readiness to meet the objectives of our national 
security strategy, and to improve the lives of our Active and 
Reserve component members and their families.
    In my current role, these continue to be my focus in the 
service of our soldiers, civilians, and their families. My 
three priorities are readiness, including quality of life and 
prevention of harmful behaviors, manning the Army of 2030, and 
the strategic modernization of our personnel, policies, 
processes, and systems across the entire spectrum of our Army 
people strategy.
    Readiness ensures that we have the ability to project 
combat power whenever, wherever it is required. Manning the 
Army of 2030 requires not only the new weapons systems and 
doctrines to succeed in the future of warfare, but also the 
people who have the appropriate skills and competencies for 
tomorrow, not just today.
    Strategic modernization includes how we recruit and hire, 
how we grow, employ, and manage talent, and how we create a 
workplace culture that enables people to thrive and want to 
expand their careers in the Army. The Army's mission remains 
unchanged, to fight and win our Nation's wars.
    We are building the Army of 2030, and in doing so, taking 
care of our people because they are the foundation of our great 
Army and our No. 1 priority. The future of multi-domain 
operations requires highly trained, agile, and resilient 
personnel across the total force.
    Active guard, Reserve, and civilians, people perform the 
best when they are part of cohesive teams founded on treating 
everyone with dignity and respect.
    All of the Army's personnel programs and initiatives are 
focused on this because we lead with our values, and in doing 
so is essential to the readiness required to accomplish our 
mission.
    Chairwoman, Ranking Member, and Members of the 
Subcommittee, thank you for your unwavering bipartisan support 
of our outstanding soldiers, civilians, and their families. I 
look forward to our discussion on our questions today, as well 
as continuing this conversation in the future.
    [The prepared statement of Dr. Schaefer follows:]

            Prepared Statement by Dr. Agnes Gereben Schaefer
    Chairwoman Warren, Ranking Member Scott, Distinguished Members of 
this Subcommittee, thank you for the opportunity to appear before you 
on behalf of the men and women of the United States Army.
    At the end of December 2022, the Senate confirmed me to be the 
Assistant Secretary of the Army for Manpower & Reserve Affairs and I 
joined an amazing Army team that works tirelessly every day to improve 
the lives of our Army soldiers, civilians, and their families. I bring 
both deep and broad expertise to my current position, as well as a 
renewed emphasis on leveraging data and analysis to assess the 
effectiveness of our policies and programs to better target our 
resources, in alignment with the Secretary's second objective. Between 
my positions in the Deputy Secretary of Defense office, my research at 
RAND, my focus every day for years has been on improving our military's 
readiness to meet the objectives of our national security strategy, and 
to improve the lives of our Active and Reserve component members and 
their families.
    In my current role, these continue to be my focus in service of our 
soldiers, civilians, and their families. In addition, my overarching 
priority is the strategic modernization of our personnel policies, 
processes and systems. This includes the modernization of policies, 
processes and systems across the entire spectrum of our Army People 
Strategy (Acquire, Develop, Employ and Retain), including how we 
recruit and hire; how we grow, employ and manage talent; and how we 
create a workplace culture that allows people to thrive and want to 
expand their careers in the Army. It also includes prioritizing cross-
cutting issues such as increased permeability across the Total Force; 
increased flexibility in talent management and career opportunities; 
and better matching of individuals' competencies with civilian and 
military career fields.
    While we undoubtedly need to maintain our focus on some immediate 
issues and concerns, we cannot afford to lose sight of longer-term 
strategic policies, processes, and systems that will enable us to 
recruit the competencies and skill sets necessary to build the future 
Army, maintain healthy career pipelines over the long-term, and ensure 
both immediate and longer-term readiness in the face of increasingly 
varied and complex challenges.
    The Army's mission remains unchanged, to fight and win our Nation's 
wars. We are building the Army of 2030 and in doing so, taking care of 
our people because they are the foundation. The Army of 2030 requires 
highly trained, resilient, and healthy teammates across the Total 
Force--Active, Guard, Reserve, and Civilians. People perform their best 
when they are part of cohesive teams founded on treating others with 
dignity and respect. Therefore, the Army's No. 1 priority is our 
people--our soldiers, Army civilians, families, and veteran soldiers 
for life. All the Army's personnel programs and initiatives are focused 
on taking care of our people, because we lead with our values, and 
doing so is essential to the readiness required to accomplish our 
mission.
                       building the army of 2030
    The Army of 2030 will provide the Joint Force with trained and 
ready forces capable of combined arms maneuver in a multi-domain 
operating environment. Building the Army of 2030 while maintaining 
readiness, depends on a quality all-volunteer force. The Army is taking 
active measures to overcome unprecedented recruiting challenges without 
compromising standards. We will continue to develop and implement 
innovative ideas to identify high quality recruits and investing in the 
youth of America.
Military Accessions
    Investing in the Army of 2030 requires investing in our youth and 
helping them realize their full potential. In fiscal year 2022, the 
Army enlisted 44,901 recruits in the Active Component (AC), 24,829 
recruits in the Army National Guard (ARNG), and 9,095 recruits in the 
United States Army Reserve (USAR). As of February 27, 2023, the AC 
achieved more than 25 percent of its fiscal year 2023 recruiting 
mission of 65,500. The ARNG achieved more than 38 percent of its fiscal 
year 2023 recruiting mission of 30,880. The USAR achieved more than 23 
percent of its recruiting mission of 14,650.
    The recruiting challenges facing the Army are not new, and are not 
based on a single cause. Several of the trends we are observing and 
responding to are years in the making. We are in an intense competition 
for talent. Some of the benefits that long set the Army apart from the 
private sector, are becoming more common. Pandemic-specific challenges 
also changed the recruiting environment, and young Americans' 
perception of work. The Army is addressing each of these challenges 
head-on.
    For instance, the Future Soldier Preparatory Course (FSPC) is an 
investment in America's youth. FSPC is a holistic program that assists 
potential recruits meet either the physical or academic aptitude 
standards to fully qualify for Army service. In fiscal year 2023, as of 
the 8 March, 6,883 trainees have enrolled in both the academic and 
fitness components of FSPC. Of those, 4,784 graduated and moved on to 
Basic Combat Training (BCT) with an average Armed Forces Qualification 
Test score improvement of 19.4 points. Within the fitness component of 
FSPC, the average weekly body fat loss is 1.5 percent. Across both the 
physical and academic components, 130 soldiers graduated Advanced 
Individual Training as of 8 March 2023.
    We are also investing in our recruiters by selecting recruiters 
differently, improving their training, increasing their resources, and 
educating their families on those resources available to them. Other 
initiatives to improve our recruiting efforts include the development 
of the Soldier Referral Program to provide an opportunity for soldiers 
in the Active Army, USAR, and ARNG to connect with youth where they 
are, share their Army story, and be rewarded when referred recruit join 
the Army. In January 2023, the Army began the Recruiter Production 
Incentive--Assignment Incentive Pay to incentivize recruiters to exceed 
their quarterly recruiting mission. This new program earns the 
recruiter financial incentive for different categories of recruits 
brought in above the mission.
    The Army is also carefully monitoring, and, adjusting incentives to 
position itself as a highly desirable employer of choice. We are 
adjusting enlistment bonuses to help recruit into critical skills 
specialties. Recruits can combine multiple enlistment bonuses and can 
combine up to four different incentives. Training of choice and station 
of choice remain the most popular incentives.
Civilian Workforce Recruiting
    Our civilian workforce is a force multiplier across the Total Army 
and our investments into its capabilities are crucial for meeting the 
needs of the Army of 2030. The Army has implemented several initiatives 
to reduce civilian time-to-hire in support of the former Secretary of 
Defense's fiscal year 2025 hiring goal of 45 days. The Civilian 
Implementation Plan within the Army People Strategy places specific 
emphasis and focus on reducing time-to-hire to ensure the Army is 
competitive for top talent with other employers. A multi-year strategy 
to execute tasks supporting the Civilian Implementation Plan is in 
progress. These efforts will assess hiring quality, leverage Office of 
Personnel Management resources, and optimize Civilian Human Resources 
Agency and Command civilian hiring operations. As our multi-year 
strategy to reduce the time to hire matures, we expect to achieve 
consistent reductions in the time it takes to hire civilian personnel.
Marketing
    The Army is about possibilities and investing in oneself for a 
better life. The Army offers 178 career fields as options for recruits, 
and Army Marketing is laser-focused on re-introducing the Army to 
America's youth. Our research informs us that potential recruits have 
gaps in knowledge about what Army service can offer, trouble 
identifying with service culture and lifestyle, and diminished trust 
that they will be treated fairly. However, the top concerns amongst the 
audience of potential recruits continue to be that serving in the Army 
will either delay or put them off-track from their life goals, and that 
they will be separated from friends and family.
    The Secretary of the Army and the Chief of Staff of the Army have 
just announced the Army's first new brand refresh effort since ``Army 
Strong'' nearly 20 years ago. This new effort was the culmination of 2 
years of research and preparation to bring the Army back to relevancy 
in the minds of Generation Z and others. The Army conducted extensive 
research among prospects and our important stakeholder audiences and 
influencers before deciding on the elements of this brand refresh, 
which include a modernized logo and the tagline ``Be All You Can Be.'' 
While this tagline is very popular amongst our veterans, it was not 
chosen for the sake of nostalgia; it was chosen because testing amongst 
our target audience and others revealed it to be the most favored and 
best suited for communicating the possibilities available with service 
in the Army and the purpose and passions of our potential recruits. 
This concept of possibilities addresses one of the highest barriers to 
entry of putting life on hold. Elements of this campaign are now in 
market and events like the Men's and Women's NCAA Basketball 
tournaments, with more planned this fiscal year.
                       taking care of our people
    For the Army, ``People First'' means we develop and implement 
programs designed to keep our people safe and provide them with the 
quality of life they deserve. It also means we foster positive command 
and organizational climates and culture which enables the formation of 
cohesive teams. Positive climate and culture, plus cohesive teams, 
reduce harmful behaviors, and allows our men and women to focus on 
training to achieve their assigned missions. This equation achieves 
readiness.
Quality of Life
    Investments in our people are directly correlated to the quality of 
life that we provide for them. Quality of life remains a cornerstone of 
the Army's People Strategy. These programs support and enhance 
readiness, recruitment, and retention by providing a positive 
experience for soldiers and families, including, well-maintained 
barracks and housing; quality, affordable childcare, and youth services 
programs; and meaningful employment and educational opportunities for 
spouses.
Barracks and Housing
    Improving barracks and housing for our soldiers and families is a 
top priority for all Army senior leaders. The Tenant Bill of Rights 
helps us rebuild trust, ensure a positive living experience for 
military members and their families and increase their negotiating 
power with the Military Housing Privatization Initiative companies. We 
have fully implemented all 18 tenant rights at our 44 Army 
installations with privatized housing. We are committed to improving 
through the annual Tenant Satisfaction Surveys, which have enhanced our 
communication with residents, helped us create and prioritize action 
plans, and corrected deficiencies. We are improving other systems and 
processes including completing third-party inspections of privatized 
family homes; implementing a Housing Environmental Hazard Response 
Registry for those living in privatized or government-owned/leased 
housing; hiring engineer technicians to provide quality assurance and 
implementing a Housing Certificate Program to build a skilled 
workforce.
Childcare
    Childcare is a readiness issue. Our soldiers and their families 
must have peace of mind as they start and end the day in service to our 
Nation. We appreciate Congress funding seven of the Army's priority 
childcare centers in beginning in fiscal year 2021 (Hawai'i and 
Alaska), then again in fiscal year 2022 (Kansas and Kentucky) and 
recently in fiscal year 2023 (Georgia and Louisiana). These investments 
were crucial in bringing down the wait-list times for our families. We 
are also making significant investment in facilities sustainment, 
restoration, and modernization to ensure that child development centers 
are free of hazards and maintain continuity of service. To recruit and 
retain quality staff, we increased the salary of entry-level direct 
care staff; instituted recruitment bonuses; reduced childcare staff 
fees; and authorized commissary access for staff at 17 pilot locations. 
We also increased the provider rate cap for families who use community-
based childcare when installation care is not available and applied the 
same concept to on-post family childcare (FCC) providers to increase 
the number of FCC homes.
Spouse Employment and Educational Opportunities
    With frequent relocations and soldier deployments, Army spouses 
face distinct challenges in gaining and retaining employment compared 
to their civilian counterparts. We continue to reimburse up to $1,000 
for professional licensing and certification in a new State after a 
Permanent Change of Station move. We appreciate Congress' action taken 
in the fiscal year 2023 National Defense Authorization Act to extend 
the authority for reimbursement. More than 617 reimbursements have been 
paid since the inception of the program in May 2019, totaling more than 
$272,000. We continually promote the Office of the Secretary of Defense 
Spouse Education and Career Opportunities Program's My Career 
Advancement Account scholarship program. The program provides eligible 
spouses with up to $4,000 to pursuit of a license, certification or 
associate degree in any career field to attain the education, 
certifications, or licenses they need to find employment. Finally, we 
are investing in the Employment Readiness Program to help spouses find 
and maintain employment by hiring additional staff across Army 
installations.
                       reducing harmful behaviors
    Our leaders are the first line of defense to combat harmful 
behaviors and care for our soldiers in our formations. Nothing corrodes 
team cohesion and reduces its effectiveness faster and more completely 
than the scourges of sexual harassment and sexual assault, prohibited 
discrimination, harassment, hazing, bullying, domestic violence, or 
suicide. The Army is focused not only on responding to these harmful 
events and providing care and support to victims, but also preventing 
them. To do this, we rely on leaders at all levels to create and 
sustain healthy command climates.
Prevention
    The Integrated Prevention Advisory Group (I-PAG) is a dedicated 
capability for Senior Commanders designed to implement and evaluate 
evidence-based primary prevention activities across the individual, 
relationship, organizational, community, and societal levels. The I-PAG 
consists of individuals with specialized training and experience 
focused on engaging the community; empowering leaders with data and 
research; implementing comprehensive, community-based integrated 
prevention activities; and sustaining progress over time. These 
individuals are responsible for assessing holistic data sets, 
evaluating local policies, planning multiple reinforcing prevention 
activities, and evaluating outcomes. The I-PAG will provide the 
technical expertise necessary to connect the science of prevention and 
the art of command within an optimized prevention system.
Sexual Harassment/Assault Response and Prevention Program (SHARP)
    The harmful behaviors of sexual assault and sexual harassment are 
detrimental to readiness and have no place in our Army. The Army 
continues to take action to reduce harmful behaviors within its ranks, 
with an emphasis on integrated prevention to produce demonstrated 
results.
    Through the Sexual Harassment/Assault Response and Prevention 
(SHARP) program, the Army is committed to enhancing readiness by 
preventing sexual harassment, sexual assault, and associated 
retaliatory behaviors and providing comprehensive victim advocacy and 
response capabilities when such incidents occur.
    All 70 of the Fort Hood Independent Review Committee (FHIRC) 
recommendations have been addressed, and of these, 56 recommendations 
have been implemented Army-wide. An additional 10 recommendations have 
been transferred in support of the Department of Defense's (DoD) 
deliberate and phased implementation of the recommendations of the 
Independent Review Commission on Sexual Assault in the Military (IRC) 
as approved of the Secretary of Defense, and four have been superseded 
by IRC recommendations. We have modified our policies, making it 
mandatory for commanders to initiate separation proceedings for any 
soldier with a substantiated complaint of sexual harassment. The Army 
is also adding 348 full-time SHARP professionals trained and 
experienced to support victims effectively.
Suicide Prevention Program
    Taking care of our people is about building soldiers whose 
commitment to duty is underpinned by strong family relationships, peer 
support and leadership teams. Suicides affect unit cohesion and 
readiness and have no place in our Army. We must find ways to prevent 
harmful behaviors instead of responding to them after they occur. 
Individual soldiers, units and installations are all unique, with their 
own challenges. Suicide prevention programs are, therefore, not one-
size-fits-all. We are working to pair the right resources for the right 
issue to support our soldiers and their families best.
    We resolutely continue our efforts to: enhance leader engagement; 
strengthen individual, unit, and community resilience and 
connectedness; and mitigate stressors that may lead someone to suicide. 
This comprehensive approach focuses on the integration of a variety of 
primary prevention and intervention strategies and activities.
                        ]personnel modernization
    The foundation of Army Readiness is personnel readiness. Programs, 
policies, innovations, and management models are transforming the 
Army's manpower and personnel systems to meet future needs. These 
changes will give our soldiers and civilians more opportunities to 
excel; give our Army the enduring advantage of a transparent, data-rich 
personnel environment; and improve our ability to compete for and 
retain talent.
Talent Management
    The Army must prioritize managing its talent by capturing its 
soldiers' critical talent data (Knowledge, Skills, and Behaviors), 
balanced with the needs of the Army, which is at risk of losing its 
overmatch capabilities to potential adversaries.
    The Command Assessment Program (CAP) improves the Army's ability to 
select the best leaders at the battalion and brigade levels. In 
November 2022, the Army completed the fourth iteration of CAP. Over the 
past 3 years, over 5,000 leaders at lieutenant colonel, colonel, GS-14, 
GS-15, and E-9 levels have assessed through this program. To date, CAP 
has screened out 168 leaders who would have been selected using only 
the pre-2020 system. When compared to the legacy Centralized Selection 
List system, CAP assesses and identifies leaders who are more 
cognitively capable, better written, and verbal communicators, more 
physically fit, more self-aware, and less likely to exhibit 
counterproductive or ineffective leadership traits. The DOD IRC 
recognized CAP as a promising practice for identifying leaders who are 
committed to the well-being of those under their command, and screening 
for leaders who do not show similar commitment.
    The Army Talent Alignment Process (ATAP) is a decentralized, 
regulated market-style hiring system that aligns officers with jobs 
based on preferences shaped by the unique knowledge, skills, and 
behaviors of each officer, and the talents desired by commanders for 
their available positions. To date, 60,000 officers and warrant 
officers have been assigned using the Talent Marketplace. During the 
most recent marketplace cycle (fiscal year 2023) with reportable data, 
69 percent of officers participating in the market obtained a Top 3 
preference while 80 percent of officers obtained a Top 10 preference. 
Talent markets also enable the Army to experiment with monetary and 
non-monetary incentives to fill critical positions and retain talent. 
Monetary incentives have included Selective Retention Bonuses, 
Assignment Incentive Pay, and Special Duty Assignment Pay so the Army 
remains highly competitive with other governmental agencies and private 
industry. Non-monetary incentives such as advanced specialty training, 
stabilization, credentialing, and broadening assignments are also 
available.
    Similar to ATAP, we have begun to implement the Assignment 
Satisfaction Key-Enlisted Module (ASK-EM) to support Active-Duty 
Noncommissioned Officers (NCOs) being considered for Staff Sergeant 
through Master Sergeant (MSG) assignments. On average, 7,000 to 9,000 
NCOs participate in the market each cycle with approximately 30,000 
NCOs receiving their assignments through this process each year. Unlike 
Assignment Incentive Marketplace 2.0, ASK-EM does not allow the unit to 
preference NCOs. In conjunction with Human Resources Command, we are 
working to implement a two-sided market for the MSG population through 
the Integrated Personnel and Pay System--Army (IPPS-A) platform. A 
pilot of this capability is expected by the end of fiscal year 2023.
The Integrated Personnel and Pay System--Army (IPPS-A)
    IPPS-A is the critical enabler for The Army People Strategy. IPPS-A 
is embracing emerging technologies, integrating modern personnel 
management and data analytics capabilities, and aligning with the 
Army's efforts to build a more effective and efficient force. It 
delivers the Total Force a secure, comprehensive, and data-rich human 
resource (HR) talent management system.
    IPPS-A automates H.R. processes and interfaces with 200+ legacy 
H.R. and Pay systems. With the deployment of Release 3, 12 of these 
systems are sunsetting while an additional 11 are partially subsumed. 
Upon full implementation, IPPS-A will fully subsume 32 legacy systems. 
What began nearly 3 years ago when the ARNG became the first component 
to implement IPPS-A is complete with the deployment of Release 3. All 
three components are executing personnel, limited pay, and basic talent 
management functions in IPPS-A seamlessly across the Total Force.
    Work will continue to expand IPPS-A functionality and add 
additional capability through a series of improvements out 2030 and 
beyond. Our H.R. information technology modernization efforts support 
the talent management system we are designing to recruit better, 
retain, and reward the very best personnel essential to sustaining the 
all-volunteer Force. IPPS-A will integrate the new Army global payroll 
system, providing a congressionally mandated fiscal audit capability 
and improved talent management functionality.
                               conclusion
    The men and women in our United States Army serving our Nation, 
both in and out of uniform, along with their families, are our strength 
and legacy. Their talents, courage, and commitment make our Army the 
greatest in the world. To keep our Army strong, we must build our Force 
with individuals who embody the best of America, and offer them 
opportunities that allow their careers and families to flourish. A 
diverse, talented, strong, healthy, and resilient force is the most 
important indicator of our readiness.
    Thank you for your generous and unwavering support of our 
outstanding soldiers, civilians, and their families.

    Senator Warren. Thank you very much. Secretary Parker, 
representing the Navy.
    Senator Scott. Go Navy.
    Senator Warren. That Navy--stop that.
    [Laughter.]
    Senator Warren. I just want to point out, my brothers, Air 
Force, Army, so. We are trying to do the best we can--
[technical problems.] Secretary Parker.

   STATEMENT OF THE HONORABLE FRANKLIN R. PARKER, ASSISTANT 
     SECRETARY OF THE NAVY FOR MANPOWER AND RESERVE AFFAIRS

    Mr. Parker. Thank you. Chairwoman Warren, Ranking Member 
Scott, and Distinguished Members of the Subcommittee, thank you 
for allowing me to join you here today. I am honored by this 
opportunity to appear before you to talk about our Department 
of the Navy, sailors, marines, civilians, and their families.
    As the 2022 National Security Strategy makes clear, we face 
unpredictable threats and global challenges. Our Nation needs a 
strong, well-trained, well-equipped Navy and Marine Corps to 
address the wide array of challenges and threats, and we must 
leverage our talent to retain both our competitive edge and our 
multi-domain dominance.
    The changing strategic landscape demands we maintain and 
strengthen our Nation's maritime dominance so our forces can 
deter, fight, and win against potential adversaries. As an 
integrated team demonstrating talent, capabilities, and 
dedication second to none, together, our sailors, marines, and 
civilians can overcome any challenges they face.
    Our people are our greatest strength and the core to our 
success, both as a military and as a Nation. I am incredibly 
proud of their performance, commitment, and unparalleled 
resilience in the face of the dynamic global challenges that 
have become our present operating environment.
    Our Nation needs a strong, well-trained, well-equipped Navy 
and Marine Corps to address the wide array of challenges and 
threats facing our Nation. To be a combat ready force, we must 
leverage the strengths of all our people.
    Further, because we have an All-Volunteer Force, we must 
ensure that also means our society see value in serving and are 
treated with respect when doing so. In our constantly evolving 
environment, we must continue to invest in mechanisms that 
ensure the services are positioned to meet their recruitment 
goals. However, we do have some challenges.
    The general decrease in propensity to serve and several 
years of the COVID-19 pandemic limited both student attendance 
and recruiter access to schools, making it difficult for our 
recruiters to make and maintain contact with potential 
recruits.
    The Secretary of the Navy is personally involved in 
addressing these challenges. As part of these efforts, we have 
engaged with leadership from the Department of Education for 
support with school access.
    We also contact the principals that have restricted 
recruiters access to their schools. Through these and other 
efforts, we seek to ensure our services have what they need to 
meet their recruiting goals. In addition to recruiting, the 
Navy and Marine Corps team remains committed to retaining the 
right talent and experience, which also complements our 
recruiting efforts.
    We will explore every lever within our authority to 
maximize retention, and we are already seeing positive trends 
in retention rates across both services. Over the course of the 
last year, the Department of the Navy has made significant 
strides to assess how education is delivered to the force and 
modernize our educational objectives.
    Today's Navy and Marine Corps team is one of the most 
technologically advanced ever conceived, able to dominate in 
the air, sea, and undersea. As we become a more technologically 
advanced force, education will be a crucial warfighting 
enabler.
    Through our naval university system, we are creating a 
continuum of learning that develops leaders to serve at every 
level and equips them with skills to maintain and operate 
increasingly complex systems in an ever-changing warfighting 
environment.
    We are well aware of the fundamental link between mental 
health resiliency and the readiness of our force. To that end, 
we are committed to supporting and ensuring the mental health, 
safety, and well-being of all sailors, marines, and Department 
of Navy civilians. Suicide is a national issue to which the 
military services are not immune.
    Given the complexity of this challenge, our Office of Force 
Resiliency has taken a comprehensive approach to holistic, data 
driven suicide prevention efforts that harmonize with the 
defense strategy for suicide prevention.
    We have also taken note of the recently released report 
from the Suicide Prevention Response Independent Review 
Committee and will work within the DOD's coordination framework 
to implement key recommendations. The Department of the Navy is 
committed to eliminating sexual assault within the Navy and 
Marine Corps at every level.
    In addition to the toll brought on individual victims, 
sexual assault directly impacts our cohesion, our unit 
cohesion, and ultimately undercuts our readiness. Sexual 
assault is a persistent challenge that requires a multi-pronged 
approach that leverages a wide range of initiatives, not only 
to address sexual assault but also to prevent it before it 
occurs.
    Secretary Del Toro directed the establishment of an 
implementation advisory panel last spring, bringing the leaders 
of all Department of Navy principal officers to the table to 
implement the recommendations of the Secretary of Defense's 
Independent Review Commission on Sexual Assault.
    Through this effort, the Department of the Navy has made 
significant strides to implement the IRC recommendations, 
though we fully recognize additional work remains. Further, to 
those efforts, we are investing significant resources to fuel 
the necessary changes, and we have made substantial progress in 
standing up a dedicated workforce to prevent harmful behaviors, 
professionalized the response to sexual assault, and best 
support survivor recovery.
    Quality of life issues are critical to our servicemembers 
and their families. The stresses on our spouses and children 
weigh on the minds of our servicemembers, especially when they 
are deployed. By caring for our families, we enable our 
servicemembers to continue their focus on the warfighting 
mission.
    To this end, we have taken action to implement increases in 
parental leave, support spousal licensing and career 
advancement, and expand dependent care support in early 
childhood access.
    Additionally, we are pushing to end food insecurity among 
our most junior sailors and Marines through access to financial 
literacy tools and other forms of support. Regardless of the 
challenge, the Department of the Navy, sailors, marines, and 
civilians consistently answer the call. They step forward and 
perform superbly in our country's times of greatest need.
    Time and again, our Navy and Marine Corps team has 
invariably risen to meet all challenges and defend our Nation, 
bonded together by almost 250 years of tradition and an 
unwavering, deep seated sense of duty to our country.
    I look forward to working with you to ensure our efforts 
meaningfully and effectively support the well-being of our 
sailors, marines, civilians, and their families, and that we 
always best position them to fulfill their vital roles for our 
Nation. Thank you for the opportunity to be here today, and I 
stand ready to answer your questions.
    [The prepared statement of The Honorable Franklin R. Parker 
follows:]

         Prepared Statement by The Honorable Franklin R. Parker
                              introduction
    Chairwoman Warren, Ranking Member Scott, and Distinguished Members 
of the subcommittee, thank you for allowing me to join you here today. 
I am honored by this opportunity to appear before you to talk about our 
sailors, marines, (Active Duty and reservists) as well as their 
families and our Department of the Navy civilian workforce.
    As the 2022 National Security Strategy and National Military make 
clear, today we face a wide range of threats and global challenges. 
Coupled with complex systems and advancing technology, our Nation needs 
a strong, well-trained, well-equipped Navy and Marine Corps. We must 
leverage our talent to retain our competitive edge and multi-domain 
dominance.
    The changing strategic landscape demands we maintain and strengthen 
the Nation's maritime dominance, so our forces can deter, and prevail 
against potential adversaries. Our Navy/Marine Corps Team must foster a 
culture of warfighting excellence, while treating each other with 
dignity and respect. As an integrated team, collectively demonstrating 
talent, capabilities, and dedication second to none, our people can 
overcome any challenge they face.
    Our workforce comprised of . . . servicemembers and civilians . . . 
are at the core of our success--both as a military and a nation. I am 
incredibly proud of their performance, commitment, and unparalleled 
resilience in the face of the dynamic global challenges that have 
become our present operating environment.
                                covid-19
    In January, the Secretary of Defense rescinded his direction that 
all servicemembers receive the COVID-19 vaccine, as directed by the 
Fiscal Year 2023 National Defense Authorization Act (NDAA), Section 
525. Like many in leadership, I am proud of the commitment shown by 
members of our team during the Department's years-long effort to reduce 
risk to the force and preserve combat effectiveness. Our sailors and 
marines received the vaccine, helping to reduce the threat of COVID-19 
to the force, their families, and our country. Notwithstanding the 
rescission of the vaccine mandate, we remain committed to protecting 
the force from COVID-19 and other diseases and will continue 
encouraging our sailors, marines, and civilians to vaccinate against 
them. We also have standing procedures for bringing members, separated 
under the prior policy, back into service, ensuring that such sailors 
and marines who wish to return may re-apply.
                        recruitment & retention
    Right now, we enjoy a total force of unprecedented quality. 
Achieving maritime dominance demands an agile force of undisputed 
lethality, resiliency and capacity. In our new environment, we must 
continue to ensure the Services are positioned to meet their 
recruitment and end-strength goals. We have some challenges.
    A general decrease in propensity to serve and several years of the 
COVID-19 pandemic limited both student attendance and recruiter access 
to schools, making it difficult for our recruiters to make and maintain 
contact with potential recruits. The Secretary of the Navy is 
personally involved in addressing those challenges and we are working 
with both internal and external partners to foster success. As part of 
that effort we have reached out to the highest levels of the Department 
of Education, seeking to address school access issues, and have also 
reached out to the school principals who restricted recruiter access. 
Through these and other efforts, we seek to ensure our Services have 
what they need to meet recruiting goals and achieve force readiness.
    While a picture of the current recruiting environment is 
complicated, the Navy and Marine Corps are actively committed to 
overcoming recruiting challenges through strong collaboration and 
innovative thought. In addition to recruiting, the Navy/Marine Corps 
Team remains committed to retaining the right talent and experience. 
This complements our efforts with recruiting. We will explore every 
lever within our authority to maximize retention and we already are 
seeing positive trends in retention rates across both services.
                               education
    Over the course of the last year, the Department of the Navy has 
made significant strides to assess how education is delivered to the 
force, and modernize our educational objectives. Today's Navy and 
Marine Corps Team is a forward deployed, highly sophisticated network, 
one of the most technologically advanced networks ever conceived, and 
one that operates either in concert with other combat units or fully 
self-sustained, able to dominate the air, sea, and undersea. This 
network has but one purpose--to focus the capability of the American 
sailor and marine, assisted by technology, to serve the national 
interests of the United States and her allies and partners across the 
spectrum of engagement, whether for humanitarian purposes, to maintain 
freedoms in the global commons, or in combat.
    As we become a more technologically advanced force, education will 
be a crucial warfighting enabler to maintaining America's might upon 
the sea. Our naval education enterprise is working together to develop 
leaders with warfighting knowledge, intellectual dynamism, and 
creativity to maintain a strategic advantage against competitors and 
global adversaries. Through our Naval University system, we are 
creating a continuum of learning that develops such leaders to serve at 
every level and equips them with skills to maintain and operate 
increasingly complex systems in an ever-changing warfighting 
environment.
                         resiliency & readiness
    Mental health concerns and rising suicide rates are national issues 
to which the Services have not been immune. We are well aware of the 
inextricable link between mental health, resiliency and the readiness 
of our force. To that end, we are committed to supporting and ensuring 
the mental health, safety, and well-being of all sailors, marines, and 
Department of the Navy civilians. We must do everything we can to 
foster the well-being of our people and prevent suicide. No one 
solution applies to every sailor, marine, or civilian.
    Given the complexity of this challenge, our Office of Force 
Resiliency has taken a comprehensive approach to enhance holistic, 
data-driven suicide prevention efforts that draw from and harmonize 
with the Defense Strategy for Suicide Prevention. We have also taken 
note of the recently released report from the Suicide Prevention and 
Response Independent Review Committee (SPRIRC), and will work within 
DOD's coordination framework to implement key recommendations that will 
further our prevention effort.
    The Department of the Navy (DON) is laser focused on countering 
sexual assault within the Navy and Marine Corps at every level. In 
addition to the toll on victim, sexual assault directly impacts unit 
cohesion and ultimately undercuts our readiness. We must maintain 
environments that foster respect, strengthen the dignity of military 
service, and increase our warfighting readiness. Sexual assault is a 
persistent challenge that requires a multi-pronged approach leveraging 
a wide range of initiatives, not only to address sexual assault, but 
also to prevent it before it occurs.
    Secretary Del Toro directed the establishment of an Implementation 
Advisory Panel (IAP) for the Department of the Navy last spring, 
bringing the leaders of all principal offices to the table to pinpoint 
strategies for the Navy and Marine Corps to implement the 
recommendations of the Independent Review Commission on Sexual Assault 
in the Military (IRC), as approved by the Secretary of Defense. Through 
the IAP, the DON has already made significant strides to implement the 
IRC recommendations, focusing first on the highest priority efforts. We 
fully recognize that we need to continue to confront and prevent these 
destructive behaviors. We are investing significant resources to fuel 
the needed changes and we have made substantial progress in standing up 
a dedicated prevention workforce, professionalizing the sexual assault 
response workforce to better provide victim care and support, and 
establishing Offices of Special Trial Counsel.
    Additionally, our Office of Force Resiliency actively synchronizes 
the DON's sexual assault awareness and training, prevention, victim 
response, and accountability initiatives with the DOD Office of Force 
Resiliency. Sexual assault is more than just a crime. It undermines the 
trust and commitment that is foundational to our forces and erodes 
faith in our leaders, institutions, shipmates, and marines. This is a 
leadership issue, and you have my commitment to clearly and actively 
support these efforts and to demonstrate that sexual assault and sexual 
harassment will not be tolerated in any way, shape, or form.
    Our Nation needs a strong, well-trained, and well-equipped Navy and 
Marine Corps to address the wide array of challenges and threats facing 
our Nation. To be a combat-ready force, we must leverage the strengths 
of all our people. Further, because we are an all-volunteer force, we 
must ensure that all segments of our society see value in serving and 
are treated with dignity and respect when doing so.
    As Secretary Del Toro stated in his posture testimony last year, 
``We draw talent from all of America to building our warfighting 
advantage. We need a diverse force, so every child in America can see 
themselves wearing the uniform or working in our civilian ranks 
tomorrow, and every viewpoint is represented in our operations today.''
    Thanks to the leadership of Secretary Del Toro, Admiral Gilday and 
General Berger, our force is more potent today because we do just 
that--we draw from all of America. Yet, there is still more work to be 
done.
    All Americans qualified to serve in the Navy and Marine Corps 
should have the opportunity to serve if they can meet the appropriate 
standards. Anything less would not allow the Navy and Marine Corps to 
avail ourselves of the best possible talent in America, and would 
render us less fit as a total force.
    We are working to reduce barrier to accession, promotion, and 
retention, in recognition of the value of the service rendered by all 
of our sailors, marines, and civilians.
                     support for military families
    Quality of life issues are critical to our servicemembers and their 
families. The stresses on our spouses and children weigh on the minds 
of our servicemembers, especially when they are deployed. By caring for 
our families, we enable our servicemembers to continue their focus on 
the warfighting mission.
    In January, the Department of the Navy implemented increases in the 
entitlement to parental leave as required by NDAA. Such measures not 
only are the right thing to do for our sailors and marines, but they 
also are crucial for recruitment and retention by providing necessary 
flexibilities for families to care for their children.
    In addition, last fall, the Department of Defense directed services 
to make Permanent Change of Station (PCS) moves easier, strengthen 
support to our military families, expand spousal employment, and ensure 
affordable basic needs. We have since taken action to support spousal 
licensing and career advancement, expanding dependent care support and 
early childhood access. Additionally, we are pushing to end food 
insecurity among our youngest Sailors and Marines through access to 
financial literacy tools, spousal employment programs and other forms 
of support.
                               conclusion
    Regardless of the challenge, The Department of the Navy's sailors, 
marines, and civilians consistently answer the call. They step forward, 
raise their right hand, and perform superbly in our country's times of 
greatest need. Our Navy and Marine Corps Team has invariably risen to 
the meet all challenges and defend our Nation, bonded together by 
almost 250 years of tradition and an unwavering, deep-seeded sense of 
duty to our country.
    I look forward to working with you to ensure our efforts 
meaningfully and effectively support the well-being of our sailors, 
marines, civilians, and their families and that we always best position 
them to fulfill their vital roles in support of our national security 
interests. Thank you for the opportunity to be here today, and I stand 
ready to answer your questions.

    Senator Warren. Thank you. Thank you, Secretary Parker. 
Secretary Wagner, representing the Air Force.

STATEMENT OF ALEX WAGNER, ASSISTANT SECRETARY OF THE AIR FORCE 
                FOR MANPOWER AND RESERVE AFFAIRS

    Mr. Wagner. Chairman Warren, Ranking Member Scott, 
Distinguished Members of the Committee, thank you for the 
opportunity to appear before you today and thank you for your 
continued support for our airmen, our guardians, and their 
families.
    I am looking forward to working with both of you and 
continue the work with your terrific staff. I am proud not only 
of the adaptability, but also the tenacity of our force as 
current world events such as pandemic recovery, inflation, and 
a return to great power competition pose ever evolving 
challenges for our Nation.
    In order to recruit and retain a lethal, expert, and 
resilient force, the DAF [Department of the Air Force] needs 
our partners on the Hill to help us tell our story to the 
American people, and showcase both the unique missions of 
military service, but also the unique value of military life.
    We are implementing the vision of the Secretary of Defense 
outlined in his Taking Care of People Initiative but have also 
gone further in important areas like childcare and spouse 
unemployment.
    Our members need to know that we are doing everything we 
can to take care of and support their loved ones. That also 
means providing a competitive compensation package, housing, 
and education benefits, and quality health care.
    I believe we have made progress in this respect as 
validated by our 90 percent retention rate, but I acknowledge 
we must do more to promote resilience and prevent those harmful 
behaviors that are counter to our values, undermine our team, 
and diminish our readiness.
    In particular, sexual violence will not be tolerated, 
condoned, or ignored within our ranks, and those that breach, 
that trust will be held accountable. Finally, I want to talk 
about the recruiting challenge that the DAF and the other 
services have been facing.
    The Air Force is currently projected to miss its enlisted 
Active component recruiting goals for the first time since 
1999. There are multiple factors that have made recruiting 
challenging, including historically low unemployment, strong 
private sector wage growth, and a lack of access to high 
schools exacerbated by the COVID-19 pandemic.
    However, the most important factor, propensity to serve, is 
the lowest we have seen in decades. But what does that really 
mean? It starts with a lack of familiarity. Secretary Cisneros 
said in an earlier panel, in 1995, 40 percent of Americans had 
a parent who served. But today, that number is less than 13 
percent.
    After 9/11, military installations became more hardened and 
more secure, but it also further separated those who serve from 
those whom they protect. That lack of familiarity has been 
filled in by a public narrative that emphasizes the risks of 
service while missing the benefits.
    The DAF is taking steps to address this issue by opening up 
opportunities for communities to visit our bases, sharing 
inspiring and authentic stories of servicemembers, and 
highlighting the stakes of our high-tech mission to deter near-
peer competitors. But the Department can't do this alone, and 
we need your help.
    Congress has a critical oversight function of the military, 
but we also need to enhance our partnership to increase 
propensity to serve. You are an important voice to your 
constituents, to the young people, to the parents, and to the 
influencers that can help shape the next generation of service 
by elevating opportunities and highlighting the benefits of our 
values and our team.
    Now, 50 years into an All-Volunteer Force, we must be able 
to reach all communities of America, geographic and 
demographic, to ensure we recruit the brightest and the best. 
You can't be it if you can't see it.
    Every person in America's Air and Space Forces play a 
critical role in ensuring that this organization is prepared to 
meet the challenges of today and tomorrow, and in particular, 
our pacing challenge.
    We are excited to partner with you and to rebuild this 
relationship with the American people together. With that, I 
look forward to your questions.
    [The prepared statement of The Honorable Alex Wagner 
follows:]

            Prepared Statement by The Honorable Alex Wagner
                              introduction
    Chairwoman Warren, Ranking Member Scott, Distinguished Members of 
this Committee, thank you for your continued support of our airmen, 
guardians, and their families. A cornerstone of the National Defense 
Strategy is building a resilient joint force. Since the beginning of 
this administration, the Secretary of Defense has prioritized taking 
care of the people of the Department of Defense: those who wear the 
uniform, the civilians who support them, and the dependents who rely on 
them. The human capital portfolio is integral to this strategic 
priority, and it is reflected in the Department of Defense's Fiscal 
Year 2024 budget request. I am proud of not only the adaptability, but 
the tenacity of our force as current world events such as pandemic 
recovery, inflation, and a return to great power competition pose ever 
evolving challenges to our Nation.
    The Department of the Air Force (DAF) is not just a collection of 
aircraft, munitions, and computers. The platforms are animated by a 
highly skilled, cohesive, and expertly trained group of individuals who 
work together as a team--within our force, across the military 
services, and with allies and partners--toward a common goal. Our 
people are the backbone of the Department's readiness, and their 
contributions are fundamental to the success of the mission. From 
pilots and mechanics to intelligence analysts, medics, and security 
forces, every person in America's Air and Space Forces plays a critical 
role in ensuring that the organization is prepared to meet the 
challenges of today and tomorrow--and in particular, our pacing 
challenge, the People's Republic of China (PRC). As the PRC seeks to 
increasingly compete with us in the air and space domains, maintaining 
our competitive edge requires that we fully leverage the talents, 
diversity, creativity of the DAF's Total Force. I am confident that the 
quality of our people is critical to deterring aggression; but if 
deterrence fails, they are essential to providing a decisive edge in 
denial and defeat of our competitors.
                    empowering airmen and guardians
End Strength
    Air Force. The United States Air Force's end strength is tied to 
specific weapons systems and our ability to rapidly transition to a 
wartime posture against a peer competitor. Our Total Force end strength 
target of about 503,000 reflects the critical balance of readiness, 
modernization, and the ability to resource future capabilities to 
compete and win in the high-end fight.
    This requires the Air Force to divest legacy force structure to 
fund modernization for the capabilities the Air Force needs in 2030 and 
beyond. Our military end strength reductions in fiscal year 2024 are 
commensurate with proposed force structure and divestitures. The fiscal 
year 2024 end strength reduction is 1,044 Total Air Force Airmen.
    Reductions were taken in multiple weapons systems to include 
Airborne Warning and Control System E-3, A-10, Joint Surveillance and 
Target Attack Radar System (JSTARS), C-130, F-15, F-16, and Tactical 
Air Control Parties. Moving away from these platforms and missions 
redirects manpower to our newest aircraft, such as the B-21, E-11, and 
F15-EX, many of which require both experienced maintainers and pilots 
to assure our competitive edge.
    Space Force. As we all know, space is increasingly contested, 
congested, and competitive. Securing space is getting harder, driving 
the need to increase inventory of space-focused military and civilian 
personnel beyond what was previously required. Military end strength 
growth of 800 in fiscal year 2024 is a result of intra- and inter-
service transfers from the Air Force and Army.
    The Space Force's 9,400 guardians will support integrated 
deterrence required by the National Defense Strategy, and ensure our 
total workforce possesses the competencies to address the actions of 
our adversaries.
    We thank you for your continued favorable congressional support of 
the Fiscal Year 202024 President's Budget request to ensure the Air 
Force and Space Force can access the talent we need to compete in a 
world defined by ambiguity, rapid change, and near peer competition.
Recruiting Talent
    The DAF is acutely aware of the requirements of our technologically 
dependent force and the challenges of competing for top talent, 
particularly given historically low unemployment. As a result, we 
anticipate a challenging recruiting environment moving forward. More 
concerning, the youth market is increasingly disconnected and 
unfamiliar with today's military, resulting in fewer youth interested 
in or planning to join the military. Today, 50 percent of youth have 
never considered serving in the Armed Forces. Additionally, 23 percent 
of 17- to 24-year-old men and women in the United States are eligible 
to serve in the military without a waiver, and only one in 11 have the 
propensity to serve. The Air Force is currently trending to miss goals 
across all three components: Regular Air Force by about 13 percent, 
over three thousand individuals, while the Air Guard and Reserve 
components are projected to miss their goals by even higher margins.
    While the Space Force will meet its recruiting goal, we must be 
prepared if recruiting declines. We believe that the proposal for a 
Space Force single military personnel system offers a new model of 
service that will attract a broader range of candidates with essential 
skill sets. Additionally, the Space Force is investing in a ``brand'' 
recognition marketing campaign to increase awareness across the 
American public of this new service, its unique mission and the talent 
required to achieve it, and the impacts we have both to the Nations' 
defense and our modern way of life.
    The DAF has a series of initiatives underway that I believe will 
tangibly impact our ability to recruit and meet near-term needs. This 
includes expanding the aperture of who can meet our high standards by 
addressing key areas that have led to disqualification from service 
such as tattoo locations and weight restrictions. Additionally, we 
revised our enlistment drug screening physicals to allow for a re-test 
if an enlistee tests positive for THC, which aligns with the increasing 
number of states legalizing marijuana use. We are also looking at 
increasing the recruiting force, modernizing the underlying technology 
systems they use, and creating a centralized e-recruiting cell to 
virtually recruit and increase national lead conversions. We are also 
expanding our influencer program to include airmen and guardian 
referral incentives for new recruits. We plan to meet new airmen where 
they are with our Directed Recruiting Assistance Program which brings 
recent recruits back to their hometowns to assist in outreach. Finally, 
we are also bolstering incentives, including initial enlistment bonuses 
to attract high quality talent needed to address peer competitor 
challenges.
    Significant focus is also on increasing our national and local 
marketing efforts to create broader brand awareness. While we believe 
any short-term efforts will allow us to access a high-quality force 
consistent with our standards, our long-term challenge requires us to 
grow rather than stifle propensity to serve.
Talent Management
    The DAF is aggressively defining future competencies and skills 
required for 2030 and beyond with force management that can adapt to an 
evolving and uncertain future. This demands digitally savvy and multi-
capable airmen and guardians. The DAF is moving to evolve talent 
management processes and systems that create a competitive advantage in 
shaping, developing, and employing the future force we need.
    Modernizing talent management processes and systems is critical to 
increasing agility, flexibility, and data access needed to meet future 
force structure and skill requirements. To do this, the DAF is 
undertaking a five-to-seven-year overhaul to update talent management 
architecture. We are replacing ?111 H.R. IT systems, moving into six 
modern platforms. These new systems will enable us to make data driven 
talent management decisions while significantly reducing administrative 
burden.
    The Air Force is committed to transforming how we develop, promote, 
and retain our force to execute the National Defense Strategy. Our work 
centers on two distinct lines of effort to prepare for the high-end 
fight. First, we are aggressively defining future competencies and 
skills required for 2030 and beyond. These include an increased focus 
on digital and Multi-Capable Airmen. Second, we are modernizing talent 
management processes and systems to create a competitive advantage in 
shaping, developing, and employing the future force.
    One example of how the Air Force is modernizing talent management 
processes includes our recently launched new performance evaluation 
system and transition to how we evaluate airmen, using the Airman 
Leadership Qualities. The new performance evaluation process sets clear 
expectations about what we value as a Service, measures how an airman's 
performance and behaviors embody those values and incentivize them to 
continue their development through meaningful feedback.
    Additionally, the DAF implemented a dual track ``Civilians We 
Need'' career model that recognizes the need for both functional 
experts and enterprise leaders in our civilian corps. This model allows 
our civilian airmen and guardians to plan their job experiences, 
education, training, and leadership opportunities to meet their 
professional goals. This dual-track civilian career model also offers 
greater diversity benefits while and enhancing retention.
                          supporting readiness
Taking Care of People
    While our servicemembers are compensated competitively, the unique 
complications of military life, like frequent moves and unanticipated 
expenses demand an ever-vigilant focus on expanding initiatives that 
enhance and increase stability for servicemembers and their families. 
Thanks to the support of Congress, the DAF offers each of our 
servicemembers a competitive compensation package. We are grateful for 
the recent increases in Basic Pay, Basic Allowance for Housing, and 
Basic Allowance for Subsistence that constitute the core of our members 
compensation. The DAF acknowledges the current economic environment 
poses a challenge to our airmen, guardians, and their dependents, 
particularly as inflation and the associated housing and rental markets 
increased. Economic conditions were also exacerbated by the COVID-19 
pandemic and Russia's invasion of Ukraine. We know that to build a 
resilient force, we must provide our servicemembers and their families 
stability with reliable access to safe, affordable housing and 
appropriate tools to ensure financial readiness. As a result, we are 
committed to providing additional support to families through a 
comprehensive network of resources focused on financial literacy 
education, improving military spouse employment, and expanding access 
to quality and affordable childcare on and off the installation. We 
further sought to enhance economic security by expediting Temporary 
Lodging Expense extension requests, promoting the DOD's Military 
Leader's Economic Security Toolkit, and implementing the Basic Needs 
Allowance.
    We knew the stressors of moving can reduce a sense of financial 
stability, particularly when unexpected expenses are incurred. As a 
result, the DAF has sought to increase geographic stability for 
servicemembers and their families by implementing 36-month tour lengths 
for Unaccompanied First Permanent Assignments in certain overseas 
locations. Currently, 76,821 airmen and guardians have more than 36-
months' time-on-station; of those the vast majority, 68,578, are CONUS.
    The DAF has also created a Food Service Working Group to review all 
our dining facilities consistent with the Office of the Secretary of 
Defense's Strategy and Roadmap to Strengthen Food Security Within the 
Force. Today, our members are saving money at the register, with cost 
of goods in commissaries on average 25 percent lower than at local 
marketplaces. Our future efforts to increase access to healthy food 
center on four key pillars: expanding dining facility hours, enhanced 
access to healthy options, effectiveness of the meal card program, and 
the insights into the installation-wide food landscape. These insights 
will shape the multiple lines of effort the DAF will undertake in 2023 
to improve access to healthy food options across the DAF enterprise.
Child Care
    Accessible, affordable, and high-quality childcare is a critical 
enabler of the Department's mission. This is a readiness issue, as our 
airmen and guardians rely on us to focus on the mission while knowing 
their youngest family members are being cared for at our Child 
Development Centers (CDCs). I believe that the DAF's Child and Youth 
Programs are the gold standard and as a result, they are in high 
demand. Currently, the DAF has 15,828 children enrolled in military 
child development centers across 74 installations and 1,682 children 
enrolled in 381 Family Child Care (FCC) homes (2,286 spaces) at 57 
locations. As of 1 January 2023, 4,630 children have not been placed in 
an installation CDC/FCC program on the date care was needed with an 
average wait time of 143 days.
    Those numbers are not acceptable, and here is what we are doing 
about it. The DAF's fiscal year 2024 budget seeks to improve access to, 
and reduce wait lists for, childcare includes leveraging staffing 
initiatives, adding FCC providers, increasing community-based fee 
assistance, and targeted construction investments.
    The DAF has employed various incentives to recruit and retain our 
CDC providers. We are leveraging new direct hiring authorities, while 
executing $2 million in incentive bonuses for sign-on, employee 
referrals, meeting training targets, and longevity. We continue to 
implement the $15 per hour minimum rate and increased compensation to 
remain competitive with employers outside the gate. With these efforts, 
we saw staffing level increased through 2022 Permanent Change of 
Station (PCS) season from 65 percent on July 1, 2022 to 72 percent on 
October 1, 2022.
    Recently, the Secretary of Defense instructed military departments 
to provide a minimum 50 percent childcare fee discount for the first 
child direct care of providers in our CDCs. Recognizing that this 
incentive could substantially help with staffing shortages, the DAF 
went further and directed additional policy changes to include a 100 
percent discount for direct care staff and established new discounts 
for the additional children of those providers as well as other 
personnel within the Child Development Program.
    So far, the results are promising: 23 percent of providers have 
children and are receiving childcare fee discounts. The incentive is 
attractive to applicants with children who may not have otherwise 
applied. Preliminary data suggest that DAF direct care staffing levels 
have increased since implementing the enhanced discount. We continue to 
look at compensation and incentives to recruit and retain direct care 
workers in highly competitive national childcare labor market.
    While we improve our staffing, we continue to prioritize 
infrastructure requirements to support the childcare need. The Child 
and Youth Facility Master Plan identifies 31 new CDC requirements, nine 
are funded for construction, and 12 are funded for planning and design. 
In fiscal year 2024, we are expanding compensation for servicemembers 
during PCS moves to assist with childcare when services are not readily 
available upon arrival at new installation. The proposed budget also 
sets aside $50 million in Facility Sustainment, Restoration, and 
Modernization (FSRM) funds for focused investment in CDCs. 
Additionally, installations receive discretionary sustainment funding 
for routine preventative maintenance and repair for facility projects 
with costs below the thresholds for centralized funding.
Exceptional Family Member Program (EFMP)
    EFMP is a vital component of taking care of our DAF families. 
Navigating military and community resources during major life events 
can be challenging as a military family. EFMP is included in the DAF 
PCS process to ensure required specialty medical and/or educational 
care is available for dependents at the gaining duty location. This 
comprehensive, coordinated, multi-agency program is integral to serving 
our 36,000 servicemembers and 55,000 family members who are enrolled in 
EFMP across the DAF.
    Over the last 2 years, the DAF has made significant improvements to 
EFMP, as required by the Fiscal Year 2021 NDAA, including 
centralization of DAF EFMP as well as leveraging technology and data to 
improve consistency of decisions. With the launch of an automated 
system and implementation of centralized medical screening, the DAF 
effectively removed the extensive administrative burden on our 
families. We have completed approximately 70 percent of the 
transformation and remain on track to complete these improvements.
    To ensure we are doing everything to provide members with the 
necessary support and services their families need, the Air Force Audit 
Agency is currently evaluating the EFMP enterprise. Their report will 
include a full assessment of metrics being used to measure performance 
and satisfaction, remaining manning gaps, appropriate alignment of 
roles and responsibilities between the medical and personnel staff, and 
policy considerations for overall program efficiency and effectiveness.
Resilience, Prevention, and Accountability
    Prevention and response efforts against harmful behaviors such as 
sexual assault, suicide, and domestic violence are critical to building 
a resilient force. We recognize that one servicemember experiencing any 
of these issues is one too many and overall, we need to do more to 
prevent and reduce these incidents that are counter to our values and 
undercut the lethality and efficacy of our force.
    Sexual Assault. The Independent Review Commission (IRC) on Sexual 
Assault in the Military recommended improvements to accountability, 
prevention, culture and climate, and victim care and support. The DAF 
is on track to complete implementation of the recommendations as 
approved by the Secretary of Defense. We are increasing the response 
workforce, developing an independent reporting structure outside the 
chain of command for our Sexual Assault and Response Coordinators 
(SARCs) and enabling sexual harassment complainants to access victim 
advocacy support from a SARC or Sexual Assault Prevention and Response 
(SAPR) Victim Advocates. In accordance with the Fiscal Year 2022 NDAA, 
the DAF implemented the requirement for an independent Office of 
Special Trial Counsel, with exclusive prosecution authority over 
certain categories of UCMJ offenses, to include sexual assault and 
domestic violence committed on or after December 28, 2023. The DAF's 
Office of Special Trial Counsel reached initial operational capacity in 
June 2022 and is poised to continue the effort to promote a culture 
which reduces instances of sexual assault and domestic violence by 
holding offenders accountable.
    Additionally, we have implemented a Safe-to-Report policy that 
encourages victims to report sexual assault by withholding punishment 
for minor collateral misconduct related to the sexual assault incident 
or report, like underage drinking or fraternization. These improvements 
are aimed at empowering survivors and ensuring they receive critical 
support and care.
    Last year, we launched an Integrated Response Co-Location Pilot 
Program where we tested a more holistic approach to responding and 
assisting survivors of sexual assault, sexual harassment, domestic 
violence, stalking and cyber harassment across seven CONUS/OCONUS 
installations. The 6-month pilot program centralized five key support 
service entities including SARC, SAPR Victim Advocate, Domestic Abuse 
Victim Advocate, Victims Counsel, and the Religious Support Team to 
simplify access and advocacy processes for Airmen and Guardians. We 
also comprehensively surveyed providers, commanders, and survivors to 
assess program benefits as well as areas for modification. Initial 
feedback demonstrated that co-locating response services increased 
support, access, and awareness for survivors. We intend to use this 
feedback to consider how and where to inform decisions on further co-
location of these essential services.
    Suicide. The DAF recognizes that suicide is a complex issue with no 
single cause or solution but is committed to reducing the numbers of 
suicides within our ranks. While we are making strides to increase help 
seeking behavior, one suicide is too many and we continue to enhance 
our prevention approach to align with empirically based best practices, 
including ``warm hand-off'' policies, time-based prevention campaigns, 
and encouraging lethal means safety measures.
    As compared to DOD-wide trends, DAF Active Duty suicides showed the 
greatest reduction of all the Services since 2019; Active Duty suicides 
decreased by 38 percent over the period 2019-2021. Those who died by 
suicide were largely enlisted, male, and under the age of 30, across 
all three components, with firearms being the leading method of 
suicide.
    On February 24th, the Suicide Prevention and Response Independent 
Review Committee (SPRIRC) published its findings and recommendations. 
The SPRIRC report focuses on four main areas, including restructuring 
suicide prevention training, providing additional resources to help 
servicemembers access existing support services, promoting lethal means 
safety, and emphasizing leader stewardship in addressing servicemember 
needs.
    The Secretary of Defense has reviewed the report from the Suicide 
Prevention & Response Independent Review Committee. The DAF will work 
diligently to ensure processes can continue to make progress toward 
meaningful, long-term reductions in Total Force suicides. We are 
positioned to develop plans to implement the recommendations he 
accepts.
    Domestic Violence. While we have taken important steps to better 
support domestic violence survivors, we must do more to establish a 
foundation of trust, integrity, and respect that encourages reporting 
and engenders confidence in our enterprise.
    Most recently, the Secretary of the Air Force directed a 90-day 
cross-functional review to comprehensively look at how we investigate 
and respond to domestic violence cases, increase survivor confidence in 
leadership, and enhance our survivor support capabilities. 
Specifically, this includes identification of leader actions that 
undermine trust and to better connect all of those involved or affected 
by domestic violence to services and support; and where an 
investigation does not result in criminal prosecution, identification, 
and analysis for the role of any available command administrative 
actions. This increased focus on improving the experiences of domestic 
violence survivors will also advance ongoing efforts to deliver better 
care and support across the range of multiple forms of interpersonal 
violence, including sexual assault and sexual harassment.
A Ready Medical Force
    In conjunction with the Air Force Medical Readiness Agency and the 
Defense Health Agency, in July of last year the DAF launched a new 
medical profiling system with the goal of improving both communication 
and overall readiness. This system, called the Airman and Guardian 
Availability Management system creates a new way of generating a 
profile while remaining under the same management system. This program 
was tested at 14 locations for Active Duty personnel as well as seven 
Air National Guard and Reserve units. The idea is to empower 
servicemembers to be more engaged in their recovery.
    The DAFs efforts to protect our servicemembers and their families 
at the onset of COVID-19 was carried out quite expeditiously while 
simultaneously executing our global mission. The DAF has acted and 
continues to act upon lawful guidance from the Office of the Secretary 
of Defense in a timely manner. When Secretary Austin mandated 
immunization for servicemembers, the DAF acted swiftly to protect lives 
and to effectively execute our important mission. As a result of the 
quick DAF response, 99 percent of the Active and nearly 98 percent of 
the 500,000 total force Airmen and Guardians were vaccinated, ensuring 
they maintained their readiness while enabling their deployment to 
several states that were experiencing shortages in medical personnel. 
Our vaccination efforts saved of thousands of lives. What we know now 
about COVID is drastically different than what we knew in the spring of 
2020.
    On January 10th of this year, Secretary Austin rescinded his August 
2021 memorandum mandating COVID-19 vaccination, consistent with legal 
requirements of the Fiscal Year 2023 NDAA. As a result, the Secretary 
of the Air Force formally rescinded all mandate-related requirements 
and in February provided clear guidance to the force regarding removal 
of adverse actions and handling of pending Religious Accommodation 
Requests related to refusal of COVID-19 vaccinations. I assure you that 
implementation of these processes will be efficient, transparent, and 
fair.
                               conclusion
    This year marks the 50th anniversary of the All-Volunteer Force, a 
cornerstone of our personnel policy. The commitment of our airmen, 
guardians, and their families is a testament to the success of 
dedicated, proud, and impactful Air and Space Forces, and we must 
continue to support and sustain it for the next fifty years and beyond. 
We look forward to continuing to partner with you.

    Senator Warren. Thank you. I am going to ask the first 
round of questions here. The Junior Reserve Officer Training 
Corps, or the JROTC, is a DOD funded program for middle school 
and high school students that is designed to teach students the 
value of citizenship and public service.
    Schools hire and oversee the instructors, and then the 
military services that train and pay part of the salaries for 
the instructors who are all retired servicemembers. DOD and the 
Department of Education share oversight for the program, but 
there are some pretty serious gaps in that oversight.
    A recent New York Times investigation found that at least 
33 JROTC instructors have been criminally charged with sexual 
misconduct. I started my own investigation with Senators 
Blumenthal, Gillibrand, and Hirono in response to this alarming 
situation and found that there were at least 114 allegations of 
abuse over the past decade.
    Now, when the services learned about these 114 cases, they 
did the right thing and suspended or fired the instructor. But 
I am worried that we are seeing only the tip of the iceberg.
    Secretary Schaefer, the Army has the largest JROTC program 
of all the military services so let me start by asking you. One 
of the main ways that we track whether we are making progress 
on military sexual assault is an annual report. Is there any 
kind of formal annual reporting on instances of sexual assault 
and harassment in the JROTC program?
    Dr. Schaefer. Senator Warren, thank you for your question. 
This is an issue that deeply concerns me as well. There is an 
annual--my understanding is there is an annual report, but it 
has not had that tracking in it, yet----
    Senator Warren. So, there is no--the annual report I am 
asking about, is there a report tracking the incidences of 
sexual assault?
    Dr. Schaefer. So, yes, there is a report. It has not 
tracked sexual assault----
    Senator Warren. So, the answer is no.
    Dr. Schaefer. To this point--yet my office has directed it. 
Before I came in, in December, my office directed that we 
include that in the report that already----
    Senator Warren. Okay, but right now there is not--you are 
now trying to put this in. Okay, that is good. It is a good 
thing. Another tool recommended by experts for tracking this 
type of problem is a survey that allows individuals to 
anonymously report instances of sexual harassment or abuse. 
Does the Army have that kind of survey for JROTC?
    Dr. Schaefer. I am not aware of it, but I can look into it. 
I agree that that might be a good----
    Senator Warren. I think you will find the answer is no on 
that. So let me ask the other services. Annual report, 
Secretary Parker?
    Mr. Parker. Chairwoman Warren, no, there is no annual 
report.
    Senator Warren. No annual report. Secretary Wagner?
    Mr. Wagner. Chairwoman, there is an annual report. It is 
called the Defense Organizational Climate Survey (DEOCS) for 
military folks and for DOD civilians. These are employees of 
schools, the JROTC instructors are school employees. The 
students are obviously students, and so, the optic of the 
military, asking a survey----
    Senator Warren. I am not asking you that. What I am asking 
is, do you have an annual report that records how many people 
reported sexual assault against your folks who were in the 
JROTC program?
    Mr. Wagner. The Air Force JROTC program office tracks this 
extremely closely----
    Senator Warren. So, you do--so if I request that annual 
report, you will get a copy of it and it will show me how many 
people reported incidences of sexual harassment or assault?
    Mr. Wagner. I can't say it is a formal report. What I can 
say is I have seen a list of every single incident and the 
disposition over the last 5 years.
    Senator Warren. So, the answer to my question about is 
there an annual report, is that a yes, or no?
    Mr. Wagner. We--as far as I am aware, we don't have an 
actual annual report.
    Senator Warren. All right, and do you do a survey? 
Secretary Parker.
    Mr. Parker. No, we do not do a survey.
    Senator Warren. Secretary Wagner.
    Mr. Wagner. Senator, we don't do a survey, but we do 
provide a number of mechanisms for either parents or students 
to report incidents.
    Senator Warren. If you are serious about sexual assault and 
sexual harassment, these are two best tools that we know we 
have available. I am asking the question, are the military 
services doing it? I am hearing from Secretary Schaefer that 
she is starting with the Army. I am not hearing it from the 
Navy.
    I am not hearing it from the Air Force, and I am asking all 
three of you using the second tool, and that is surveys, and I 
am hearing the answer is no, no, and no. So, look, no annual 
reporting or just starting some annual reporting, no surveys.
    In other words, there is no real way for the DOD or the 
services to have the kind of information they need to exercise 
basic oversight. You got to start with knowing what is going 
on. We know the problems with these service. We know that 
people under-report. We know they underreport formally.
    We know they underreported surveys. But you have got to at 
least start there. You know, one of the biggest problems that 
has come to light in these investigations is also that some of 
the instructors who abuse these students had done it before.
    For at least seven of the instructors that we know about 
who were eventually criminally charged, it turns out that 
students had already raised concerns with the school before the 
incident that got these instructors arrested.
    So let me start there. Secretary Schaefer, if colleges fail 
to report public safety issues like sexual assault, the 
Department of Education can fine them under the Cleary Act or 
even strip them of all Federal funding. There are serious 
consequences for failure to report. So, let's ask about DOD 
accountability.
    If schools fail to report or stop this behavior in JROTC 
programs, does DOD have any mechanism for saying you no longer 
get to operate a JROTC program?
    Dr. Schaefer. My understanding is that it is the 
responsibility of the schools to report any of these 
instances----
    Senator Warren. I know, and I am asking when school falls 
down on that responsibility, if this were the Department of 
Education, the Department of Education actually has tools to 
use to say you are going to pay consequences if you fail to 
report. Because we all understand nobody wants to report this 
stuff.
    The schools that are responsible certainly don't want to 
report this. So, I am asking, is there anything in the Army 
JROTC program that will tell a school, if you fail to report, 
there will be consequences?
    Dr. Schaefer. Again, I am not aware of that, but I can look 
into it for you and give you----
    Senator Warren. Okay. I am going to take that as a no 
unless you tell me something different. Secretary Parker, how 
about the Navy?
    Mr. Parker. I am not aware that there is a specific trigger 
for----
    Senator Warren. I will take that as a no. Secretary Wagner.
    Mr. Wagner. Senator Warren, the memorandum of agreement 
between Air Force ROTC and each school has specific 
requirements----
    Senator Warren. I am not asking about the requirements. I 
am asking about whether there is consequence if the school just 
keeps its mouth shut.
    Mr. Wagner. If the school violates and consistently 
violates the memorandum of agreement, then the school would be 
decertified as would any----
    Senator Warren. Have you ever decertified a school?
    Mr. Wagner. I will have to look into that.
    Senator Warren. Okay. All right. But you say you actually 
have a mechanism.
    Mr. Wagner. We have a mechanism.
    Senator Warren. Okay. All right. So, we have got this on 
sexual assault. Very disturbing findings, and sexual 
harassment. There is one other thing I want to cover very 
quickly, and that is recent investigations have also found that 
dozens of schools have forced students to participate in the 
JROTC program against their will.
    Parents have to sign a permission slip for a kid to go to 
the museum on a field trip. The notion that thousands of 
students are forced to participate in JROTC programs is just 
out of line with the program's values.
    Secretary Schaefer, would the Army support requiring JROTC 
programs to certify that their units are made up only of 
students who have provided informed consent to participate?
    Dr. Schaefer. Well, we certainly don't condone forced 
enforcement of this, and that may be an opportunity to look 
into----
    Senator Warren. So, you would like to see--so perhaps a way 
to certify that that is the case?
    Dr. Schaefer. Perhaps, yes.
    Senator Warren. Secretary Parker, how would the Navy feel 
about that?
    Mr. Parker. Senator Warren, I believe that is something 
that we would be willing to consider.
    Senator Warren. Okay, and Secretary Wagner.
    Mr. Wagner. Absolutely.
    Senator Warren. Okay. Well, we have an All-Volunteer Force. 
We should have an All-Volunteer JROTC. I think we should all be 
able to agree on that. You know, if the military doesn't step 
up and prevent these kinds of abuses, then you endanger our 
ability to continue programs that build our force for the 
future.
    This is your reputation on the line here, and I hope you 
will work with me to get some procedures in place to make this 
program a safe program for all of our kids. Thank you.
    Senator Scott. Ranking Member Scott.
    Thank you. Secretary Wagner, first off, thanks for being 
here. One thing--you guys watched the earlier panel.
    Anything that is required under the NDAA, if you will just 
make sure or you let us know where you are in the process 
because it can't be a lot of fun to be up here and then 
somebody asks you why you didn't do it.
    If you could make sure you let us know where you are and 
anything that you think that is required under the NDAA. So, 
that will be helpful. Secretary Wagner, Space Force just 
celebrated its third birthday last December. I think a lot of 
us are concerned that many Americans don't really understand 
why--Space Force--or why our national security matters in 
space. What are you doing to raise the profile of the Space 
Force, introduce the unique missions of guardians to the 
America's youth, and compete for talent with the booming 
private sector commercial space industry, especially in my 
great State of Florida?
    Mr. Wagner. Ranking Member Scott, I am excited to talk 
about the U.S. Space Force. Three years in, the mission is 
incredibly important. It helps every day protect not only our 
modern way of war, but more importantly, our modern way of 
life.
    We are excited to continue to work with Congress to develop 
a proposal to manage talent in the Space Force very differently 
than we have in the rest of the military departments. You will 
be seeing a legislative proposal on that topic in order to 
allow us to access a different type of talent and to have a 
talent process where we are able to have a better permeability 
between full time and part time guardians.
    We can do that for two reasons. One, because of the small 
size of the Space Force, but also because of the ability to 
attract high tech STEM talent. We are focused on building brand 
identity because, frankly, the American people really don't 
understand what the Space Force is or what they do, and so we 
are committing this year to spend $12 million on building that 
brand identity, principally with influencers.
    You know, the Space Force today is meeting its recruiting 
mission, but we are concerned about the future. Finally, in the 
era of declining propensity, we need to access a greater 
variety of talent and, as I said, manage them differently.
    In order to access that specialized STEM talent, we need to 
take on new approaches and try some new things. I think the 
space is leading the way. I think to get to your question, 
folks who have the ability to look at the option of military 
service today differently than maybe one would have looked in 
the past where it is a full career.
    Today, being able to talent manage and say, I am going to 
go take a couple of years off to focus on making sure my kids 
get into college or raising them at a certain time or take care 
of a sick parent, those are some of the things that we are 
looking at in order to allow people to plan their careers 
differently and see themselves serving in a different way than 
we could have done before.
    Senator Scott. Thank you. Secretary Schaefer, the Army, as 
you know, has had trouble with recruiting, and so I think you 
guys have relied more on retaining. So how does that impact the 
readiness of the Army?
    Dr. Schaefer. Thank you for your question. So, I think that 
this really is--end strength is sort of a three-legged stool as 
we think about it. So, we have accessions, attrition, and 
retention, and our retention is historically high right now, 
which is wonderful. I think that that, somebody mentioned it in 
the earlier panel, that once we get them through the door, they 
want to stay.
    We are really focused on addressing the civilian military 
divide that we talked about. My sense is it keeps getting wider 
and deeper. I think there is, in the Army in particular, there 
is a sort of historical piece to this as well. We BRACed a lot 
of our installations in the Northern part of the country.
    Our biggest recruiting tool is somebody walking down the 
street in uniform and talking to people about their 
experiences, and they just don't see that in the Northern part 
of the country or know somebody who has in the military in 
general. I think that creates a huge knowledge as well as 
cultural gap that we need to fill.
    So, along with what Secretary Wagner mentioned, we too are 
looking at this. I am bringing my RAND lens to this and 
thinking about all of the complaints that I have heard over the 
years from servicemembers.
    A lot of it is this, it is too hard to serve in many 
instances. That is what I keep hearing, and it is modernizing 
these systems, right? We have a postindustrial personnel 
system, and it is those annoying things that people are sort of 
working through.
    I want to make sure that we don't lose people because of 
those annoying things, so that we can bolster and keep that 
retention piece high, as we try to bridge this gap across the 
civil military divide on the recruiting side.
    Senator Scott. Thank you. Thank you, Chairwoman.
    Senator Warren. Thank you. Secretary--Senator Blumenthal. I 
am promoting everybody today. Senator Blumenthal.
    Senator Blumenthal. Thank you. Secretary Parker, I had a 
dialog with Secretary Cisneros, I don't know whether you were 
in the room at the time. So, you know that I asked about the 
sailors on the USS Washington, in particular, Xavier Sandor. It 
is a Connecticut family. The others are from elsewhere in the 
United States. In addition, there are others who have committed 
suicide. Is there a report, and when will it be released?
    Mr. Parker. Senator Blumenthal, thank you very much. I was 
present for your prior comments, and I appreciate your concern 
and advocacy on this point. I am familiar with the report.
    That is the phase two report from the GW investigation. 
This one pertains to quality of service. I believe this is the 
report that you are referring to, and so, this looks really 
kind of at the quality of service, quality of life factors 
influencing the sailors who died by suicide during that period.
    I understand that report will be released this spring, and 
I commit to you that I will go back and really push for the 
speediest issuance of that report.
    Senator Blumenthal. Well, I would like to see the report 
now. Meaning--now. Why is that not possible?
    Mr. Parker. Senator, I have not seen the report personally 
myself either, but that is something I will take back and see 
how----
    Senator Blumenthal. It is almost a year after Xavier Sandor 
took his own life. I think the family has a right to see that 
report. What would you say to the family? What would you say to 
John Sandor? His son committed suicide almost 11 months, a day 
ago, and the Navy still has not given him the facts. What would 
you say to him?
    Mr. Parker. Senator, I have no response that I could give 
to him that would be sufficient.
    Senator Blumenthal. Well, my response would be, I will show 
him the report, ask him to come down. I am going to invite him 
to come down next week, and I would like you to come to a 
meeting with me in my office and John Sandor. Will you do that?
    Mr. Parker. I will, Senator.
    Senator Blumenthal. All right, and I hope you will bring 
the report.
    Mr. Parker. I will go back and I commit to you, I will do 
my very best, Senator, but I will be in that meeting next week.
    Senator Blumenthal. Well, with all due respect, and I know 
this is not your decision alone, so I am not blaming you 
personally, but I am a dad. Two of my sons have served. One as 
a Marine Corps Infantry Officer in Afghanistan. The other is a 
Navy SEAL, and if it were my son, I would be pretty angry. So, 
I hope you can be there with the report.
    Mr. Parker. Senator, I look forward to working with you on 
this issue. I will do my very best, but I will be in that 
meeting if you desire.
    Senator Blumenthal. Thank you.
    Senator Warren. Thank you, Senator Blumenthal. I want to 
thank our witnesses for their service. I want to thank you for 
testifying today.
    I also want to thank John Clark, Gary Leeling, Andy Scott, 
Sofia Kamali, Sean O'Keefe, Katie Magnus, and Brendan Gavin for 
their work in putting together today's hearing. I value your 
contributions and I look forward to working with all of you.
    Today's hearing makes it clear that we still have a lot of 
work to do to offer our servicemembers, our extended military 
families, and even our civilian employees, and the civilians 
who interact with our military the very best.
    I look forward to working with Ranking Member Scott as we 
go forward on a bipartisan basis to do the very best for our 
people. Thank you all. This hearing is closed.
    [Whereupon, at 5:11 p.m., the Committee adjourned.]
    [Questions for the record with answers supplied follow:]

            Questions Submitted by Senator Elizabeth Warren
                         civilian care in japan
    1. Senator Warren. Assistant Secretary Martinez-Lopez, I appreciate 
that DOD reversed its policy to reduce healthcare for DOD-affiliated 
civilians and contractors at bases in Japan. However, I remain 
concerned about the steps that were taken in making this decision and 
the under-resourcing of healthcare at Japan bases. Are any military 
treatment facilities in Japan trauma certified and what levels of 
emergency treatment are available at urgent care clinics?
    Mr. Martinez-Lopez. There are no trauma-certified military medical 
treatment facilities (MTF) in Japan.

    2. Senator Warren. Assistant Secretary Martinez-Lopez, how many 
cases have you had in the past 5 years where DOD-affiliated civilians 
or contractors have had to request leave in order to get access to 
medical services that were not available to them in Japan?
    Mr. Martinez-Lopez. Unfortunately, there is no mechanism within the 
Department to track or maintain awareness of medical leave for DOD-
affiliated civilians or contractors. The Department does not collect 
data for the rationale of sick leave requests for travel or otherwise.

    3. Senator Warren. Assistant Secretary Martinez-Lopez, is DOD 
currently evaluating or has it previously evaluated reducing access for 
DOD-affiliated civilians and contractors at military treatment 
facilities at other bases around the world? If so, which bases? Please 
specify whether these evaluations have been completed, their findings, 
and which are still ongoing.
    Mr. Martinez-Lopez. Section 199.17 of Title 32, Code of Federal 
Regulations provides direction regarding space available care for 
personnel who are not Active Duty servicemembers or their family 
members when outside of the continental United States (OCONUS). To 
increase the efficient use of OCONUS MTFs, these MTFs are expected to 
offer any additional appointments available to non-Active Duty 
servicemembers and their family members, if the care requested is 
within the scope of the MTF's capabilities and the MTF can safely 
provide care.

    4. Senator Warren. Assistant Secretary Martinez-Lopez, I sent a 
letter to the Defense Health Agency dated January 23, 2023 on this 
issue that was due on February 15, 2023. When can I expect a response?
    Mr. Martinez-Lopez. DHA apologizes for the delay in response. A 
response dated March 14, was mailed to your office. The Department is 
available to provide further information if needed.

    5. Senator Warren. Assistant Secretary Martinez-Lopez, what steps 
is DOD taking to evaluate how to better support DOD-affiliated 
civilians and contractors in healthcare at bases overseas?
    Mr. Martinez-Lopez. At the direction of the Acting Assistant 
Secretary of Defense for Health Affairs (ASD(HA)), the Defense Health 
Agency (DHA) issued a standard guidance memorandum on space-available 
care overseas on March 3, 2023, which supersedes all other DHA 
guidance. This guidance states that appointments not used for Active 
Duty servicemembers and their families may be used to provide space-
available care. The Office of the ASD(HA), working closely with other 
key stakeholders in the Department of Defense, is developing solutions 
to address the other concerns the Under Secretary and Acting Assistant 
Secretary heard while in Japan that lie outside the scope of space 
available care.
                  suicide prevention and mental health
    6. Senator Warren. Assistant Secretary Martinez-Lopez, DOD 
announced on March 16 that it would be implementing ten of the 
recommendations from the Suicide Prevention and Response Independent 
Review Committee (SPRIRC). What specific steps is DOD taking to 
implement each of these recommendations and when does it expect these 
recommendations to be implemented?
    Mr. Martinez-Lopez. The Secretary of Defense has provided direct 
guidance, including designating specific leadership for each of the 10 
recommendations and the authority under which the directed component is 
operating to implement the immediate response recommendations. The 
Under Secretaries of Defense for (Personnel & Readiness) and 
(Intelligence & Security) and Director, Defense Health Agency are 
already leveraging current authorities to rapidly implement the 
recommendations designated to them. In addition, information campaigns 
in support of other recommendations are in development.
    Finally, DOD has designated $8M funding in the President's Budget 
for fiscal year 24 to implement additional recommendations of the 
SPRIRC as well as designated the leadership of the Suicide Prevention 
Implementation Working Group to take these efforts into the second 
phase of implementation.

    7. Senator Warren. Assistant Secretary Martinez-Lopez, the SPRIRC 
report emphasizes the critical need to limit or reduce access to highly 
lethal methods for suicide. What steps are you taking to reduce access 
to these methods, particularly firearms, and which of the SPRIRC 
recommendations regarding lethal means reduction do you plan to 
implement?
    Mr. Martinez-Lopez. Lethal Means Safety has been and will remain a 
priority for the Department's suicide prevention efforts. While the 
Suicide Prevention and Response Independent Review Committee provided a 
number of recommendations supporting Lethal Means Safety, the 
Department is currently in the process of assessing these 
recommendations and developing implementation courses of action to 
present to the Secretary of Defense. Until the Secretary has reviewed 
the Department's proposed response, we cannot be certain of which of 
the recommendations regarding Lethal Means Safety will be implemented. 
With that said, firearms continue to be the primary method of suicide 
death for servicemembers, their spouses, and dependents.
    Suicide attempts using a firearm are overwhelmingly more likely to 
result in death than other methods. Further, research has found that 
servicemembers at risk for suicide frequently practice unsafe firearm 
storage, and individuals with ready access to a firearm are at 
increased risk of dying by suicide. In addition, putting time and space 
between a person in crisis and their access to lethal means has been 
shown to be an effective way to prevent suicide.
    Given such evidence, promoting lethal means safety is a critical 
component of suicide prevention efforts within the Department and 
across the Federal Government. This is reflected in the White House 
strategy for military and veteran suicide, which was published in 
November 2021, and guides comprehensive, interagency suicide prevention 
efforts and draws attention to the need for identifying and promoting 
lethal means safety practices, such as safe storage of firearms and 
medication.
    Within the Department, the Deputy Secretary of Defense directed a 
Department-wide effort to promote lethal means safety through plans 
developed by each of the Military Services, tailored to the needs of 
their servicemembers. These plans were built around the Lethal Means 
Safety suite of tools and highlight the importance of safe firearm and 
medication storage practices in mitigating suicide risk through 
messaging and resources. This suite includes a guide to lethal means 
safety for servicemembers and their families, sample public messaging, 
communications guidance for leaders and service providers, and a 
toolkit intended to help support collaborations with firearm retailers, 
disseminate suicide prevention information, and promote safe firearm 
storage.
    Another key component of the Department's Lethal Means Safety 
effort is the continued implementation, monitoring, and evaluation of 
Counseling on Access to Lethal Means (CALM) training. CALM training 
aims to increase awareness of risk factors for suicide and to increase 
safe storage practices of lethal means among servicemembers. CALM 
prepares non-medical military support providers with counseling 
strategies to promote safe use and storage of firearms for individuals 
at risk for suicide. Since 2019, more than 2,000 non-medical providers, 
including Military and Family Life Counselors, have participated in 
CALM training. The Department is further developing a modified version 
of CALM training that will be available online. In addition, in August 
2022, the Defense Health Agency developed and mandated training on 
lethal means safety for all of its health care providers--those in 
behavioral health as well those in other specialties.
    Additionally, by promoting lethal means safety early in a 
servicemember's career, the Department aims to enhance early adoption 
of safe firearm storage practices. The Department is sponsoring 
research to identify best practices for integrating lethal means safety 
into early military career training, such as basic recruit training and 
Officer Candidate School.
    The Department will continue to assess current DOD and Service-
level lethal means safety (LMS) policies to better understand how these 
policies are implemented to assist in identifying and resolving any 
gaps and ensuring consistency throughout organizational levels.

    8. Senator Warren. Assistant Secretary Martinez-Lopez, can you 
please provide data on the breakdown of suicides by service over the 
past 5 years?
    Mr. Martinez-Lopez. The Department publishes suicide data quarterly 
for each Component and Service on a public facing web site for the 
Defense Suicide Prevention Office. The Quarterly Suicide Report (QSR) 
provides the most up-to-date counts of all suicide deaths (confirmed 
and pending) for each Calendar Year (CY) quarter. Suicide numbers are 
reported to DSPO by the Armed Forces Medical Examiner System (AFMES). 
The counts are reconciled with the Military Services to ensure the most 
accurate information is reported. The last report (though Quarter 4 of 
CY 2022) shows the number of servicemembers who died by suicide for the 
last 5 years. The number of suicide deaths in the current report are 
preliminary and subject to change, as previously unknown cases are 
reported and some known cases are further investigated.
      
    
    
      
    9. Senator Warren. Assistant Secretary Martinez-Lopez, what mental 
health services do you provide to DOD-affiliated civilians and 
contractors and what steps do you plan to take to support those 
communities in suicide prevention?
    Mr. Martinez-Lopez. DOD civilians and contractors, who are also 
beneficiaries of the Military Health System and enrolled to TRICARE, 
have access to all mental health or behavioral health services 
available to their enrollment category. Generally, the Department does 
not provide treatment for non-beneficiaries in its MTFs or private care 
sector unless it is authorized by statute, legislation, or memorandum 
of agreement. A percentage of DOD civilians and contract employees are 
non-beneficiaries. However, in a crisis such as a person with suicidal 
ideation, a behavioral health provider at a local MTF will often 
conduct a safety assessment and then refer the individual 
appropriately. That would be the extent of behavioral health 
intervention for DOD-affiliated civilians and contractors who are non-
beneficiaries.
    DOD civilians are also eligible for the DOD Employee Assistance 
Program (EAP). EAP provides short-term behavioral health counseling, 
safety assessment for high risk individuals and referral to appropriate 
care. The EAP is not a substitute for the long-term behavioral health 
counseling that can be obtain from the civilian employee' s health 
insurance. The coverage of behavioral health services for DOD 
contractors is based on the terms of their contracts.

    10. Senator Warren. Assistant Secretary Martinez-Lopez, what steps 
are DOD and the Services taking to address concerns about drug 
overdoses among Active Duty servicemembers?
    Mr. Martinez-Lopez. The Department has comprehensive, evidence-
based strategies to address and prevent drug misuse and overdose 
utilizing a combination of prevention, effective treatment, and harm 
reduction programs. Our robust, randomized drug testing program 
historically has helped keep illicit drug misuse at very low levels and 
was one of the first workplace drug testing programs to include 
fentanyl testing.
    We recognize that drug misuse is dynamic and changes over time, 
which is why our policies and programs maintain flexibility to adapt to 
these changes. We continue work to identify installations and regional 
areas with higher drug positive rates, to include high fentanyl 
positive rates and high polydrug rates. Our efforts increase focus on 
these areas, to include drug testing, anti-drug prevention and 
education efforts, and healthcare resources.
    Additionally, the Department aims to dispel the stigma of seeking 
services for concerns related to problematic substance use by 
implementing notification practices that are consistent with DODI 
6490.08, ``Command Notification to Dispel Stigma.'' Further, the DOD 
promotes embedded mental health and integrated primary care mental 
health programs, which address stigma associated with mental health 
treatment by increasing immediate access and improving mental health 
literacy. These programs place mental health resources in close 
proximity to servicemembers, reducing barriers to accessing care.
    Addressing drug abuse and preventing overdose deaths in our force 
will continue to be a high priority for the Department.

    11. Senator Warren. Assistant Secretary Martinez-Lopez, how does 
DOD and the services plan to use SPRIRC's recommendation to develop a 
misuse prevention policy (recommendation 5.1.2) and align substance 
abuse treatment programs with behavioral health treatment programs 
(recommendation 6.26) to help address substance use among 
servicemembers?
    Mr. Martinez-Lopez. Following the SPRIRC report and its 
recommendations, Sec. Austin signed a memorandum directing a two-phase 
approach to drive progress on implementation.
    In the first phase, Sec. Austin's immediate actions include 
improvements to access behavioral and mental healthcare--with a focus 
on rapid and effective implementation--such as expediting hiring for 
behavioral health professionals, expanding opportunities to treat 
common mental health conditions in primary care, and improved 
utilization of behavioral health technicians.
    In the second phase, the Under Secretary of Defense for Personnel 
and Readiness established an Implementation Working Group (IWG) to 
assess feasibility of implementing each of the remaining SPRIRC 
recommendations; identify any program, policy, resourcing, barriers, 
and timeline matters that may need to be addressed, as appropriate; 
and, to the extent applicable, identify recommendations that can be 
synchronized with other prevention activities that resulted from the 
earlier Independent Review Commission on Sexual Assault in the 
Military. Once the Secretary reviews and approves any recommendations 
from the IWG, the Department will update Congress on new actions, 
including those that may relate to substance abuse treatment and 
behavioral health matters.
    While we recognize that suicide has no single cause--and no single 
preventative action, treatment, or cure will eliminate every individual 
suicide death--we will exhaust every effort to promote the wellness, 
health, and morale of our Total Force.

    12. Senator Warren. Under Secretary Cisneros, is DOD coordinating 
with the Substance Abuse and Mental Health Services Administration to 
align substance abuse treatment programs with behavioral health 
treatment programs (recommendation 6.26)?
    Mr. Cisneros. Secretary of Defense Lloyd Austin is directing 
multiple immediate actions following the SPRIRC's recommendations and 
establishing a ``Suicide Prevention Implementation Working Group'' 
(IWG). Immediate actions focus on improving access to mental health 
care, through actions such as expediting hiring for behavioral health 
professionals, expanding opportunities to treat common mental health 
conditions in primary care, and improved utilization of behavioral 
health technicians. The IWG is coordinating with stakeholders from 
across the Department, including the Services, to evaluate the 
remaining recommendations of the SPRIRC. Many of the Department's 
subject matter experts on substance abuse matters routinely work with 
or leverage best practices from colleagues from the Substance Abuse and 
Mental Health Services Administration. The Secretary has directed the 
working group to give full consideration to all other SPRIRC 
recommendations, and the IWG will provide him with recommendations on 
the feasibility and impact of each one in an Implementation Plan due to 
the Secretary by June 2, 2023.

    13. Senator Warren. Under Secretary Cisneros, in the DOD's response 
letter on February 23, you noted significant installation trends with 
the 31 fatal overdoses at Fort Bragg, 16 at Fort Hood, and 13 at both 
Fort Bliss and San Diego. Are there specific steps DOD is taking to 
address response efforts at installations with the highest fatal 
overdoses?
    Mr. Cisneros. As part of ongoing efforts to refine and improve the 
DOD Overdose Prevention Strategy, the Department continues to establish 
more expedient monitoring of fatal and nonfatal drug overdoses, drug 
testing and drug positive rates with associated demographics at the 
DOD, Service, regional, State and installation level. This will better 
allow the Department to communicate trends, life-saving prevention and 
drug related messaging at the DOD, installation, and command levels and 
help mobilize prevention, education, outreach and healthcare resources 
to high-risk regions and installations.

    14. Senator Warren. Under Secretary Cisneros, in the DOD's response 
letter on February 23, you mentioned that naloxone or other FDA and 
enterprise-approved opioid antagonists are available to outpatients 
considered at risk for opioid overdose. What does the DOD consider at 
risk?
    Mr. Cisneros. DOD defines ``high-risk'' as meeting any one the 
following criteria: 1) patients who have been treated with opioid 
therapy (excluding Tramadol) for at least 90 days in the past 180 days; 
2) patients who are being treated with a combination of both opioid 
therapy and benzodiazepines (for at least 2 days overlap in the given 
month); 3) patients who are taking a high-dose of opioid therapy 
(technically defined as a ``Morphine Equivalent Daily Dose'' greater 
than or equal to 50); or 4) patients who score greater than 32 on the 
Risk Index for Overdose or Serious Opioid-induced Respiratory 
Depression (RIOSORD). The RIOSORD score is a published, validated 
measure that is assigned based on multiple factors, such as recent 
treatment or hospitalization for certain medical and mental health 
conditions; types of opioids and other medications prescribed; and the 
patient's current dose of opioid therapy.

    15. Senator Warren. Under Secretary Cisneros, is DOD considering 
increasing the availability of naloxone?
    Mr. Cisneros. Naloxone is already available to any ADSM or Tricare 
beneficiary who 1) meets high-risk criteria, 2) in accordance with the 
provider's clinical judgment, or 3) at the request of the patient. DHA 
guidance specifying when and how naloxone should be dispensed to 
patients is contained in DHA-Procedural Instruction 6025.07 ``Naloxone 
Prescribing and Dispensing by Pharmacists in Medical Treatment 
Facilities (MTFs)'', and DHA-Administrative Instruction 6025.08 ``Pain 
management and Opioid Safety in Military Medical Treatment 
Facilities.''

    16. Senator Warren. Under Secretary Cisneros, is the DOD looking at 
making fentanyl test strips and other harm reduction materials 
available?
    Mr. Cisneros. The Department does not make fentanyl strips 
available, but has developed NARCAN distribution policies. DOD is 
constantly evaluating changes to policy considering the commercial 
availability of the fentanyl test strips in the future.

    17. Senator Warren. Under Secretary Cisneros, does the DOD survey 
whether a friend or family member of the servicemember is struggling 
with their mental health or a substance use order?
    Mr. Cisneros. We are not currently aware of any organization wide 
health-related surveys that specifically ask about the mental health 
and/or substance use disorder struggles of a servicemember's friend or 
family member. This includes individual surveys, like the 
servicemembers Periodic Health Assessment and population surveys like 
the DOD Health Related Behaviors Survey (HRBS).

    18. Senator Warren. Under Secretary Cisneros, is DOD considering 
any changes to improve the drug take back program and help address 
overdoses among servicemembers?
    Mr. Cisneros. DOD does not plan to adjust the current Drug Take 
Back program. The program is extensively available to our beneficiaries 
and covers all drug take back options with over 13,000 collection 
receptacles at MTFs and pre-paid mail-back envelopes. These are 
provided at no cost to all beneficiaries. Additionally, as of April 3, 
2023, the United States Food and Drug Administration is requiring 
manufacturers of opioid analgesics dispensed in outpatient settings to 
make prepaid mail-back envelops available to outpatient pharmacies and 
other dispensers as an additional opioid analgesic disposal option for 
patients.
        junior reserve officers' training corps (jrotc) program
    19. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, in a letter sent to my office on March 14 the Department of 
Defense wrote that all of the memorandums of agreement for the JROTC 
program are under review. Does that review include adding language 
prohibiting programs from enrolling students without their consent or 
prohibiting mandatory participation?
    Assistant Secretary Schaefer. In coordination with the Secretaries 
of the Military Departments, the Office of the Under Secretary of 
Defense for Personnel and Readiness is drafting a standardized Junior 
Reserve Officers' Training Corps (JROTC) memorandum of agreement that 
will include language that student participation in the program shall 
be strictly voluntary.
    Mr. Parker. Yes, the Department of the Navy, in coordination with 
the Office of Secretary of Defense and the other Services' Secretaries, 
will issue a standardized memorandum of agreement that will include 
language prohibiting programs from enrolling students without their 
consent and prohibiting mandatory participation.
    Mr. Wagner. Yes. The current AFJROTC Memorandum of Agreement (MOA) 
already contains language indicating the program is to be voluntary. 
This is stated multiple times and is signed by each School District 
Superintendent. OSD is currently revising a uniform MOA for all DOD 
JROTC programs, and we understand that this version will include this 
same language to make clear to schools that this is a voluntary 
program.

    20. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, when do you think your memorandums of agreement for JROTC 
programs will be complete?
    Ms. Schaefer. In coordination with the Secretaries of the Military 
Departments, the Office of the Under Secretary of Defense for Personnel 
and Readiness is drafting a standardized Junior Reserve Officers' 
Training Corps (JROTC) memorandum of agreement. Once complete, the Army 
will adhere to its content.
    Mr. Parker. The revised standardized memorandum of agreement, is 
currently in the final development stage, pending Office of Management 
and Budget (OMB) approval.
    Mr. Wagner. OSD is drafting and coordinating the new standardized 
MOAs. They have indicated a timeline of July 2023 for completion 
subject to OPM approval. Once OSD provides the Department of the Air 
Force an approved standardized MOA, within 2 weeks, we will add 
Department specific additions (e.g., minimum required storage space, 
access to an appropriately sized marching practice area) and begin the 
signature process with school superintendents. HQ AFJROTC expects all 
MOAs to be formally signed by the associated school district 
superintendents within 6 months given our presence at approximately 600 
different school districts.

    21. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, will you provide copies of the revised memorandums of agreement 
for JROTC programs to the Committee?
    Ms. Schaefer. In coordination with the Secretaries of the Military 
Departments, the Office of the Under Secretary of Defense for Personnel 
and Readiness is drafting a standardized Junior Reserve Officers' 
Training Corps (JROTC) memorandum of agreement. Once complete, the Army 
will provide copies.
    Mr. Parker. Yes, copies of the revised memorandum of agreement will 
be provided to the Committee.
    Mr. Wagner. Once the revised standardized MOAs are finalized, and 
Department specific additions made, we will provide a copy as 
requested.

    22. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, do memorandums of agreement include any penalties if a school 
does not allow a student to transfer from the JROTC elective?
    Ms. Schaefer. The Army does not influence schools on their 
enrollment decisions. The Army does not have a policy requiring or 
prohibiting automatic enrollment into JROTC classes except for military 
secondary educational institutions, at which JROTC enrollment is a 
prerequisite that students/parents agree to prior to attendance. While 
the Army does not endorse mandatory enrollment, we have always 
recognized and believed that it was in the best interest of the program 
to allow local school officials and parents to decide what works best 
in their communities.
    Mr. Parker. The current memorandum of agreement (MOA) does not 
include any penalties for schools that do not allow a student to 
transfer from the JROTC elective. However, the revised MOA will 
prohibit schools from enrolling students without their consent and 
prohibit mandatory participation. The Department of the Navy's JROTC 
program will work with schools and school districts' administrations to 
adhere to respective schools' enrollment policies to transfer students 
who wish to disenroll from JROTC academic courses to another academic 
course to meet high school graduation requirements.
    Mr. Wagner. Yes, schools that do not comply with this requirement 
will be placed on probation until corrected. HQ AFJROTC does follow up 
to ensure corrective actions have taken place. If the school chooses 
not to comply (disregards the MOA), AFJROTC will notify the school 
district the unit will be closed. To date, however, AFJROTC does not 
have any indication of non-voluntary enrollments.

    23. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, the Department of Defense's March 14 response said ``the 
military services inform JROTC instructors during new instructor 
training that they should not solicit donations from any corporate 
entities or local businesses.'' What is the penalty if an instructor 
solicits funds in violation of this policy?
    Ms. Schaefer. Army JROTC programs are allowed to accept funds from 
outside entities to support the JROTC program/unit. U.S. Army Cadet 
Command (USACC) does not have a written policy regarding JROTC 
instructors supporting fundraising for outside entities; that activity 
would be covered by the local school/district policy.
    USACC Regulation 145-2 governs JROTC instructors' fundraising 
activities to support the JROTC unit. It states:
    4-10. Fundraising Activities
    a. Fundraising in JROTC serves to provide goods and services that 
supplement the educational, curricular, and co-curricular activities of 
the unit. All fundraising activities are controlled by the respective 
schools and must be conducted in accordance with their rules and 
requirements. The following are guidelines per this regulation:
    (1) Cadet participation is voluntary and grades will not be 
affected by participation or lack thereof.
    (2) Wearing the Army uniform is strictly prohibited.
    (3) Salaries, staff development, and in-service activities are not 
allowable expenditures.
    (4) Government equipment or funds cannot be used in fundraising. 
(p. 47)
    If a JROTC instructor were to violate the terms of USACC Regulation 
142-5, the Army, in coordination with the local school/district, would 
review the facts and take appropriate administrative action.
    Mr. Parker. All policy violations are reviewed on a case-by-case 
basis in partnership with the host school's administration. Instructors 
found in violation of this policy are subject to unsatisfactory marks 
on their annual performance evaluation, which could result in the 
instructor being placed in a probationary status. The instructor is 
also subject to having their certification suspended.
    Mr. Wagner. AFJROTC Instruction defines the policy on soliciting 
donations. Any substantiated policy violation by an instructor can lead 
to suspension, probation, or decertification and removal.

    24. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, how many JROTC instructors have violated the policy that 
prohibits soliciting donations from any corporate entities or local 
businesses in the past 10 years?
    Assistant Secretary Schaefer. The Army does not prohibit soliciting 
donations from corporate entities or local businesses. Schools apply 
for outside funds based on local school/district policies. JROTC 
instructors who submit funding requests do so as employees of their 
schools/districts.
    Mr. Parker. The Department of the Navy has not received any reports 
of JROTC instructors violating the policy in the past 10 years.
    Mr. Wagner. None. The Air Force has no records indicating 
violations of this policy over the last 10 years. HQ AFJROTC has spent 
significant amounts of energy on providing instructor training in this 
area. Additionally, this topic is part of the HQ AFJROTC inspection 
checklist.

    25. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, the Department of Defense's March 14 response said memorandums 
of agreement ``are under review and will clarify fundraising 
guidelines.'' When will that review be complete?
    Ms. Schaefer. In coordination with the Secretaries of the Military 
Departments, the Office of the Under Secretary of Defense for Personnel 
and Readiness is drafting a standardized Junior Reserve Officers' 
Training Corps (JROTC) memorandum of agreement that will include 
language clarifying fundraising guidelines.
    Mr. Parker. The review of the memorandum of agreement as it relates 
to fundraising guidelines is complete.
    Mr. Wagner. OSD is drafting and coordinating the new standardized 
MOAs. They have indicated a timeline of July 2023 for completion 
subject to OPM approval.

    26. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, will the review of memorandums of agreement include evaluating 
the voluntary donation policy?
    Ms. Schaefer. In coordination with the Secretaries of the Military 
Departments, the Office of the Under Secretary of Defense for Personnel 
and Readiness is drafting a standardized Junior Reserve Officers' 
Training Corps (JROTC) memorandum of agreement which includes 
evaluating the voluntary donation policy.
    Mr. Parker. Yes, the review includes evaluating the voluntary 
donation policy.
    Mr. Wagner. OSD is drafting and coordinating the new standardized 
MOAs. All policies to include the voluntary donation policy are being 
reviewed during the development of the standardized MOA.

    27. Senator Warren. Assistant Secretary Wagner, what is the Air 
Force's policy to decertify a school under the JROTC program?
    Mr. Wagner. AFJROTC uses the term deactivation in reference to 
closing schools and uses the term decertify in reference to 
decertifying instructors. HQ AFJROTC attempts to work with schools that 
are non-compliant by placing them on probation and giving them the 
opportunity to correct the issue. Continued non-compliance with the MOA 
will result in deactivation and closure of the unit.

    28. Senator Warren. Assistant Secretary Wagner, how many times 
would a school have to fail to report sexual assault or sexual 
harassment by a JROTC instructor to be considered a violation of the 
memorandum of agreement?
    Mr. Wagner. A single failure to report is considered a violation 
and not in compliance with the MOA.

    29. Senator Warren. Assistant Secretary Wagner, how many times has 
the Air Force decertified a school for failing to report sexual assault 
or sexual harassment?
    Mr. Wagner. To date, HQ AFJROTC has not deactivated any schools for 
failing to report occurrences of sexual assault or sexual harassment. 
The HQ AFJROTC program has been notified of 26 sexual misconduct 
allegations occurring over the last decade. In every case the 
instructor has been decertified by HQ AFJROTC.

    30. Senator Warren. Assistant Secretary Schaefer, Parker, and 
Wagner, how many times has your service decertified a JROTC program in 
the past 10 years?
    Assistant Secretary Schaefer. The Army certifies and decertifies 
individual instructors, not schools or JROTC programs. In the past 10 
years, the Army has not closed any JROTC programs for cause, although 
school officials may request that the Army close a program (usually for 
financial reasons).
    Mr. Parker. The Department of the Navy does not decertify programs, 
but instead mutually disestablish the unit. Over the past 10 years, the 
DON has disestablished a total of 63 units (38 NJROTC/NNDCC units and 
25 MCJROTC units). The disestablishment of the 63 units was due to the 
host schools' inability to maintain the statutory enrollment 
requirement.
    Mr. Wagner. AFJROTC uses the term deactivation when closing schools 
and uses the term decertify when decertifying instructors. From 1 July 
2013 to 20 April 2023, the Air Force has deactivated 119 AFJROTC 
programs. The primary two reasons for these deactivations include 
failure of the school to maintain viability (minimum # of cadets) or 
maintain the minimum # of instructors.
                       servicemember medical debt
    31. Senator Warren. Assistant Secretary Martinez-Lopez, does DOD 
currently collect any data about the incidence of medical debt among 
servicemembers and their families?
    Mr. Martinez-Lopez. The TRICARE program does not currently collect 
data on medical debt. However, there are systems in place to assist 
servicemembers and their families with medical claims that should have 
been paid.
    DOD TRICARE customer service representatives assist with medical 
debt issues that are self-reported by affected servicemembers and their 
families.
    TRICARE policy grants specific urgency to medical debts currently 
in collections. DOD has identified Debt Collection Assistance Officers 
(DCAOs), who work with the Managed Care Support Contractors (MCSC) to 
resolve claims that should have been paid under the TRICARE benefit.
    DHA policy requires DCAOs to log cases into DHA's Assistance 
Reporting Tool (ART). Debt Collection cases in ART do not account for 
all incidences of medical debt amount servicemembers and families.
    There are multiple ways for servicemembers to receive claims 
assistance from the government and the managed care support 
contractors. There is no central system to definitively capture all 
issues.

    32. Senator Warren. Assistant Secretary Martinez-Lopez, if so, what 
types of data in question 1 does DOD collect and what do these data 
reveal about the extent of medical debt among servicemembers and their 
families, including:

      (i)  What types of treatments did servicemembers or their 
families receive that led to medical debt?;

     (ii)  What types of providers did servicemembers or their families 
see that led to medical debt?; and

     (iii)  Is DOD gathering data about the types of medical debt 
collection practices such as lawsuits, garnishing wages, and credit 
reporting?

    Mr. Martinez-Lopez. TRICARE collects self-reported debt collection 
items resulting from claim denials and recoupments by a TRICARE MCSC or 
from medical claims never submitted to TRICARE for processing.
    The data is not complete enough to accurately report the ``extent'' 
or amount of medical debt among servicemembers and their families.
    The ``average amount of medical debt'' among servicemembers cannot 
be accurately calculated due to the numerous venues from which to seek 
assistance, and the reliance of self-reporting.
      (i)  ``Types of treatments'' is not a tracked category. The notes 
within individual ART cases may have additional details on the types of 
treatments.
     (ii)  ``Types of providers,'' by specialty or status, is not a 
tracked category. Notes within individual ART cases may have additional 
details on the provider type or specialty involved.
     (iii)  The TRICARE benefit program does not collect data regarding 
the types of medical debt collection practices. DOD TRICARE Beneficiary 
Counselors and DCAOs assist beneficiaries on a case-by-case basis in 
resolving TRICARE medical claims issues that result in medical bills 
being sent to collections, or wage garnishments from the Department of 
Treasury due to unpaid medical claims that should have been submitted 
to TRICARE or paid as a covered benefit.

    33. Senator Warren. Assistant Secretary Martinez-Lopez, if DOD does 
not collect the data referenced in question 1 and 2, what would be 
required for DOD to begin collecting these data?
    Mr. Martinez-Lopez. This data would have to be self-reported by 
beneficiaries. DOD would need to establish a centralized reporting 
system or data base where types of medical debt collection practices 
would be recorded. All Military Health System (MHS) personnel who 
assist in resolving TRICARE beneficiary claims issues would need 
access. Additionally, the MCSCs would need a contract requirement to 
track and label medical debt collection practices in greater detail.

    34. Senator Warren. Under Secretary Cisneros, does DOD consider 
medical debt when making hiring decisions or when considering 
promotions for servicemembers?
    Mr. Cisneros. Individual military personnel are promoted on the 
basis of merit, their manner of performance to date and their ability 
to serve in the higher grade. Debts, including medical debts, are not 
taken into consideration when promotions are being considered.
    Additionally, medical debt is not a consideration for promotions 
for general and flag officers.
    With respect to the hiring of civilian employees, medical debt is 
not taken into consideration. DOD components provide information about 
the availability of healthcare services in the host nation as well as 
space available care, as appropriate, in vacancy announcements and/or 
provide such information when making a tentative job offer. Such 
information allows selectees to make informed decisions about personal 
and/or family healthcare needs and costs prior to accepting a final job 
offer. Medical conditions nor health related issues do not factor into 
hiring decisions, except where there are physical requirements for 
certain positions.

    35. Senator Warren. Under Secretary Cisneros, if DOD does consider 
medical debt when making hiring decisions or when considering 
promotions for servicemembers, how many servicemembers have been denied 
promotions or a security clearance as a result of outstanding medical 
debt?
    Mr. Cisneros. With respect to the hiring of civilian employees, 
medical debt is not taken into consideration. Individual military 
personnel are promoted on the basis of merit, their manner of 
performance to date and their ability to serve in the higher grade. 
Debts, including medical debts, are not taken into consideration when 
promotions are being considered. Additionally, there have been no 
general or flag officers that have been denied promotions due to an 
outstanding medical debt because this is not a consideration of a 
promotion selection board.

    36. Senator Warren. Under Secretary Cisneros, if DOD does consider 
medical debt when making hiring decisions or when considering 
promotions for servicemembers, how many prospective servicemembers have 
been prevented from enlisting due to outstanding medical debt?
    Mr. Cisneros. With respect to the hiring of civilian employees, 
medical debt is not taken into consideration. Individual military 
personnel are promoted on the basis of merit: their manner of 
performance to date and their ability to serve in the higher grade. 
Debts, including medical debts, are not taken into consideration when 
promotions are being considered. Outstanding medical debts would not, 
in and of itself, disqualify someone from enlisting in the military. An 
individual's financial health is generally reviewed when an individual 
discloses a bankruptcy or is trying to enlist with a large family. In 
these cases, a broader assessment of the individual may be conducted. 
More significantly, any significant debt could make an individual a 
greater security risk and as such this type of debt would be more 
likely to impact someone's ability to get an advanced security 
clearance than it would their eligibility to join.

    37. Senator Warren. Assistant Secretary Martinez-Lopez, how has DOD 
engaged with medical providers or third-party billing companies to 
ensure medical claims for servicemembers insured through TRICARE are 
accurately processed? What has DOD discovered about the extent of these 
problems and what steps has DOD taken to address them?
    Mr. Martinez-Lopez. The DHA's TRICARE Health Plan Division is 
responsible for oversight, management, and performance assessment of 
the TRICARE MCSCs.
    Subject matter experts with extensive experience and knowledge of 
the TRICARE program, health care administration, and specific topics 
such as medical management, claims and claims processing, networks, 
provider relations, customer service, enrollment, and all contract 
subject areas conduct routine oversight and assessment of contractor 
performance of requirements and metrics.
    Oversight and performance assessment includes onsite reviews of 
contractors' systems and processes, review of contract required 
performance reports, and monitoring of inquiries or concerns regarding 
contractor performance.
    All contract oversight and performance assessment activities and 
findings are documented, reporting to the Contracting Officers' 
Representatives and to the Contracting Officers.
    The Contracting Officers utilize the contract oversight and 
performance assessment documentation to complete annual performance 
documentation in the Federal Contract Performance Assessment Reporting 
System.
    Normal claims processing would not necessarily involve medical 
debt, as the possibility of medical debt is usually outside of the 
covered benefit claim or is the result of other issues causing a 
servicemember to incur debt.
    If there are additional services, or out-of-network charges 
resulting from a decision by the beneficiary to seek care outside the 
normal TRICARE benefit, there could be a ``balance bill,'' which is an 
amount owed above and beyond a TRICARE claim paid.
    If a Military Service miscategorized the eligibility of a 
Servicemember, for example when the status of a retiree is not updated 
in the Defense Eligibility Enrollment Reporting System (DEERS) and the 
person continues to receive care as if an Active Duty servicemember 
(ADSM), once the record is corrected, all claims paid for services 
rendered are subject to recoupment and potential debt collection.
    If an ADSM/Active Duty Family Member (ADFM) seeks any care in the 
private sector that is not a TRICARE covered benefit, or care from a 
non-network provider that requires balance billing, the ADSM/ADFM is 
responsible for all charges outside the TRICARE-covered benefits and if 
they fail to pay and had signed documents accepting responsibility to 
pay, the charges are likely to get sent to collections.
    If an ADSM has medical debt, the DCAOs have specific policies and 
procedures to address medical debt and support beneficiaries.
    Per TRICARE policy, there are specific policies and procedures for 
situations where a covered benefit that would normally be paid by 
TRICARE is also covered by another insurance company. This typically 
occurs in motor vehicle accidents involving personal injury, which are 
also covered by property and casualty insurance companies.
    In these situations, the property and casualty company is a third 
party liable for the cost of the medical care, and TRICARE is required 
by statute to have the third party pay for the medical services.
    If TRICARE has already paid for the medical care, recovery of the 
costs must be made from the third party or from the beneficiary if the 
third party has already paid for the services.
    Third Party Liability (TPL) Recovery is the responsibility of the 
Uniformed Services Claims Officers (USCOs). The TRICARE MCSCs are 
responsible for making a preliminary investigation of all potential 
third-party recoveries.
    Any medical claim with specific diagnosis codes defined by TRICARE 
and having a potential TRICARE liability exceeding $500, shall be 
considered a potential third-party claim and shall be developed with 
the questionnaire ``Statement of personal Injury--Possible Third Party 
Liability'' (DD Form 2527).
    If the enrollee fails to submit a completed DD Form 2527 within 35 
days when requested by the MCSC, the contractor will deny the claim.
    Any claims which appear to be possible third-party claims shall be 
referred to the USCO for determination and recovery action, if 
appropriate.
    Education of beneficiaries, private sector care providers, and MHS 
staff and providers on third party payment responsibility and recovery 
is accomplished through a collaborative effort between DHA 
Communications and the MCSCs.
    The Government furnishes all printed educational materials, except 
for region-specific provider education materials.
    The MCSCs provide an outreach and education program on TRICARE 
requirements for all network and TRICARE-authorized providers that 
includes education on applicable TRICARE program requirements, 
policies, and procedures.
    MCSC outreach and education includes direct interactions with 
network and TRICARE authorized providers and information provided via 
web pages, TRICARE Provider Handbooks, and during monthly TRICARE 
webinars.
    Published by the TRICARE overseas contractor and each TRICARE 
regional contractor, the Provider Handbook includes information on 
claims submission, reimbursement, how to avoid collection activities, 
and the TRICARE DCAO program.
    Providers may also call the Customer Call Centers or Provider 
Relations for questions regarding TRICARE reimbursement and third-party 
billing.
    In response to what DOD has discovered about the extent of these 
problems and the steps DOD has taken to address them, the TRICARE 
Health Plans Division's experience with TPL or billing issues with the 
MCSCs concluded that many of the problems are tied to beneficiaries 
and/or providers not understanding their role in the billing process.
    Many cases sent to collections occur because there is no submitted 
claim on file.
    There are multiple reasons that contribute to cases being sent to 
collections, including patient failure to pay their co-payment or other 
balance due (which is a beneficiary responsibility), Network and 
TRICARE-authorized providers not following balance billing rules for 
TRICARE beneficiaries, Other Health Insurance Explanation of Benefit is 
missing, the required TPL form not being submitted, and missing medical 
documentation.
    Additional reasons for cases being sent to collections include the 
beneficiary may have chosen to see a non-network provider or non-
TRICARE authorized provider or decided to be seen for a Non-Covered 
Service.
    While TRICARE Prime-enrolled beneficiaries are permitted to use the 
Point of Service (POS) option, which allows them to see non-network 
providers, this choice comes with the beneficiary's responsibility of 
paying the higher POS charges above what TRICARE covers.
    To avoid beneficiary POS payments, the MCSCs encourage 
beneficiaries to follow TRICARE requirements for prior authorizations 
and to utilize the Network Provider Directories to select network 
providers, when available.

    38. Senator Warren. Under Secretary Cisneros, does DOD provide any 
services to help servicemembers address these billing concerns?
    Mr. Cisneros. DOD provides several avenues for servicemembers and 
their families to request assistance with unpaid medical claims that 
should have been covered by TRICARE.
    The TRICARE MCSCs are the first level of customer service for 
TRICARE claims issues.
    DOD TRICARE customer service representatives, most commonly those 
titled as Beneficiary Counseling and Assistance Coordinators (BCACs), 
are also available to assist with self-reported medical debt issues.
    TRICARE policy grants specific urgency to medical debts currently 
in collections. DOD has identified DCAOs, who work with the MCSCs to 
resolve claims that should have been paid under the TRICARE benefit. 
BCAC and DCAO essential duties are outlined in DHA-PI 6015.02.

    39. Senator Warren. Under Secretary Cisneros, military personnel 
have access to free legal assistance, including for consumer issues. Is 
this available to help servicemembers and their families address debt 
collection, including medical bills? If so, how many servicemembers and 
their families seek assistance for these issues?
    Mr. Cisneros. Yes, the Military Services provide free legal 
assistance to servicemembers, their families, retirees, and in some 
circumstances civilian employees in accordance with 10 U.S.C. 1044. 
Legal assistance attorneys provide counseling on a wide variety of 
issues, including retail purchases, identity theft and other fraud, 
motor vehicle purchase or repair, bankruptcy, consumer credit, debt 
collection (including medical bills), indebtedness, involuntary 
allotments and consumer protections provided by Federal, State or local 
law. Legal assistance attorneys may even contact and negotiate with 
creditors to resolve disputes. When appropriate, attorneys will refer 
clients to the Consumer Financial Protection Bureau or other relevant 
agencies. However, legal assistance attorneys are prohibited from 
providing assistance related to claims against the U.S. Government.
    Additionally, the Department provides mandatory financial literacy 
training to servicemembers across the military lifecycle, in accordance 
with 10 U.S.C. 992(a). Financial literacy topic areas and terminal 
learning objectives include ``Basic Finance'' and ``Understand the 
fundamentals and management of debt and credit,'' respectively. The 
Department's financial readiness programs also provide no-cost, on-
demand personal financial counseling, in accordance with 10 U.S.C. 
992(b), and supplemental education and resources to servicemembers and 
spouses.
    When eligible legal assistance clients request to speak to a legal 
assistance attorney, the client will identify the general subject area 
that they need help with, such as, consumer affairs, debt, taxation, 
domestic relations, or wills and eState planning. The subject area is 
annotated and statistically trackable, but unfortunately the specifics 
of each issue (such as type of debt) are not captured. The specifics of 
any legal issue oftentimes include sensitive, personal information and 
therefore left to be discussed privately between the attorney and the 
client within their attorney-client relationship. Therefore, 
identifying the specific type of debt issue, such as medical debt, is 
not available.
    In the past year, Military Service legal assistance attorneys have 
assisted with roughly 7,200 consumer and debt related legal issues 
across the Department. Specifically, over the past 12 months, the Army 
has assisted 1,910 clients (servicemembers, their families, and 
retirees) with ``consumer law'' issues and 262 clients with ``debt'' 
issues. The Department of the Air Force also tracks using both a 
``consumer affairs'' category and a ``personal finance/debt'' category. 
Over the past 12 months the Air Force and Space Force have collectively 
assisted 1,200 clients with consumer affairs-related issues and 759 
clients with personal finance/debt issues. The Navy and Marine Corps 
track debt issues under the broader category of ``consumer law'' and 
over the past 12 month the Navy has assisted approximately 2,400 
clients and the Marine Corps approximately 700 clients in this area. 
Coast Guard legal assistance attorneys have also assisted seven clients 
in the past 12 months with ``debt collection'' issues.

    40. Senator Warren. Assistant Secretary Martinez-Lopez, has DOD 
issued guidance to servicemembers and their families to ensure they are 
aware of potential billing concerns between TRICARE and private medical 
providers?
    Mr. Martinez-Lopez. TRICARE Health Plans Customer Service Education 
and Outreach (CSEO) does not provide guidance concerning potential 
billing issues between TRICARE and private medical providers. However, 
CSEO does oversee MCSC actions to facilitate resolution when 
beneficiaries encounter billing issues with private medical providers, 
on a case-by-case basis, when resolution cannot be accomplished at the 
lowest levels.

    41. Senator Warren. Assistant Secretary Martinez-Lopez, how many 
complaints has TRICARE received about billing concerns from private 
medical providers? Regarding these complaints:

      (i)  are the complaints evenly distributed across different 
provider types and geographies?;

     (ii)  how many of these complaints result in medical debt?; and

    (iii)  what steps does DOD take to ensure that servicemembers do 
not receive incorrect bills and that any missed payments for incorrect 
bills are not sent to collections?

    Mr. Martinez-Lopez. ``Billing concerns from private medical 
providers'' is not a category tracked by DOD, but the MCSCs provided 
the following:
    Out of 64.7 million claims processed between January 2022 and 
February 2023, the MCSCs combined received 200 complaints from private 
medical providers regarding billing concerns.

      (i)  The MCSCs reported that the 200 complaints received from 
private medical providers were evenly distributed across a wide variety 
of provider specialty types and were distributed across geographies as 
would be expected based on beneficiary populations.

     (ii)  ``Billing concerns from private medical providers'' is not a 
category tracked by DOD, and the MCSCs may not have visibility on which 
complaints result in medical debt. Separate from the 200 complaints the 
MCSCs received from private medical providers, they also assisted DHA 
DCAOs with cases related to beneficiary medical debt. From January 2022 
through February 2023, the MCSCs assisted the DCAOs with 4,273 cases 
related to beneficiaries sent to collections by a provider for a 
medical debt.

    (iii)  The TRICARE program does not ensure the accuracy of bills 
received from individual providers. The decision to send a bill to 
collections remains with individual medical providers, and neither the 
DOD nor the TRICARE MCSCs can prevent a provider for taking this 
action. There exists the small possibility that incorrect bills from 
providers may be the result of claims payment errors by TRICARE MCSCs. 
For claims received by TRICARE MCSCs, processing accuracy standards are 
as follows:

    TRICARE Operations Manual, Chapter 1, Section 3, Paragraph 1.6.1: 
Claim Payment Errors: The absolute value of the payment errors shall 
not exceed 2 percent of the total billed charges for the first two 
option periods. In all remaining option periods, the absolute value of 
the payment errors shall not exceed 1.75 percent of the total billed 
charges.

    42. Senator Warren. Assistant Secretary Martinez-Lopez, is DOD 
exploring efforts to ensure that servicemembers and their families get 
mail regardless of where they are stationed?
    Mr. Martinez-Lopez. DOD Instruction 4525.09 (Military Postal 
Service (MPS)) defines authorized patrons as, ``individuals authorized 
to use MPS postal services and mail program within and outside the 
United States, consistent with international agreements; laws; and 
Federal, USPS, GSA, and DOD regulations.''
    Over the last 850 years, MPS privileges expanded to 53 patron 
categories in 54 countries. While fiscal authority exists for each 
patron category, not all categories are authorized in every country 
because some host nation agreements do not permit them. Those patrons 
not authorized MPS privileges must use other means such as the host 
nation postal service.
    A 2020 Human Resources Command legal review prompted the Office of 
the Secretary of Defense (OSD) and the Military Postal Service Agency 
(MPSA) to conduct a fiscal and host nation agreement review to identify 
patrons authorized MPS privileges by host nation agreement and U.S. 
law. At the conclusion of this review, MPSA will recommend retention of 
patron categories authorized by international agreements, laws, and 
regulations to OSD and will publish an approved patrons list authorized 
MPS privileges by country.
                         workforce requirements
    43. Senator Warren. Under Secretary Cisneros, Assistant Secretary 
Schaefer, Assistant Secretary Parker, and Assistant Secretary Wagner, 
according to repeated Government Accountability Office findings, the 
management of services contracts remains on the Department's high-risk 
list in part because of the failure of the so-called Services 
Requirements Review Boards to similarly validate and prioritize the 
workload requirements for services contracts, whose main focus 
continues to be on year of execution acquisition planning for 
individual contact transactions rather that strategic requirements 
validation and prioritization. While some Military Departments may have 
at one time documented contract services requirements on their manpower 
documents, and there was an Enterprise Contractor Manpower Reporting 
Application (ECMRA), it's unclear how DOD can properly oversee the size 
and cost of the contractor workforce. What systems does the Department 
currently use to measure this workforce?
    Mr. Cisneros. When the Department contracts for services, it is not 
purchasing individual people to perform the work. Rather, the 
Department is purchasing performance outcomes and deliverables and the 
number of contractors performing the work may not be relevant. For 
example, different companies might approach the same task ways that 
would lend themselves to greater or fewer personnel. Assuming the 
successful execution of the contract's requirements, this overall 
difference in labor would not be pertinent to the Department.
    The Department focuses its efforts on getting the best value for 
taxpayer dollars by ensuring services performed meet DOD requirements 
efficiently and effectively. The Department continues to meet its 
statutory requirements from title 10, U.S.C. section 4505 via the 
annual submission of the Inventory of Contracts for Services, but it 
does not capture additional data points related to the number of 
contractor employees on contract for the Department for the reasons 
above.
    Ms. Schaefer. The Army does not track the number of service 
contractors as we do not contractbased on number of personnel; we 
contract based on the service required.
    Mr. Parker. The Department of the Navy does not currently collect 
contractor service workforce data, specifically, nor track the size and 
cost of such workforce other than through the Federal Procurement Data 
System (FPDS). The Department's position when contracting for services 
is that the procurement is for a product (performance outcomes and 
deliverables) and not the purchasing of service support from individual 
people. The number of contractors performing the work may not even be 
relevant. For example, different companies might approach the same task 
in a variety of ways lending themselves to more or fewer personnel 
being involved. Assuming the successful execution of the contract's 
requirements, this overall difference in labor would not be pertinent 
to the Department. Rather, the Department focuses its efforts on 
getting the best value for taxpayer dollars by ensuring services 
performed meet DOD requirements. The Department does continue to meet 
its statutory requirements from Title 10, U.S.C. section 4505 via the 
annual submission of the Inventory of Contracts for Services; however, 
it does not have a system or mechanism for additional data capture 
related to the number of contractor employees on contract beyond the 
FPDS.
    Mr. Wagner. The DAF is committed to overarching DOD efforts to 
collect data and monitor service acquisitions. The Department is 
focused on buying capabilities based on mission owner performance-based 
requirements that are achieved through approved, strategic acquisition 
strategies. The DAF Senior Services Manager provides a governance 
process for the acquisition and management of contracted services in 
accordance with DAFI 63-138, Acquisition of Services and DODI 5000.74, 
Defense Acquisition of Services.
    The DAF is nearing closure on a revision of DAFI 63-138, 
Acquisition of Services, that seeks to improve the Department's 
management of Air Force services acquisition programs ensuring their 
effective, efficient, and timely execution in support of mission needs. 
The revision encourages synergy within the services acquisition 
community, which consists of Program Managers/Services Acquisition 
Leads and designated multi-functional teams charged with developing, 
executing, and monitoring a services requirement from identification to 
contract close-out.
    With regard to measuring the contractor workforce, the Department 
does not track numbers of contractors in the same way it does civilian 
and military personnel. For accountability purposes, the Department 
uses the Synchronized Pre-deployment and Operational Tracker-Enterprise 
Suite (SPOT-ES) in contingency areas outside the continental United 
States. Beyond that, the Department does not specifically track 
contractor personnel since contracts are based on dollars and 
associated deliverables to be provided. Since contractors are not 
employees of the Department, it is up to the contracting company to 
determine how many people are required to meet the deliverables under 
the contract.
    The Department does comply with the requirements in 10 USC 4505 
(previously 10 USC 2330a) to collect an annual Inventory of Contracts 
for Services (ICS). The Department submits and makes publicly available 
a summary of that Inventory every year. This information is provided by 
the SAF/AQ community. Services contract reporting is now codified with 
program Annual Execution Reviews (AERs) and an overall major command 
Effectiveness Review chaired by AFPEO, Combat and Mission Support 
(AFPEO/CM) on an annual basis. These reviews ensure commitments to out 
year requirements and budgeting are clearly understood across program 
stakeholders. In addition to required program reviews, the updated DAF 
policy requires AF leadership at major commands and field reporting 
units to ensure personnel assigned to work services acquisition 
elements within their organizations are properly resourced and trained 
on the services acquisition life cycle from requirements generation 
through contract closeout.

    44. Senator Warren. Under Secretary Cisneros, Assistant Secretary 
Schaefer, Assistant Secretary Parker, and Assistant Secretary Wagner, 
how many contractor full time equivalents did your Department and 
components have in 2021 and 2022?
    Mr. Cisneros. Per the Inventory of Contracts for Services (ICS) for 
fiscal year 2021, the Department had approximately 251,258 contractor 
full-time equivalents (CFTEs). The ICS for fiscal year 2022 has not yet 
been submitted by the Office of the Under Secretary of Defense 
(Acquisition and Sustainment), but it will contain CFTE data for fiscal 
year 2022 when it is published.
    Ms. Schaefer. The Army does not track the number of Contract Full 
Time Equivalents (CFTEs). Theestimated number of CFTEs is 117,853 for 
fiscal year 2021 and 114,119 for fiscal year 2022. These CFTE figures 
are calculated in accordance with Section 807 of Public Law 110-181 and 
are derived using approved Office of the Under Secretary of Defense for 
Acquisition and Sustainment calculation methodologies. They do not 
represent an actual depiction of the contract workforce. The Contractor 
FTE data cited above is reported in the Army's Operation & Maintenance 
Justification Budget Books for fiscal years 2018 to 2022.
    Mr. Parker. Per the Inventory of Contracts for Services (ICS) for 
fiscal year 2021, the Department had approximately 54,580 contractor 
full-time equivalents (CFTEs). The ICS for fiscal year 2022 has not yet 
been submitted and released from the Office of the Under Secretary of 
Defense for Acquisition and Sustainment, but it will contain CFTE data 
for fiscal year 2022 when complete.
    Mr. Wagner. Estimated fiscal year 2021 DOD Contractor FTEs Prime 
Contractors and Subcontractors for Contracts Required to be Reported 
Under 10 U.S.C. Sec. 4505, by DOD Component: Department of the Air 
Force, 52,987.
    Note, the information above has been provided to Congress, in 
fulfillment of the statutory requirements to supply an inventory of 
Department of Defense service contracts for certain activities, per 
Section 4505(c) of title 10, United States Code and per the annual 
Appropriations Act. This information is made available in the Inventory 
of Services Contracts data base by Defense Pricing and Contracting,
Assistant Secretary of Defense for Acquisition and is available at the 
following web site: https://www.acq.osd.mil/asda/dpc/cp/policy/service-
contract-inventory. html
    At this time, fiscal year 2022 FTE data has not been published.

    45. Senator Warren. Under Secretary Cisneros, Assistant Secretary 
Schaefer, Assistant Secretary Parker, and Assistant Secretary Wagner, 
what was the estimated cost of the contractor workforce in 2021 and 
2022?
    Mr. Cisneros. Per the ICS for fiscal year 2021, approximately 
$161.5 billion was obligated for the above-referenced 251,258 CFTEs. 
The ICS for fiscal year 2022 has not yet been submitted by the Office 
of the Under Secretary of Defense (Acquisition and Sustainment), but it 
will contain cost data for fiscal year 2022 when it is published.
    Ms. Schaefer. The Army cannot isolate the costs for the contractor 
workforce, and the amounts provided reflect what was executed on 
Service Contracts in total (excluding Ukraine and Supplementals). The 
estimated cost of the Army contractor workforce for fiscal year 2021 
was $31,185,965 for OMA, OMAR and OMNG. The estimated cost of the Army 
contractor workforce for fiscal year 2022 was $30,422,715 for OMA, OMAR 
and OMNG.
    Mr. Parker. Per the ICS for fiscal year 2021, approximately $9 
billion was obligated for the above-referenced 54,580 CFTEs. The ICS 
for fiscal year 2022 has not yet been submitted to the Office of the 
Under Secretary of Defense for Acquisition and Sustainment, but it will 
contain cost data for fiscal year 2022 when complete.
    Mr. Wagner. Estimated fiscal year 2021 cost of DOD Contractor FTEs 
Prime Contractors and Subcontractors for Contracts Required to be 
Reported Under 10 U.S.C. Sec. 4505, by DOD Component and based on Total 
Dollar Amount Invoiced: Department of the Air Force, $11,723,478,273 
per above reference to 52,987 FTEs.
    Note, the information above has been provided to Congress, in 
fulfillment of the statutory requirements to supply an inventory of 
Department of Defense service contracts for certain activities, per 
Section 4505(c) of title 10, United States Code and per the annual 
Appropriations Act. This information is made available in the Inventory 
of Services Contracts data base by Defense Pricing and Contracting, 
Assistant Secretary of Defense for Acquisition and is available at the 
following web site: https://www.acq.osd.mil/asda/dpc/cp/policy/service-
contract-inventory.html
    At this time, fiscal year 2022 FTE data has not been published.
                    dod civilian workforce readiness
    46. Senator Warren. Under Secretary Cisneros, the Center for Naval 
Analysis (CNA) in September 2021 mapped much of the DOD civilian 
workforce to (1) intermediate and near-term readiness; (2) middle term 
readiness; and (3) long term readiness based on the missions to which 
the DOD civilian workforce were assigned rather than the traditional 
civilian personnel occupational series, which the CNA found less useful 
for the purposes of measuring the workforce's contribution to 
readiness. How has the Department changed its risk assessments 
involving the requirements performed by the DOD civilian workforce in 
response to this study?
    Mr. Cisneros. The Department has not changed its risk assessments 
in response to this study. federally Funded Research and Development 
Centers such as CNA do excellent work for the Department, and my office 
frequently accepts and implements recommendations they make. In this 
case, the recommendations made by CNA were not considered for 
implementation as the Services already inform their risk assessments 
during the annual Program and Budget Review process. Also, the 
Department has Total Force Management policies that are aimed at 
providing a maximum amount of flexibility to local commanders and 
managers when evaluating risk, within the bounds of applicable law, 
regulation, and policy, who are best positioned to make workforce mix 
determinations.

    47. Senator Warren. Under Secretary Cisneros, how does the 
Department's programming and budgeting process consider civilian 
workforce readiness based on its missions?
    Mr. Cisneros. Strategic Readiness is the ability to build, 
maintain, and balance warfighting capabilities and competitive 
advantages that ensure the Department of Defense can achieve strategic 
objectives across threats and time horizons. This includes cultivating 
a workforce (civilian and military) with the appropriate disciplines 
and knowledge base to compete with our strategic competitors. The 
Department's civilian workforce is a critical enabler of warfighter 
readiness, lethality, and capability; both directly, such as medical 
providers, and indirectly, such as support staff.
                     total force management policy
    48. Senator Warren. Under Secretary Cisneros, Section 129a of title 
10 places the Under Secretary for Defense of Personnel and Readiness 
(USD (P&R)) in charge of total force management policy. The overarching 
Department of Defense Instruction 1100.22 for total force management 
was last updated in 2017. Congress has enacted several changes to 
section 129a since 2017 and yet the USD (P&R) has not updated 
Department of Defense Instruction (DODI) 1100.22. Additionally, the USD 
(P&R) has not consistently provided required reports from section 129 
and 129a to Congress, particularly related to the Department's 
projected hiring plans for the DOD civilian workforce over the Future 
Year Defense Program. When will the USD (P&R) update these policies and 
when will it provide these required reports?
    Mr. Cisneros. My office will be issuing a memorandum to provide 
guidance for the Department on the recent changes to section 129a. In 
addition, Department of Defense Instruction 1100.22 is currently under 
review and an approach is being developed for the best way to update it 
to reflect these and other statutory changes.
    The annual report required by section 129 on the civilian workforce 
has been submitted as part of the Defense Manpower Profile Report 
(DMPR) (previously the Defense Manpower Requirement Report) since 
fiscal year 2018. The Department will continue to meet this annual 
requirement, and this year's DMPR is currently being compiled and will 
be transmitted no later than August 15, 2023.
                           contract services
    49. Senator Warren. Under Secretary Cisneros, there are concerns 
that the Undersecretary of Defense (Comptroller), Director of Cost 
Assessment and Program Evaluation (CAPE), Under Secretary of Defense 
for Personnel and Readiness and Under Secretary of Defense for 
Acquisition and Sustainment have not updated the two Defense Business 
Board Slides showing the comparative spending on contract services and 
corresponding estimated contract full time equivalents done in 2017 to 
reflect spending through 2022 for the Department overall with each 
Military Department doing the same for the Army, Navy, Air Force, Space 
Force and Marine Corps. Please provide updated information for 2022.
    Mr. Cisneros. Costing and CFTE data is not yet available for fiscal 
year 2022, but will be available in the annual submission of the 
Inventory of Contracts for Services provided by the Office of the Under 
Secretary of Defense (Acquisition and Sustainment).

    50. Senator Warren. Under Secretary Cisneros, you were required to 
submit a budget exhibit for services contracts in compliance with 
section 4506 of title 10 with the President's budget. Please provide a 
copy of that exhibit.
    Mr. Cisneros. Section 4506 requires the Under Secretary of Defense 
(Comptroller) and the Director, Cost Assessment and Program Evaluation, 
to submit this information. While I defer to my colleagues on the 
contents of this budget exhibit, my understanding is that this 
reporting requirement will be met with a chapter in the fiscal year 
2024 Defense Operation and Maintenance (O&M) Overview Book. The Defense 
O&M Overview Book will be provided to Congress by early May 2023, and 
will be included in subsequent annual President's Budget submissions.
                               __________
              Questions Submitted by Senator Mazie Hirono
                          ocola cuts in hawaii
    51. Senator Hirono. Mr. Cisneros, My office has heard from our 
Servicemembers in Hawaii that they are deeply concerned about imminent 
cuts to their cost of living allowance by around 50 percent, a concern 
I share. Hawaii has the most expensive cost of living of any State in 
the country. As we continue to combat inflation, the thought of 
slashing the cost of living allowance for servicemembers in Hawaii is 
absurd. Does the Department of Defense have information suggesting the 
cost of living has fallen by 50 percent in Hawaii?
    Mr. Cisneros. The Overseas Cost-of-Living Allowance (OCOLA) program 
is designed to supplement the pay of servicemembers assigned outside 
the continental U.S. (OCONUS) to maintain an equivalent level of 
purchasing power as their CONUS counterparts-not less purchasing power, 
but not more either.
    Every year, the Department assesses the cost of living in overseas 
locations, including Hawaii, by comparing shopping pattern (a Living 
Pattern Survey depicting servicemembers' aggregate shopping patterns) 
and price data (a Retail Price Schedule capturing prices of a market 
basket of non-housing goods and services collected) to the same data 
collected across CONUS (the average CONUS baseline). A comparison of 
cost-of-living data Hawaii submitted at the end of 2022, to the same 
data collected CONUS resulted in an OCOLA rate of 108 for Oahu, 
indicating it is 8 percent more expensive, on average, to purchase non-
housing goods and services in Oahu than in CONUS. This is, however, a 
calculated downward adjustment of 8 index points from the 2021 Oahu 
OCOLA index of 116. This decrease does not indicate Hawaii's cost of 
living has fallen by 50 percent; instead, it illuminates the effects of 
high U.S. inflation over the past year. Significant price increases in 
the average CONUS baseline, not matched or exceeded by price increases 
in Hawaii, resulted in a smaller differential in the cost comparison 
and a lower OCOLA rate for Oahu and other islands in Hawaii.
    The Department, with the help of Congress, has taken action to 
combat the effects of inflation on the finances of servicemembers and 
their families through other pay and allowances (e.g., servicemembers 
received a 4.6 percent increase in basic pay, an 11.2 percent increase 
in basic allowance for subsistence, and an average 12.1 percent 
increase in the basic allowance for housing). Even with the computed 
OCOLA decrease, many members receive more pay now than they did in 2022 
due to these increases. For example, an E-6 with 10 years of service 
and three dependents, stationed on Oahu, received a net pay increase of 
approximately $538 per month.
    Additionally, on December 8, 2022, Secretary Austin paused OCOLA 
rate decreases resulting from cost-of-living data. That pause remains 
in effect as the Department works to implement the provisions of the 
James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 
that affect the DOD's OCOLA program.

    52. Senator Hirono. Mr. Cisneros, if not, how does DOD justify 
cutting the Cost of Living Allowance for our Soldiers, Sailors, Airmen, 
Guardians, and Marines in what is far and away the most expensive State 
in America?
    Mr. Cisneros. Although it may seem counterintuitive that OCOLA 
would decrease during a time of high inflation, the foundation of the 
OCOLA program is to maintain economic parity between servicemembers 
stationed CONUS and OCONUS. Data indicating that CONUS inflation 
increased at a greater rate than inflation in Hawaii over the past year 
warrants the adjustment to the OCOLA rate for members stationed in 
Hawaii. While I understand OCOLA decreases are not desired, the changes 
calculated for Hawaii are data-driven decisions; they are consistent 
with the policies and practices governing the OCOLA program and used to 
compute OCOLA for over 600 OCONUS locations, and they are consistent 
with changes computed for OCONUS installations worldwide due to 
continued high CONUS inflation.
               family planning and health in the military
    53. Senator Hirono. Mr. Cisneros and Mr. Constable, what is the 
importance of the Department of Defense's new policies to Ensure Access 
to Reproductive Health Care for our servicemembers?
    Mr. Cisneros and Mr. Constable. These policies reinforce the 
Secretary's commitment to taking care of our people protecting their 
health and well-being, and ensuring the force remains ready and 
resilient.
    As of March 2023, servicemembers are afforded the option--similar 
to their civilian counterparts--of having up to 20 weeks before they 
are required to notify their commanders of pregnancy, except in certain 
circumstances in which earlier notification is necessary based upon 
individual circumstances of the servicemember and mission requirements. 
This provides servicemembers the time and flexibility to make personal 
health care decisions. Servicemembers and eligible dependents may also 
use an administrative absence and travel allowance to access assisted 
reproductive technology to help them in building a family.
    The new policies will help servicemembers access lawfully available 
non-covered reproductive health care or accompany a dependent to access 
lawfully available non-covered reproductive health care, regardless of 
whether they are stationed inside or outside the United States.
    Due to the nature of military service, servicemembers do not choose 
where they are stationed or assigned. The policies on administrative 
absence and travel allowances for non-covered reproductive health care 
ensure access to reproductive health care irrespective of a 
servicemember's duty station or assignment. To mitigate the impact of 
certain assignment locations, servicemembers are authorized several 
allowances, benefits, and entitlements based on their geographic 
location. Examples of other allowances, benefits, and entitlements 
servicemembers are authorized based on duty station or assignment 
location include remote and austere conditions assignment incentive 
pay, cold weather duty, authorization of assignment or special duty 
pay, continuous overseas tour travel entitlement, environmental morale 
leave, basic housing allowances, cost of living allowances, and 
dependent student travel, among others. All these policies are intended 
to increase the emotional and physical well-being of all servicemembers 
and their families.
    The efforts taken by the Department on reproductive health care 
will not only ensure servicemembers and their families are afforded the 
time and flexibility to make private health care decisions but will 
also ensure servicemembers are able to access non-covered reproductive 
health care regardless of their duty station. These policies reflect 
and reinforce our commitment to taking care of our people and ensuring 
the entire force remains ready and resilient.

    54. Senator Hirono. Mr. Cisneros and Mr. Constable, 
cryopreservation is a fertility tool that Servicemembers could use if 
they wish to have children in the future. What impact would covering 
the cost of cryopreservation under TRICARE--much like the British Armed 
Forces does for their Servicemembers--have on recruitment and retention 
rates?
    Mr. Cisneros and Mr. Constable. Issues of fertility and pregnancy 
can be central to career trajectories and retention for servicemembers. 
This is particularly true for Service women, who often serve during 
their potential childbearing years and may delay starting a family to 
meet their military career goals. Facilitating access to 
cryopreservation promotes readiness and retention and offers 
servicemembers a critical tool to meet their family planning needs.
    We do not have data on how cryopreservation would impact recruiting 
and retention rates as such a procedure would not be considered a 
recruiting or retention incentive in the traditional sense.
                better countering trafficking in persons
    55. Senator Hirono. Mr. Cisneros, human trafficking, and 
particularly sex trafficking of underage women and girls, is of great 
concern to me. In Hawaii a commission on Missing and Murdered Native 
Hawaiian Women has identified a potential correlation between the 
number of military members in Hawaii and some of the trafficking 
occurring in Hawaii; but there is not currently any data to support or 
disprove the theory because this issue has not been studied. That is 
why I am working to include language in this year's NDAA to call for a 
study on trafficking and requesting more effective training and 
education on how soliciting prostitution impacts sex trafficking. What 
does the Department of Defense do currently to combat trafficking in 
persons?
    Mr. Cisneros. The Department makes clear in our Combating 
Trafficking in Persons (CTIP) Department of Defense Instruction (DODI) 
2200.01, ``It is DOD policy to oppose prostitution, forced labor, and 
any related activities contributing to the phenomenon of trafficking in 
persons (TIP). CTIP will be applied across the entire spectrum of DOD 
missions, functions, programs, and activities.''
    The CTIP DODI establishes policy, assigns responsibilities, and 
prescribes training requirements for CTIP and implements National 
Security Presidential Directive-22. The DODI requires the Secretaries 
of the Military Departments to identify commercial establishments 
patronized by DOD personnel that have indicators of Trafficking in 
Persons (TIP), place offending establishments off-limits, and provide 
support to host-country authorities involved in the battle against TIP, 
as permitted.
    In 2005, the DOD added a statute to the Uniform Code of Military 
Justice prohibiting the purchase of sex and implemented the Military 
Extraterritorial Jurisdiction Act giving commanders a method to charge 
civilians that commit a felony (including human trafficking) while 
accompanying troops overseas.
    CTIP training is mandated for all DOD military and civilian 
personnel during their initial year of entry into the DOD. In addition, 
specialized training is required for DOD Investigative personnel, 
Acquisition Personnel, DOD Education Activity staff, and as a CTIP 
resource for DOD Leaders.
    CTIP training defines Trafficking in Persons (TIP), avenues to 
report TIP, resources for those affected by TIP, and make clear the 
consequences and legal ramifications for those who engage in this 
heinous crime. DOD components are required to submit an annual CTIP 
self-assessment that includes reporting on suspected TIP incidents, TIP 
investigations, TIP prosecutions, TIP indictments, TIP convictions and 
training programs. Our Military Criminal Investigative Organizations 
(MCIOs) partner with local, State, and Federal law enforcement agencies 
to combat human trafficking and child exploitation.
    Example in Hawaii--our Army Criminal Investigative Division, Naval 
Criminal Investigative Service, and Air Force Office of Special 
Investigations are members of the Honolulu County Human Trafficking 
Task Force, comprised of the State Attorney General's Office, Hawaii 
State Prosecutor's Office, Honolulu Police Department, Homeland 
Security Investigations.
    The DOD established a DOD-wide Combating Trafficking in Persons 
Task Force with 50+ points of contact throughout the Department to 
create an ``in-reach'' infrastructure for assisting components in 
preventing human trafficking.

    56. Senator Hirono. Mr. Cisneros, what do you see as potential 
areas of improvement for the Department of Defense to better prevent 
these crimes and protect the communities in which the DOD serves?
    Mr. Cisneros. One of my priorities is to Change the Culture. P&R is 
working to do that by promoting military readiness and by decreasing 
the prevalence of readiness-detracting behavior such as human 
trafficking.
    Another priority is leadership involvement. Leaders are the key to 
improving CTIP and community relationships. Having a robust and 
effective awareness campaign is one way the DOD can work to prevent TIP 
and protect the communities around U.S. military installations.
    A third priority is to continue to expand the specialized CTIP 
trainings for personnel. In the coming months, the CTIP office will 
release a specialized training for the DOD Healthcare professionals and 
a separate training for the DOD Chaplain Corps. Both of these trainings 
will help the healthcare workforce and the Chaplains to recognize TIP 
in their respective work environments and to help protect victims and 
survivors with whom they may interact or encounter in their duties.
                     sexual assault in the military
    57. Senator Hirono. Mr. Cisneros, last year marked significant 
changes to the way crimes of sexual assault are investigated, but there 
is clearly still more to do to prevent these crimes from even happening 
across the Department of Defense. Particularly alarming is last week's 
report that showed reported sexual assaults at our military academies 
increased by 18 percent last year. One in five female students reported 
they had experienced unwanted sexual contact; this is unacceptable. How 
do you intend to curb sexual assault and harassment at our Nation's 
Military Service Academies?
    Mr. Cisneros. Preventing sexual assault remains one of the 
Department's highest priorities, and this year's survey results 
underscore the importance of implementing improvements recommended by 
the Independent Review Commission on Sexual Assault in the Military.
    The unprecedented attention, focus, and resourcing delivered by 
this Administration to counter sexual assault within the Armed Forces 
include initiatives to reform Academy programs. However, we have more 
work to do to prevent sexual assault and sexual harassment at our MSAs.
    We are taking immediate measures to address sexual assault and 
sexual harassment at our MSAs.
    The Department sent teams of experts to assist the Academies' 
prevention efforts. Specifically, fiscal year 2023 On-Site Installation 
Evaluations (OSIE) included visits to all three Academies. OSIE visits 
to the MSAs are providing immediate insights to address climate 
challenges and enhance prevention activities.
    In addition, leaders at all levels are responsible for championing 
healthy climates within their organization. DOD fundamentally changed 
its climate assessment process to better detect risk and protective 
factors known to be associated with the prevention of readiness 
impacting behaviors like sexual assault. The command climate assessment 
process has been updated to provide timely data to empower leadership 
in addressing the safety and welfare of all unit members. The Academies 
must now integrate this climate assessment process into their 
operations as a means to identify cadet and midshipman units with 
promising climates, as well as those at risk for problems.
    There is no single solution to the problem of sexual assault. 
However, the military justice reforms, prevention initiatives, and 
survivor care enhancements we have underway are the solution set for 
the academies and for the rest of the Total Force. We must redouble our 
efforts to implement these important initiatives.

    58. Senator Hirono. Mr. Cisneros, what impact do these crimes have 
on our military's recruitment and retention efforts?
    Mr. Cisneros. Survey of youth results indicate that possibility of 
Sexual Harassment/Assault is a concern of youth considering Military 
Service. Furthermore, female youths are more likely to believe the 
risks of serving outweigh the benefits (64 percent versus 51 percent), 
and in recent years, the perceived risk of sexual assault/sexual 
harassment has risen to the fifth ranked reason they would not consider 
military service. As such, our efforts to foster positive change across 
harmful behaviors is critical to both our recruiting and retention 
efforts.
                 public shipyard work force development
    59. Senator Hirono. Mr. Cisneros, the President's budget includes 
significant investments in workforce development for the private 
submarine shipyards, but unfortunately does not match that investment 
for our Nation's public yards. These public shipyards, like the one at 
Pearl Harbor, are vitally important for the readiness of our undersea 
force, and they too are facing challenges recruiting and retaining 
skilled labor to keep up with growing demand. What steps is the 
Department taking to increase the competitiveness of jobs at our public 
shipyards?
    Mr. Cisneros. The Department is reviewing data for possible 
submissions of special salary rates for General Schedule and Federal 
Wage System positions at the Norfolk Naval Shipyard, Portsmouth Naval 
Shipyard, Puget Sound Naval Shipyard and Guam Detachment, seeking to 
increase wages and salaries, as warranted. Special salary rates are 
being considered on a case-by-case basis to address staffing 
difficulties for certain positions at these locations. The Department 
of the Navy is also canvassing its major commands in other geographic 
areas for potential special salary rate coverage. OPM is the approving 
authority for both General Schedule and Federal Wage System requests.

    60. Senator Hirono. Mr. Cisneros, what steps is the Department 
taking to improve recruitment efforts for our public shipyards?
    Mr. Cisneros. TRICARE The Department is marshalling all available 
resources to improve recruitment efforts at our public shipyards. We 
are conducting job fairs to reach a broad candidate pool, promoting 
apprenticeship opportunities, using flexible direct hire authority to 
appoint qualified candidates, and offering recruitment incentives, 
special pay setting authority for candidates with superior 
qualifications, and advancing leave, when applicable, to mitigate 
recruitment challenges. In addition, we are seeking special salary 
rates for shipyards in certain geographic areas to offer more 
competitive pay within labor markets.
                    defense civilian training corps
    61. Senator Hirono. Mr. Cisneros, the Defense Civilian Training 
Corps was stood up as a result of the Fiscal Year 2020 NDAA to create a 
pipeline of graduates to enter the civil service to fill ``critical 
skills gaps'' and was again funded significantly last year. As the 
Department of Defense works to quickly field innovative systems while 
ensuring the taxpayer gets the most value for their money this program 
is more important than ever. What is the current status of the Defense 
Civilian Training Corps?
    Mr. Cisneros. TRICARE In coordination with my office, the Under 
Secretary of Defense for Acquisition and Sustainment is developing and 
leading effort to research, model, and pilot the Defense Civilian 
Training Corps (DCTC) for the Department. As also required by statute, 
the Acquisition Innovation Research Center is partnering within the 
academic community and pilot universities to initiate a pathway for 
students to enter the DOD workforce. Much work remains and we will 
learn from our pilot activities this year. We look forward to 
demonstrating a DCTC model for the future DOD civilian workforce in 
fiscal year 2024.

    62. Senator Hirono. Mr. Cisneros, what do you see as the importance 
of a robust civilian training pipeline?
    Mr. Cisneros. A robust civilian training pipeline is critical to 
DOD's continued readiness and its ability to meet global security 
challenges. The Department must ensure it has effective and efficient 
systems, processes, and policies in place to attract, grow, and 
maintain the critical skills needed to support our current and future 
mission, and must do so within an increasingly competitive global 
talent market. The Defense Business Board just released its full report 
on this topic on March 30, 2023. The Department is reviewing the report 
recommendations for implementation, as appropriate.
                  dod pregnancy policy standardization
    63. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, 
Secretary Austin recently released a significant and important change 
to the Military's Parental Leave policy. Nonetheless, I am concerned 
the language in the Military Parental Leave Program allows a level of 
ambiguity that could be used to deny convalescent leave to the 
detriment of birth parents, their children, and military readiness. Are 
your Services committed to giving our Servicemembers the full amount of 
convalescent leave they require, in addition to their Parental leave?
    Assistant Secretary Schaefer. Yes, the Army's Military Parental 
Leave policy emphasizes the 12 weeks of parental leave for the birth 
parent is in addition to and following a period of maternity 
convalescent leave. Maternity convalescent leave is authorized for the 
recovery of the birth parent from giving birth when recommended by the 
health care provider and approved by the unit commander.
    Mr. Parker. The Department of the Navy recognizes that ensuring 
Sailors and Marines have adequate time to recover following childbirth 
is critical to individual medical readiness and overall well-being.
    In line with Directive-type Memorandum (DTM) 23-001, ``Expansion of 
the Military Parental Leave Program,'' and Section 701 of Title 10, 
United States Code, the Navy and Marine Corps issued guidance that 
directed convalescent leave may be authorized for the recovery of the 
servicemember following giving birth if such leave is specifically 
recommended, in writing, by the health care provider for the 
servicemember and is approved by the servicemember's unit commander. 
This is in addition to the authorized parental leave.
    Mr. Wagner. The DAF is committed to and strictly adheres to Title 
10, Section 701(h)(3) which authorizes medical convalescent leave in 
conjunction with the birth if specifically recommended, in writing, by 
the medical provider of the member to address a diagnosed medical 
condition and approved by the member's commander. Our new parental 
leave policy ensures that parental leave begins consecutively, once 
convalescent leave expires.

    64. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, have 
your services discussed with the Office of the Secretary of Defense a 
need to standardize the convalescent leave policy for new parents 
across the Services?
    Assistant Secretary Schaefer. The Army is always looking for ways 
to better support our Soldiers and families. It's vitally important 
that the Army appropriately align our policies with OSD and the other 
Services, consistent with title 10, United States Code for the 
provision of convalescent leave.
    Mr. Parker. In accordance with DOD policy and Section 701 of Title 
10, United States Code, Navy and Marine Corps policies directed that 
convalescent leave is authorized, prior to the start of parental leave, 
for the recovery of the servicemember from giving birth if such leave 
is specifically recommended, in writing, by the health care provider 
and is approved by the servicemember's unit commander. The duration of 
convalescent leave is dependent on the individual medical needs of the 
servicemember; the health care provider tailors convalescent leave 
recommendations based upon such individual circumstances.
    OSD, in coordination with the Services, issued Secretary of Defense 
memo of March 22, 2023 directing actions across the Services to 
strengthen support to servicemembers and military families. One of the 
actions is to educate and promote the new expanded military parental 
leave benefit.
    Mr. Wagner. Yes; the DAF requested to standardize the amount of 
convalescent leave during service coordination of the DODI; however, 
the comment was rejected to align with other types of convalescent 
leave, which are not standardized in policy. Convalescent leave for any 
medical condition, including pregnancy, is limited to the minimal time 
essential to meet medical needs for recuperation.
                       childcare in the military
    65. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, we 
must make it easier for our Servicemembers to have families, whenever 
and however they choose to. These efforts to improve quality of life 
for our servicemembers bolster recruitment and retention. But, as you 
each note in your prepared testimony, a challenging barrier for our 
military families is a lack of childcare resources. How have previous 
investments, like the Army's new childcare center in Hawaii, benefited 
our military families and where have you identified places for 
additional investment?
    Assistant Secretary Schaefer. Previous childcare infrastructure 
investments benefited our families by increasing overall childcare 
capacity and availability. Today, ongoing staffing challenges continue 
to impact/limit childcare availability at some locations, so in 
addition to investing and sustaining infrastructure and off-post 
options, we will continue to provide incentives to hire and retain 
quality staff.
    Mr. Parker. The Department of the Navy (DON) is addressing overall 
child care wait list challenges by increasing installation-based 
capacities and through multiple initiatives focusing on employee 
recruiting/retention. Readily available child care helps working 
parents better navigate life's stressors and reduces negative outcomes 
for families.
    To expand capacity the DON has a number of Military Construction 
(MILCON) projects in place, mainly in fleet concentration areas where 
demand for child care exceeds current capacity. We thank Congress for 
the planning and development funds as well as for their assistance with 
funding projects on the Unfunded Priority List.

      Fiscal year 2021--Naval Base (NAVBASE) Kitsap, Washington

      Fiscal year 2020--Marine Corps Air Station Miramar, 
California

      Fiscal year 2023--NAVBASE Point Loma, California

      Fiscal year 2023--Marine Corps Base (MCB) Camp Pendleton, 
California

      Fiscal year 2024--Naval Support Activity (NSA) Hampton 
Roads, Virginia

      Fiscal year 2024--Joint Base Little Creek--Fort Story, 
Virginia

      Fiscal year 2024--NSA Anderson Air Force Base, Guam

      Fiscal year 2025--MCB Quantico, Virginia

    Planning is underway for additional child development centers in 
Hawaii, Virginia, Washington DC, California and Okinawa, Japan to 
continue to meet demand in fleet concentration areas.
    New facilities require increased staff. As I have previously 
mentioned, child care staffing is a national challenge. To address this 
problem we have increased hourly wages from 8$11.50 per hour to $17.39 
per hour, beyond the federally mandated $15.00 per hour and in some 
locations are offering recruitment and retention bonuses.
    The U.S. Navy and U.S. Marine Corps are actively participating in 
the Deputy Secretary of Defense-directed Recruitment, Retention, and 
Compensation Task Force with OSD and the Sister Services to solve the 
problem.
    Mr. Wagner. Previous DAF investments have benefited military 
families by continuing to provide safe and high-quality childcare 
centers through Facility Sustainment, Restoration and Modernization 
(FSRM) projects, encompassing a broad array of facility mechanical and 
utility systems and maintaining facility conditions as well as 
increasing childcare capacity through classroom additions. The DAF is 
now focused on addressing childcare capacity concerns through Military 
Construction (MILCON) projects. Since fiscal year 2019, ten MILCON 
projects have been authorized for Joint Base Andrews, Osan Air Base, 
Sheppard AFB, JBSA-Lackland/Ft. Sam/Randolph, Wright-Patterson AFB, RAF 
Lakenheath, and Scott AFB. An additional 12 MILCON requirements have 
been identified and are in planning for Hanscom AFB, Barksdale AFB, 
Mountain Home AFB, Luke AFB, Nellis AFB, JBSA-Randolph, Travis AFB, 
Kirtland AFB, Seymour Johnson AFB, Little Rock AFB, Tinker AFB, and 
Eglin AFB.

    66. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, 
beyond building new Child Development Centers what else can your 
Services and Congress do to make having a family easier in the 
military?
    Ms. Schaefer. Besides building additional childcare infrastructure, 
we will continue to sustain existing centers, incentivize Family 
childcare, provide Army Fee Assistance for off post care, implement 
recruiting and retention initiatives to hire and retain quality staff, 
and explore new initiatives and partnerships.
    Mr. Parker. Families are an integral part of the team and a vital 
contributor to mission success deserving of our full support. The 
professionals at Fleet and Family Support Centers and Marine Corps 
Community Services are committed to delivering outstanding services and 
support that are dedicated to the health, educational growth, and well-
being of our families.
    Fleet and Family Readiness and Marine Corps Community Services 
offices offer programs and services to support military spouses and 
families. They provide information and referrals to educational 
workshops and services ranging from long term financial planning to 
short term needs such as resume writing assistance. Additional 
resources include Ombudsmen, Family Readiness Officers, and in-house 
clinical counseling services.
    The Department of the Navy is committed to making its quality of 
life programs and Morale, Welfare and Recreation (MWR) programs 
affordable and accessible. These programs are integral to the health 
and wellness of family members and are important to resilience and 
coping with the demands of the military lifestyle.
    Morale, Welfare, and Recreation programs offer a variety of 
programs and activities to develop new skills, build strength, and 
reduce stress. They offer programs and activities at a discount to help 
stretch incomes and still have a rewarding family vacation or weekend 
outing.
    These programs directly support mission readiness by preparing 
servicemembers and their families for the unique demands of military 
life. The Navy released the MyNavy Family mobile application, a single 
source of information for all support and educational resources that 
are available to servicemembers, their spouses, and families. The 
Marine Corps recently updated their web site platform to create a user 
friendly experience and consistency across the enterprise.
    It is critical that we continue to support these programs and 
encourage changes and improvements so that they remain responsive and 
relevant to servicemembers and families of today and the future.
    Mr. Wagner. DAF efforts to improve access to childcare include 
staffing initiatives for our Child Development Centers and School Age 
Care facilities, adding Family Child Care (FCC) providers, and 
increasing community-based childcare fee assistance.
    Recruitment and retention incentives were deployed in 2022 to 
improve staffing levels and included bonuses for sign-on, employee 
referrals, meeting training targets, and longevity.
    DAF implemented a 100 percent childcare fee discount on 1 October 
2022 for all child and youth program direct care staff for their first 
child enrolled; additional children and other child and youth employees 
receive a 25 percent discount. As a result of these initiatives, we are 
pleased that overall direct care staffing levels increased from 65 
percent in July 2022 to 75 percent in March 2023.
    The FCC program provides care to fit various work schedules, 
deployment, or other unique childcare needs. Targeted FCC provider 
recruitment and retention incentives were deployed to increase 
childcare options and spaces, including an increase in weekly and 
hourly subsidy rates, financial incentives at the time of initial FCC 
certification and annual renewal, and an increased subsidy for care 
provided between 1800 and 0600. These efforts increased FCC providers 
providing childcare services across the DAF from 331 providers in 
fiscal year 2021 to 381 providers at the end of fiscal year 2022.
    Access to community-based childcare fee assistance for military 
families not living near a military installation or unable to access 
on-base programs was enhanced in 2022 when DAF updated the 
MilitaryChildCare.com site to allow families to submit and manage their 
requests for fee assistance, providing a one-stop platform for 
childcare requests for childcare on and off the installation. We 
realize, however, that there is still unmet need, and we are committed 
to continued innovation to ensure readiness.

    67. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, where 
are each of your services in the process of standardizing the 
Exceptional Family Member Program and ensuring the needs of our 
Military families are fully met in this area?
    Ms. Schaefer. This past year, the Army developed and launched an 
integrated Exceptional Family Member Program (EFMP) system that 
streamlines enrollment, provides transparency, and synchronizes 
assignment coordination and Family support access. Additionally, the 
Army is establishing a centralized office at Headquarters Department of 
the Army to oversee the EFMP with a goal to be fully operational by the 
end of the year.
    Mr. Parker. The Department of the Navy (DON) is committed to 
supporting and providing the necessary resources to our families 
enrolled in the Exceptional Family Member Program (EFMP). The DON 
continues to collaborate with our Sister Service colleagues and the 
Office of the Under Secretary of Defense (Personnel and Readiness) 
(OUSD(P&R)) on standardization efforts and processes to ease the burden 
on our families.
    The Marine Corps Exceptional Family Member Program (EFMP) is 
compliant with the requirement for a central office. A single EFMP 
office that reports to the Deputy Commandant for Manpower and Reserve 
Affairs is responsible for program oversight of enrollment, family 
support, and assignment coordination. The program employs 107 personnel 
to support ?10,700 enrolled family members
    The Navy has implemented the initial phase to establish the central 
office under Navy Personnel Command. The office will unify enrollment, 
assignment coordination, and family support. The Navy has added 55 
installation family support case liaisons in Fiscal Years 2022 and 
2023. The program employs 138personnel to support ?23,500 enrolled 
family members.
    The Service central offices along with the increased case liaison 
personnel ratio will improve both the identification and enrollment 
experience for families and also improve continuity of services at the 
new permanent duty station. The Navy and Marine Corps are implementing 
the respite care standardized guidelines which will expand eligibility 
criteria and increase hours of care for some families.
    Both Services provide legal assistance to families when additional 
educational support is required. The Marine Corps has four attorneys 
(Marine Corps Base Hawaii, Marine Corps Base Quantico, Camp Lejeune and 
Camp Pendleton) who are trained in special education law. The Navy has 
two attorneys (Naval Station Norfolk and Naval Base San Diego) and the 
Navy Judge Advocate General's office is working to expand legal 
services, in particular to the Northwest (Washington), Southeast 
(Florida), Washington Navy District (DC), and Great Lakes regions.
    Mr. Wagner. Over the last 2 years, the DAF has made significant 
improvements to EFMP and efforts to improve the support and services 
provided to military families with special needs continues to be a 
priority. DAF EFMP transformation is approximately 70 percent complete 
in our multi-year journey. Centralization, process improvement and 
major automation efforts streamlined processes, reduced timelines, and 
increased access to information and services for our families. For 
example, the focus on the DAF EFMP Central Cell human capital strategy 
led to filling 67 critical positions and the processing time for final 
determinations for our families decreased by more than half as compared 
to this time last year.
          mental health and suicide prevention in the military
    68. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, the 
Suicide Prevention and Response Independent Review Committee, which was 
stood up by Secretary of Defense Austin, completed its comprehensive 
review in January, 2023 and detailed over 120 recommendations. The 
Fiscal Year 2024 President's Budget includes about $209 million to 
begin implementation of these recommendations. Will all of the 
recommendations in the report be implemented by your services?
    Ms. Schaefer. The Army is committed to reducing suicides and 
recognizes the importance of the recommendations made by the Suicide 
Prevention and Response Independent Review Committee (SPRIRC). The Army 
is an Active member of the Under Secretary of Defense for Personnel and 
Readiness led SPRIRC Implementation Working Group. This working group 
is using a collaborative and systematic approach to assess the 
viability and advisability of the SPRIRC's recommendations. Per the 
SECDEF's guidance, this group will provide a recommended implementation 
approach by 2 June. Working with our DOD partners, the Army has 
provided critical input and guidance on implementation approaches. 
While implementing the recommendations will take time, the Army 
understands the long-term benefits they will bring to improve the 
quality of life and public health approaches to reduce suicides.
    Mr. Parker. The Department of Defense released a report in February 
2023 following the Suicide Prevention and Response Independent Review 
Commission (SPRIRC) comprehensive review. The report issued 127 
recommendations for ``Preventing Suicide in the Military'' to the 
Military Departments (MILDEPs).
    Upon receipt of the SPRIRC, the Secretary of Defense (SECDEF) 
directed the immediate implementation of several recommendations 
addressing servicemembers' well-being, access to behavioral and mental 
healthcare, and the establishment of a Suicide Prevention 
Implementation Working Group. This working group serves as the primary 
body to assess the advisability and feasibility of implementing each of 
the remaining recommendations.
    Mr. Wagner. USD(P&R) swiftly established a Suicide Prevention 
Implementation Working Group as the primary body to assess the 
advisability and feasibility of implementing each of the 
recommendations. The working group identified specific policy and 
program changes needed to implement each recommendation and provided 
cost and manpower estimates to implement each of the recommendations. 
The Secretary of Defense will receive the internal assessment in June 
2023. The DAF will continue to support all OSD-level implementation 
efforts.
--------
    Additional information regarding AF/SG implementation activities.
    The DAF has already moved forward with utilization of behavioral 
health technicians as behavioral health care extenders. The 4C Career 
Field Manager (CFM) makes this a routine topic of focus for with Flight 
leadership when she visits DAF installations. The CFM and her staff 
also regularly advise Mental Health (MH) enlisted leadership on how to 
expand utilization of the technicians as provider extenders. The 2023 
Mental Health Flight Leadership conference is devoting a full workshop 
on how to use the MH technicians as provider extenders. Limited 
administrative support to the clinics and lack of MH case managers 
impedes our teams' ability to fully maximize the capabilities of our MH 
technicians.
    Military Treatment Facilities on DAF installations already 
implement episodes of care scheduling within behavioral health clinics. 
IAW AFI 44-172, the MH clinics already ensure individuals deemed high 
risk are seen weekly. Their treatment is carefully tracked and 
monitored, and a multi-disciplinary team of MH professionals meet 
regularly to discuss the patients' progress and determine if 
modifications to treatment plans are needed. Additionally, the success 
of our Targeted Care program, which is designed to connect individuals 
to the most appropriate resource (e.g., Mental Health, Primary Care 
Behavioral Health, Military Family Life Consultant, Military One 
Source, Chaplains) given their respective needs, has resulted in more 
availability within the MH clinics. This has enabled many of our MH 
clinics to see patients needing that level of care for follow ups at 
the frequency indicated given their MH conditions.
    DAF (MH) has already been routinely promoting skills-based suicide 
prevention training for our MH teams. There has been a concerted effort 
to get providers enrolled in the Psychological Health Centers of 
Excellence (PHCOE) training on Cognitive-Behavioral Therapy for Suicide 
Prevention (CBT-SP). In May 2022, SG 3/4 sent out a transmittal 
encouraging MH teams to complete training on Lethal Means Safety (LMS). 
That course was offered via computer-based training free of charge from 
our VA counterparts.

    69. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, how 
are each of your Services prioritizing the implementation of these 
recommendations and do you have an estimated timeline for their 
completion?
    Ms. Schaefer. The Army is actively assessing the implementation of 
the recommendations made by the Suicide Prevention and Response 
Independent Review Committee, which will be done through a phased 
approach, synchronized with the establishment of a prevention workforce 
at the strategic, operational, and tactical levels. To expedite the 
immediate action of sleep education, the Army will utilize existing 
prevention capabilities such as the Holistic Health and Fitness 
program. Additionally, the Army is in the process of Army-wide 
proliferation of a newly modernized Suicide Prevention training 
curriculum, which equips Commanders with tools to impart knowledge and 
skills through modular means in accordance with SPRIRC recommendations 
for frequency, intensity, and duration of education delivery. 
Furthermore, the Army recognizes the importance of leaders who steward 
our most valuable asset--People--and is currently reviewing and 
assessing the Commanders Assessment Program.
    Mr. Parker. The Department of Defense released a report in February 
2023 following the Suicide Prevention and Response Independent Review 
Commission (SPRIRC) comprehensive review. The report issued 127 
recommendations for ``Preventing Suicide in the Military.''
    Upon receipt of the SPRIRC, the Secretary of Defense (SECDEF) 
directed the immediate implementation of several recommendations 
addressing servicemembers well-being, access to behavioral and mental 
healthcare, and the establishment of a Suicide Prevention 
Implementation Working Group. This working group serves as the primary 
body to assess the advisability and feasibility of implementing each of 
the remaining recommendations.
    The Department of the Navy (DON) is committed to reducing suicide 
of its Sailors, Marines, Civilians, and family members. The DON, Navy 
and Marine Corps are active participants in the working group reviewing 
the recommendations, drafting initial implementation plans, 
prioritizing recommendations, and identifying barriers that may impact 
implementation. A final plan from the Suicide Prevention Implementation 
Working Group is due to SECDEF in June 2023. The DON, Navy and Marine 
Corps expect additional guidance concerning the implementation of the 
remaining recommendations after his review of the proposed 
Implementation Plan.
    Mr. Wagner. The DAF is working as part of OSD(P&R)'s SPRIRC 
Implementation working group to focus on each recommendation. The DAF's 
efforts align with OSD's prioritization level of effort toward 
implementing the recommendations from the SPRIRC report. The Secretary 
of Defense will receive the internal assessment In June 2023. DAF 
implementation plans and completion timelines will be established after 
the approvals by SECDEF.
                 gender integration in the marine corps
    70. Senator Hirono. Mr. Parker, the Fiscal Year 2020 NDAA included 
a requirement for the Marine Corps to integrate the genders during all 
recruit training--with a 5-year deadline to do so at Marine Corps 
Recruit Depot Paris Island, South Carolina, and an 8-year deadline at 
Marine Corps Recruit Depot San Diego. What is the current status update 
on how recruit gender integration in the Marine Corps is proceeding?
    Mr. Parker. We have been fulfilling the fiscal year 2020 NDAA 
requirement by executing our integrated training model at both recruit 
depots since the beginning of 2021. MCRD Parris Island is fully in 
compliance and MCRD San Diego is on track to meet the requirement as 
directed. Currently, there are no impediments to our gender integration 
efforts. By 2026 we expect to have an equal distribution of female 
recruits at both depots. Today, every female recruit, at both MCRDs, 
trains alongside her male counterpart in integrated companies.

    71. Senator Hirono. Mr. Parker, how are the units with full gender 
integration performing compared to the all-male or all-female units?
    Mr. Parker. In evaluated individual events (e.g., physical fitness 
tests, combat fitness tests, and rifle range), we see no discernable 
difference in the total average scores of integrated companies in 
comparison to all-male or all-female companies. We will continue to 
train to standard in our integrated company model and will continue to 
monitor recruit performance.
                           diversity efforts
    72. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, 
diversity in race, gender, socio-economic background, and ideas 
contributes to a stronger, more innovative military. In today's 
challenging recruiting environment, it is more important than ever for 
everyone who meets the military's standards to have the opportunity to 
serve. How are each of your services reducing barriers to accession for 
all people and informing young people about the benefits of service?
    Dr. Schaefer. The Army continues to proactively work with OSD to 
look to expand upon the traditional standards of qualification to allow 
propensed applicants the opportunity to serve.
    We continue working to tell the Army's story in new ways to ensure 
we remain a top choice for Americans who want to serve their country. 
One example of this outreach is the U.S. Army Recruiting Command's 
(USAREC) Diversity Outreach and Inclusion Team (DOIT), which engages 
and shares real life Army stories from team members in order to connect 
with diverse audiences and communities on a personal level. DOIT is 
comprised of Officers/Noncommissioned Officers from Active Duty and 
Active Guard Reserve with diverse backgrounds and experiences who are 
uniquely equipped to provide relatable information to potential 
applicants, influencers, and community leaders.
    We will continue to reach out to Americans from all backgrounds, 
talents, and regions and give them multiple reasons to come in and stay 
in our great Army. Our goal is to help all Americans to be able to see 
themselves in what the Army has to offer.
    Mr. Parker. High schools are the best sustainable market for our 
recruiters, and the best way we can share the Navy and Marine Corps 
story and the benefits of service. We are continuing to renew our 
community and school outreach efforts after the COVID-19 pandemic and 
working closely with the Department of Education to connect with local, 
State and Federal education officials to promote the value of military 
service. Ensuring State and local officials facilitate recruiting 
access is paramount to our success.
    The Navy and Marine Corps have both implemented outreach to 
underrepresented communities as we strive to recruit from every zip 
code and increase the pool of qualified accessions. We partner with 
affinity and other influential organizations that can promote our 
inclusive message of service to all communities, such as minority 
professional organizations and fraternities and sororities at 
Historically Black Colleges and Universities (HBCUs). We continue to 
assess where Naval Reserve Officer Training Corps (NROTC) units are 
established and how best to leverage cross-town affiliations at MSIs. 
Our recruiters also seek diverse and innovative STEM talent from magnet 
schools, specialized high schools, and career and technical education 
programs.
    In addition to these outreach efforts, both the Navy and Marine 
Corps have made significant investments in marketing and advertising to 
increase brand awareness among key influencers, to generate contacts, 
and to create advocates. Some of the strongest results come from social 
media (YouTube, Snapchat, Facebook, Instagram, Reddit, etc.) where we 
can reach a large and diverse population, video views and completions, 
and media and event impressions.
    We are also seeking creative ways to expand the pool of eligible 
applicants. For example, the Navy launched the Future Sailor 
Preparatory Course, which provides fitness training to help high-
potential recruits meet body composition standards to be eligible to 
enlist. The Navy is also accepting additional applicants with lower
    Armed Forces Qualification Test (AFQT) percentile scores only if 
they have qualifying line scores for a specific job assignment. This 
change removes a potential barrier to enlistment that emphasizes the 
applicant's individual aptitude (as measured by the line score) vice 
their comparison against others (as measured by the percentile score), 
and broadens our pool of potential recruits, while still sustaining the 
specific job qualifications, which is our most applicable requirement. 
Finally, we are working closely with OSD to review medical standards 
for enlistment to better reflect modern understanding and treatment of 
physical and mental health conditions and not unnecessarily disqualify 
those who are qualified and willing to serve.
    Mr. Wagner. How we take care of, and prioritize, taking care of our 
Airmen and Guardians and their families, caregivers, and survivors 
directly impacts our ability to attract talent. Today's youth are 
looking for organizations who align with their values, to work 
somewhere that respects them and everyone around them. Taking care of 
people reflects how we enhance the quality of life and quality of 
service of our members.
    This is important both to our recruiting messaging, both to 
recruits themselves, but also youth influencers. It is also important 
to our retention efforts. With a consistent average of ?90 percent 
retention, we find that once members join the DAF, we are generating a 
positive environment that ensured they want to stay.
    The Secretary of the Air Force directed the Vice Chief of Staff to 
expedite the process in which we identify and remove barriers to 
service to increase the qualified pool of applicants without decreasing 
standards. To date, the team has expedited implementation of a revised 
tattoo policy allowing for small hand and neck tattoos, modified the 
strength aptitude test requirements, and aligned the body fat 
composition standard with the DOD standard. Work continues to promote 
naturalization at Basic Training, reevaluate driver's license 
requirements for specific career fields, incentivize recruit referrals 
and authorize additional stripes for certain education and industry 
certifications, to include cyber certifications. Additionally, DAF 
reinstated the Enlisted College Loan Repayment Program and increased 
the Initial Enlistment Bonus budget for fiscal year 2023. More 
specifically, the DAF is currently developing/executing a campaign to 
encourage female participation in sports through direct marketing and 
athletic partnerships to create an enduring relationship with female 
athletes and their influencers. The DAF also employs a rigorous data-
driven approach to ensure that our marketing tactics and messaging 
align with Generation Z and their influencers. Compared to fiscal year 
2022, these efforts have led to a 3 percent increase in female, 
Hispanics, and African American recruits year-to-date with a positive 
trajectory ahead.

    73. Senator Hirono. Dr. Schaefer, Mr. Parker, and Mr. Wagner, the 
Department of Defense has initiated a number of programs to put 
Servicemembers and their families first. How have these efforts helped 
you in your recruiting mission?
    Dr. Schaefer. The Army believes there is a correlation between how 
we care for our People andoverall recruitment and retention. Investing 
in programs that put Families first has real lifeimpacts for our 
soldiers and their families, enhances Army readiness, and shapes 
publicperception. We have confidence these investments posture us to 
retain current and recruit futuresoldiers into the Army.
    Mr. Parker. While we have seen many improvements in industry in 
recent years, from compensation to education benefits, we must continue 
to emphasize the benefits that set the military apart, especially 
transformational benefits that only military service can offer. I 
believe military compensation and education benefits are still largely 
unrivaled by the private sector, especially for our largest cohort of 
non-college educated individuals with limited professional experience. 
Responsive personnel policies and quality of life programs are 
necessary to ensure the military remains relevant in the minds of 
today's youth, who have come to expect benefits such as parental leave 
to be the norm. These policies and programs contribute to positive 
perceptions of military service among those currently serving and their 
families. This in turn helps us address misconceptions about military 
service, which remain a key barrier to recruitment.
    Mr. Wagner. How we take care of, and prioritize taking care of, our 
Airmen and Guardians' and their families directly impacts our ability 
to attract talent. Today's youth are looking for organizations that 
align with their values, to work somewhere that respects them and 
everyone around them. Taking care of people reflects that we value 
quality of life and as a balance to the sacrifices of service. When we 
offer resources for spouses, childcare, health and wellness, financial 
readiness support, education, health and wellness those programs help 
counter barriers to service. When we take care of our people, our 
people can focus on innovating, growing and learning, solving problems, 
and executing the mission, which also aligns with young Americans' 
desire for work that is challenging, meaningful, and has a positive 
impact.
                               __________
                Questions Submitted by Senator Tim Kaine
                integrated disability evaluation system
    74. Senator Kaine. Secretary Cisneros and Ms. Foster, the 
Integrated Disability Evaluation System (IDES) was determined to be a 
factor for concern in the Suicide Prevention and Response Independent 
Review Committee report that was released in February of this year, 
noting that in 2012 the average timeline for completion of evaluations 
was 400 days. Although the DOD has made progress and the report stated 
that the Services are close to achieving a completion goal of 180 days, 
this is a vulnerable population with an increased suicide risk. How is 
OUSD(P&R) and/or the Office of Force Resiliency working with the 
Services to incorporate this report's recommendations involving manning 
and assignment policies and ensuring that servicemembers going through 
the IDES process are appropriately cared for?
    Mr. Cisneros and Ms. Foster. The Secretaries of the Military 
Departments operate the DOD portions of the Integrated DES (IDES) in 
accordance with Title 10, U.S.C. One of the primary duties of the 
Secretaries is to resource and train staff member with appropriate 
assistance from the Director of the DHA. In April 2020, the Department 
of Veterans Affairs (VA) suspended all in-person examinations due to 
COVID-19 (and continues to be challenged in the examination and rating 
stages of the IDES), which affected down-the-line DOD timeliness of 
IDES cases. Our VA partners are rectifying that issue now. The Military 
Departments, have experienced staff shortages, and gapped assignments 
of medical officers at the Physical Evaluation Board level (especially 
in the Department of the Navy). Turnover of well-trained uniformed 
physicians performing Medical Evaluation Board duties at DHA MTFs has 
been of issue. These factors have impacted the ability to process 
servicemembers through the IDES in optimum fashion.
    However, the Joint Executive Council (JEC) has been directly 
involved in assisting the Military Departments mitigate DES staffing 
challenge. In a recent JEC meeting, this issue was front-and-center, 
and the Military Departments reported the following organizing actions 
to improve timeliness and the percentage of cases meeting the goal:
      Prioritizing military and civilian vacancies fill actions 
to address shortages, to include:
        o  Adding additional authorizations to increase capacity/
throughput
        o  Detailing or overstaffing additional personnel to augment 
the DES workforce
      Sharing and implementing identified best practices to 
improve efficiencies
      Emphasizing and implementing Service electronic DES case-
processing systems to provide visibility into snags whether DOD or VA
    The Department does understand the impact that delayed processes 
can have on servicemembers and is taking every effort to minimize 
servicemembers' vulnerability of suicide risk. In particular, policy 
requires servicemembers undergoing DES evaluation be advised of their 
case status regularly, issues that must be resolved for their case to 
progress, and the expected timeframe for completing the DES at their 
installation. Physical Evaluation Board Liaison Officers help manage 
expectations, coordinate medical appointments related to the disability 
process, oversee the servicemember's case file, and are required to 
contact servicemembers undergoing disability evaluation at least 
monthly to offer DES case assistance.
    While the Department knows of no direct correlation between the 
Military Department's IDES queue time (and staffing) to suicidal 
ideations, we recognize that IDES delays could aggravate some 
servicemembers.
                         defense health agency
    75. Senator Kaine. Under Secretary Cisneros and Assistant Secretary 
Martinez-Lopez, I've had several constituents and advocacy groups reach 
out to me about DOD civilian access to care in Japan--an issue that has 
both highlighted and added to concerns about the scope of Defense 
Health Agency's mandate, which seems to focus exclusively on Active 
Duty servicemembers and dependents. Given that OUSD(P&R) is the 
principal staff assistant and advisor to SECDEF for Total Force 
Management, I'm curious why DHA's mandate to ``provide a medically 
ready force'' does not seem to extend to the auxiliary forces that 
support our uniformed servicemembers and the mission. Would you agree 
that there is a need to reconsider how DHA defines readiness and expand 
its mandate to ensure the medical readiness of the Total Force?
    Mr. Cisneros. Requirements for ``readiness of the force'' is in the 
lane of and identified by the Military Departments. DHA acts on those 
requirements in MTFs; however, DHA does not define the requirements of 
readiness.
    Mr. Martinez-Lopez. Requirements for ``readiness of the force'' is 
in the lane of and identified by the Military Departments. DHA acts on 
those requirements in MTFs; however, DHA does not define the 
requirements of readiness.
                support to non-deployable servicemembers
    76. Senator Kaine. Assistant Secretaries Schaefer, Parker and 
Wagner, it came to my attention during visits to the Mid-Atlantic 
Regional Maintenance Center following the suicides of 4 Sailors that a 
contributing factor to the stressors at the command was a policy that 
allows for a 60 percent increase in the assignment of personnel (30 
percent for limited duty and 30 percent for pregnancy/postpartum) with 
no additional resources to support a population that requires special 
care and attention. How do your respective services provide support to 
those in a limited duty or pregnant/postpartum status and the commands 
they are assigned to? Separately, how do your respective services do 
the same for those undergoing a disability evaluation?
    Dr. Schaefer. The Army supports soldiers in a limited duty or 
pregnant/postpartum status in several ways. To protect the Soldier, a 
medical profile is generated that is routed to the Commander for 
approval and awareness. This ensures the Company Commander is aware of 
the medically recommended limitations. In the case of a pregnancy, 
notifications are handled following the Army Directive ``Command 
Notification of Pregnancy'' dated February 27, 2023. Additionally, the 
soldier's chain of command, including the squad leader and company 
command team, look out for the soldier and may arrange assistance if 
required. The service provides support to the commands through their 
higher chain of command. This may include clarifying polices and 
regulations or facilitating additional support if needed. This may also 
take the form of assisting with a replacement if a Soldier on limited 
duty fills a key position and cannot deploy or attend a training 
exercise.
    Mr. Parker. The Navy believes it is critical to support 
servicemembers to ensure readiness and resilience. Limited duty (LIMDU) 
places servicemembers into a medically restricted status allowing for 
recovery and rehabilitation to be their primary focus. Their 
progression is proactively managed and closely monitored by a 
multidisciplinary team at Navy Medicine Readiness and Training Commands 
(NMRTC) through monthly Temporary Limited Duty Operations meetings. 
Both the NMRTC and the servicemember's command have designated, trained 
Deployability Coordinators (DC) that meet regularly and have access to 
the web-based tracking application ``LIMDU SMART'' to ensure 
coordination and communication flow effectively between the medical 
facility managing the LIMDU Sailor and the parent command.
    Navy Medicine provides a Women's Health Website that hosts 
resources for pregnant and postpartum servicemembers and their 
leadership, including education tools, postpartum return to duty 
transition guide, nutrition, exercise, and resiliency materials. In 
addition, the Female Force Readiness Clinical Community provides a 
platform for women's health leaders and stakeholders to develop 
strategic initiatives that support the female force across their 
medical readiness needs including pregnancy, postpartum, mental health, 
nutrition, musculoskeletal injury and prevention, and more.
    For servicemembers going through a disability evaluation, the 
Integrated Disability Evaluation System (IDES) is a collaboration 
between the Department of the Navy (DON) and Department of Veterans 
Affairs (VA) that includes medical evaluations from both agencies 
resulting in both Department of Defense and VA disability rating 
determinations. The goal of IDES is to close the gap between separation 
from Active Duty and the receipt of VA benefits and compensation. NMRTC 
Physical Evaluation Board Liaison Officers and parent command DCs, as 
discussed in the LIMDU process, support all servicemembers in the IDES, 
including utilization of monthly touchpoints for coordination of care 
through the Military Medical Treatment Facility or network care.
    Mr. Wagner. Department of the Air Force Instruction (DAFI) 36-2110, 
Total Force Assignments, outlines DAF assignment policies. The DAF does 
not have a policy that increases assignments to affect manning at a 
location for servicemembers in limited duty or pregnant/postpartum 
status. However, the DAF has Assignment Limitation policies which alert 
personnel managers of constraints on utilization, assignment, and 
deferment of pregnant/postpartum servicemembers. These policies assign 
codes that limit the selection of Airmen to or from certain duties or 
areas and may be permanent or semi-permanent in order to protect the 
servicemember from re-assignment, for instance while on limited duty/
pregnancy/postpartum status. Furthermore, current postpartum assignment 
policy provides deferment and stabilization for up to 12 months after 
the birth of a child. Waiver authorities exist for these deferments and 
are assessed on a case-by-case basis and allow accommodations where the 
risk to health and safety is minimal. On behalf of DAF, the Air Force 
Personnel Center's assessment is that assignment limitation codes are 
adequate and provide adequately necessary flexibility for 
servicemembers and DAF unit-level leadership to ensure the health and 
safety, and military readiness of the DAF.
    When a servicemember has a condition(s), which may make the member 
``unfit'' for continued military service, the member undergoes medical 
evaluation and may be referred into the Disability Evaluation System 
(DES). Once referred to the DES, this structured evaluation process 
(AFI 36-3212) takes approximately 180 days from initial treatment / 
medical assessment through the formal evaluation boards to the 
transition to veteran status. This process also determines any 
disability rating and post-service VA benefits. Each servicemember is 
assigned a Physical Evaluation Board Liaison Officer (PEBLO) who 
assists the member with the DES process requirements. The PEBLO also 
communicates with the member's commander and the VA Military Service 
Coordinator regarding the member's progress through the DES, the final 
determination, and the transition to the VA. Servicemembers are also 
entitled to legal representation through the Office of Disability 
Counsel.
                               __________
              Questions Submitted by Senator Dan Sullivan
                    military family life counselors
    77. Senator Sullivan. Under Secretary Cisneros, Assistant 
Secretaries Schaefer and Wagner, I am sure you're well aware of the 
suicide problem within our military and the DOD's recently released 
report on suicide prevention. Last year, Senator Murkowski and I 
introduced the Don Young Arctic Warrior Act to alleviate some of the 
hardships faced by our servicemembers in Alaska. Both the Arctic 
Warrior Act and the DOD's new study addressed servicemembers' access to 
counseling services. Right now, Military Family Life Counselors (MFLCs) 
provide confidential, non-medical counseling to servicemembers and 
their families but they are limited to doing so only in states where 
the provider is licensed. MFLCs are in high demand in Alaska so much so 
that they cannot meet demand. We can ensure more servicemembers and 
families have access counseling by allowing license reciprocity, which 
would allow a MFLC licensed in Montana to provide service to 
servicemembers and families in Alaska. Do you support license 
reciprocity for MFLCs?
    Mr. Cisneros. It is fundamentally important that servicemembers and 
families have access to counseling services. I wholeheartedly support 
solutions to ease access to MFLCs who fill a critical non-medical 
counseling role.
    Dr. Schaefer. Yes, the Army supports license reciprocity for 
Military Family Life Counselors.
    Mr. Wagner. Yes, the DAF supports license reciprocity for MFLCs. 
MFLCs are highly utilized by the DAF, with over 900 established 
requirements for adult, child and youth, and school-based programs, as 
a first-line of engagement for our Airmen, Guardians, and families.
                          recruiting veterans
    78. Senator Sullivan. Mr. Cisneros, Mr. Constable, Mr. Parker, Mr. 
Wagner, the U.S. military's current recruiting crisis is well-
documented, with the Army missing its recruiting goal by 25 percent 
last year and the other branches barely meeting theirs. The DOD has 
cited health issues, criminal records, low ASVAB scores, and a lack of 
interest in military service as some of the recruiting barriers 
services are currently facing. While I agree that we must work to meet 
the manpower goals by bringing new recruits into the military, I 
believe we must also seek to re-engage veterans who have since left the 
service to bring them back. One program I would like to highlight is 
the Marine Corps Reserve's new Marine Innovation Unit, which has 
successfully recruited veterans with strong consulting, technology, 
venture capital, and startup backgrounds back to the service in a 
reserve capacity to work on some of the Marine Corps' toughest 
problems. Do you think a focus on recruiting veterans is a 
complementary effort to other DOD-wide recruitment strategies?
    Mr. Cisneros and Mr. Constable. The Services continue to explore a 
number of different approaches to help improve recruiting outcomes. 
Veterans have always been a big component in our recruiting efforts. 
Veterans can share their personal experiences and help tell the 
positive message that many of today's youth are missing. Reengaging 
with veterans with the intent of having them return to the force is 
also an ongoing effort. Each Service has a ``Prior Service'' program 
where they seek out former military members with the skills and in the 
grades needed to help fill and shape the force. I do think that 
including veterans in our recruiting efforts is a force multiplier and 
is complementary to our ongoing recruiting efforts.
    Mr. Parker. A focus on recruiting Veterans (as well as Active to 
Reserve) is not only a complementary strategy for overall recruitment, 
but a cost-effective endeavor that allows us to place trained and 
experienced Sailors and Marines to fulfill our mission requirements. 
Veteran recruits are already trained in their occupation and may also 
bring beneficial civilian skill sets, such as those in the Marine 
Innovation Units you mention.
    The Navy and Marine Corps both provide opportunities for Veterans 
to continue serving. Within the Marine Corps, the primary method of 
recruiting Veterans back into the Marine Corps is through the Marine 
Corps Recruiting Commands' (MCRC) Prior Service Recruiting (PSR) force. 
PSR has recruited and processed Veterans into Marine Forces Reserve for 
over three decades, and into Marine Innovation Units since its 
creation. In 2022, Navy Recruiting Command (NRC) established the 
dedicated Navy Recruiting Reserve Command (NRRC) to focus on the Prior 
Service and Direct Commission Reserve recruiting mission. NRRC's model 
focuses Reserve recruiters in Reserve markets, working a Reserve-only 
mission and led by Reserve leaders. In support of this model, NRRC 
developed a Reserve-centric prior service training and prior service 
marketing and advertising effort. NRRC is staffed with Officer and 
Enlisted Canvasser recruiters from a variety of general and specialty 
rates and designators. Canvasser Recruiters are Reservists on Active 
Duty recruiting tours for up to 3 years. In essence, NRRC recruiters 
are Reservists selling Reserve careers. The Prior Service recruiters 
are strategically placed in densely populated Veteran markets in each 
State and territory. Navy Recruiting is attacking ways to expand the 
prior service reach across the Active Duty market to ensure separating 
individuals have the information they need to consider extending 
service by way of the Navy Reserve. NRRC currently attends all 
Transition Assistance Programs (TAP) in the local areas and they have 
designated benefits advisors that partner with Active Duty Command 
Career Counselors to educate separating Sailors on Navy Reserve 
benefits.
    Mr. Wagner. Yes, DAF values the skills and experience our veterans 
bring, specifically to the Reserves, and we have focused efforts 
underway designed to leverage this talent. The DAF's 'Go Blue--Stay 
Blue' campaign is a whole-of-service approach to recruiting and 
retaining America's best for service, includes attracting veterans for 
service in the Air National Guard and Air Force Reserve. We employ 
print and digital assets in our on-base and near-base advertising 
campaigns as well as paid search, digital, social, and other 
opportunities to specifically target and reach the prior-service/
veteran audience across the globe. One of our most recent programs, the 
Reserve Hypersonics Team ``Bullpen,'' is developing a structure to 
focus Reserve talent on Service priorities. We also offer affiliation 
incentives and bonuses to attract fully qualified members into the Air 
Force Reserve. We hope the increased options to put veterans' unique 
skills and strengths to work across the DAF, incentives for experience, 
and our marketing efforts will inspire and increase veteran 
recruitment.
                 servicemember mental health in alaska
    79. Senator Sullivan. Mr. Cisneros, Dr. Schaefer, in May 2022, the 
Army surged 40 counselors and chaplains to Alaska to address a 
horrifying increase in suicides in 2021. The Army also setup other 
initiatives aimed at preventing suicide including mandatory annual 
counseling sessions for soldiers, a program to connect soldiers' 
families with Army leaders, and an option for soldiers to choose to 
serve in Alaska. Congress, specifically the Armed Services Committee, 
included numerous provisions in the Fiscal Year 2023 NDAA specifically 
geared to addressing concerns that Alaska-based servicemembers, 
spouses, and mental health providers brought to my attention during 
listening sessions I conducted in 2022, including one free trip home 
during a tour of duty in Alaska and special pay for servicemembers 
regularly operating outdoors in Arctic conditions. What is your 
assessment of the Army's response?
    Mr. Cisneros. The Army's responses in Alaska are based upon 
holistic assessments of the behavioral and social health of the units, 
as well as an examination of the impacts of the military community and 
geographic location. I also support the Army's implementation of 
initiatives based upon these assessments, and I am confident they will 
continue to identify areas of concern and response.
    The Department employs a public health approach to address the 
complex interdependencies involved in suicide prevention. We work with 
the Services, including the Army, to support a culture of wellness. We 
will also continue to join with organizations, both internal and 
external to DOD, to explore public health approaches that address risk 
and protective factors, to ensure comprehensive resources are available 
and accessible to our military community, and to effectively 
communicate that life is worth living.
    Dr. Schaefer. Prevention of harmful behaviors, especially suicide, 
is a priority for the Army. We implemented Mission 100, which dictated 
that every single Soldier received wellness counseling from a 
counselor, chaplain, or behavioral health specialist. Many Soldiers 
were referred from the counseling sessions to other helping agencies 
for assistance with problems with finance, marriage counseling, and 
other problems that were creating stress in their lives. In addition, 
we focused on other parts of Soldiers' well-being such as providing 
additional hardship pay and invested in quality of life such as by 
building a new physical fitness center, community activity center, and 
child development center.
    While we've done well in supporting the Soldiers, Army Civilians 
and Family members in Alaska, we do believe that more needs to be done 
to address suicide in the USARAK AOR and across the Army.

    80. Senator Sullivan. Mr. Cisneros, Dr. Schaefer, do you need any 
additional authorities to incentivize civilian mental health providers 
to go to Alaska, like moving stipends or retention bonuses?
    Mr. Cisneros. No, no additional authorities are needed at this 
time.
    Assistant Secretary Schaefer. The Army would benefit from approval 
to exceed the Title 5 U.S.C. 5754 maximum 25 percent limitation placed 
on recruitment, relocation, and retention incentives for Behavioral 
Health occupations in Alaska. Having the flexibility to offer higher 
incentives will improve Army's ability to recruit and retain highly 
qualified behavioral health providers.
    Additionally, while we have the ability to offer paid Permanent 
Change of Station (PCS) costs to attract civilian employees to Alaska, 
these employees are subject to the initial payment of taxes for these 
benefits and entitlements. DOD has the authority to reimburse these 
costs, but the initial financial liability still falls on the 
individual.
    Employees who have accepted a PCS have experienced initial tax 
costs in the thousands of dollars, which can be burdensome and dissuade 
current employees from remaining in the position and future candidates 
from applying for these vacancies. We would benefit from exempting 
behavioral health civilian employees from paying taxes associated with 
PCS benefits and entitlements altogether instead of relying on a 
reimbursement structure, similar to their military counterparts.
                      mental health and accessions
    81. Senator Sullivan. Mr. Cisneros, Dr. Martinez-Lopez, my 
understanding of the DOD policy for mental health in the accessions 
process is that Basic accession standards for all military service are 
defined in the Department of Defense Instruction 6130.03, Volume 1, 
Medical Standards for Military Service, Appointment, Enlistment, or 
Induction (see attachment)--any applicant who has received treatment 
for depression within the last 36 months (at the time of enlistment) is 
initially disqualified and will require a waiver from the Service 
Medical Waiver Review Authority. While the disqualification is based on 
treatment within the previous 36 months and duration of treatment 
longer than 12 months, the waiver threshold is based on confirming the 
diagnosis and demonstrated level of pathology within the medical 
record. Is this understanding correct?
    Mr. Cisneros and Mr. Martinez-Lopez. An individual identified as 
having a mental health condition is considered for a medical waiver 
from the waiver authorities with sufficient mitigating circumstances 
and provided medical documentation on a case-by-case basis. A case-by-
case review includes information such as current or past diagnosis, 
severity of condition, temporality of symptoms, need for ongoing 
treatment, likelihood of recurrence, and presence of comorbidities or 
concurrent behaviors (e.g., non-suicidal self-harm, suicidality).
    Applicants for military accessions are medically evaluated and 
deemed qualified or disqualified for service based on medical standards 
outlined in DOD Instruction (DoDI) 6130.03 Volume 1 (v1), ``Medical 
Standards for Military Service: Appointment, Enlistment, or 
Induction.'' Mental health standards are detailed in DODI 6130.03v1, 
Section 6.28, ``Learning, Psychiatric, and Behavioral Disorders'' of 
the policy.
    Depressive disorder is disqualifying if: (1) Outpatient care 
including counseling was required for longer than 12 cumulative months; 
(2) Symptoms or treatment occurred within the previous 36 months; (3) 
The applicant required any inpatient treatment in a hospital or 
residential facility; (4) There has been any recurrence; or (5) Any 
suicidality (in accordance with DODI 6130.03 V1, Paragraph 6.28.m.).
    Applicants who do not meet the physical and medical standards as 
described in DODI 6130.03v1 can be considered for a medical waiver from 
the Service waiver authorities, based on additional supporting medical 
documentation and/or specialty consultation. Service Medical Waiver 
Review Authorities make waiver determinations on a case-by-case basis 
to determine suitability for service, emphasizing safety, 
functionality, assignability, and deployability.

    82. Senator Sullivan. Mr. Cisneros, Dr. Martinez-Lopez, Mr. Parker, 
Ms. Schafer, and Mr. Wagner, the chart below is from the DOD, depicting 
waivers requested and granted during the fiscal year 2016 to 2020 
period. Can you provide updated information on mental health waivers 
requested and granted, by service, through fiscal year 2022?

------------------------------------------------------------------------
                                                          Air     Marine
                                        Army     Navy    Force    Corps
------------------------------------------------------------------------
Disqualified from serving due to       89,483   35,738   35,082   31,961
 failure to meet the standards
 outlined in DOD Instruction
 6130.03, Volume 1 (includes any
 reason; i.e. vision, hearing,
 ortho, etc., to include learning,
 psychiatric, and behavioral
 disorders).........................
------------------------------------------------------------------------
Disqualified from serving              13,484    6,013    5,975    6,334
 specifically due to failure to meet
 the Learning, Psychiatric, and
 Behavioral Disorder standards
 outlined in DOD Instruction
 6130.03, Volume 1..................
------------------------------------------------------------------------
Applied for and were granted a          2,034    1,706    1,915    2,448
 mental/behavioral health waiver....
------------------------------------------------------------------------
Applied for but were denied a mental/   2,476    1,719    1,426    1,023
 behavioral health waiver...........
------------------------------------------------------------------------

    Mr. Cisneros and Dr. Martinez-Lopez. Each Service is responsible, 
through their Service Medical Waiver Review Authority (SMWRA), for 
granting medical waivers. The Department ensures that applicants meet 
accession medical standards in order to enlist in the United States 
Military. An individual identified as having a mental health condition 
is considered for a medical waiver from the waiver authorities with 
sufficient mitigating circumstances and provided medical documentation 
on a case-by-case basis. A case-by-case review includes information 
such as current or past diagnosis, severity of condition, temporality 
of symptoms, need for ongoing treatment, likelihood of recurrence, and 
presence of comorbidities or concurrent behaviors (e.g., non-suicidal 
self-harm, suicidality). OSD defers to the Services to provide their 
waiver numbers. Services provide their waiver data to AMSARA, which 
publishes the information in an annual report.
    Mr. Parker. The data you provided through fiscal year 2020 is the 
most recent available based on publication of the 2022 Annual Report on 
Medical Disqualifications, Medical Waivers, Accessions and Outcomes 
among fiscal years 2016 2020 Military Applicants by the Accessions 
Medical Standards Analysis and Research Activity
    I defer to Dr. Martinez-Lopez and the Office of the Assistant 
Secretary of Defense for Health Affairs on the availability of more 
recent data from that office.
    Assistant Secretary Schaefer. In Army, each medical waiver 
submitted for a Behavioral Health diagnosis undergoes a very rigorous 
process to ensure an applicant's record is provided a holistic review. 
In fiscal year 2021 & fiscal year 2022 the Army granted 582 Behavioral 
Health waivers of 662 requested.
    Mr. Wagner. DAF Data for fiscal year 2021 and fiscal year 2022 MEPS 
accessions:

    1.  Disqualified for any medical reason--14,322

    2.  No response. We do not have access to MEPS data for individuals 
who were disqualified for specific medical conditions. (DAF only has 
diagnostic breakdowns by medical condition when the individual applies 
for a waiver.)

    3.  Applied for and were granted a Mental Health waiver--1,967

    4.  Applied for and were NOT granted a Mental Health waiver--1,802
                               __________
                Questions Submitted by Senator Ted Budd
dod policies to permit taxpayer funding for and authorization to travel 
                          to acquire abortions
    83. Senator Budd. Secretary Cisneros, please provide the Committee 
with the previously requested information on how many women or military 
families have refused to be stationed in Germany, South Korea, or any 
other country because of those nations' laws.
    Mr. Cisneros. Unfortunately, rationale of declination of a duty 
assignment is not information collected at either the OSD or Service 
level. The information requested also cannot be retroactively obtained.

    84. Senator Budd. Secretary Cisneros, does the Department have any 
data on women being deterred from joining the military for fear of 
being stationed at an installation or base in a State or Nation that 
has restrictive abortion laws?
    Mr. Cisneros. No. The Department does not have any data on women 
being deterred from joining the military for fear of being stationed at 
an installation or base in a State or nation that has restrictive 
abortion laws. However, in servicemember engagements, the Department 
heard from Service men and women from all grades, ranks, and 
components. They repeatedly stated that access to reproductive health 
care was a concern. While many acknowledged that access to reproductive 
health care was a concern prior to the Dobbs decision, the Supreme 
Court ruling highlighted this making it a forefront issue for our men 
and women serving in uniform.

    85. Senator Budd. Secretary Cisneros, if the Department has data on 
women being deterred from joining the military for fear of being 
stationed at an installation or base in a State or nation that has 
restrictive abortion laws military, please provide that data to the 
Committee, as previously requested.
    Mr. Cisneros. The Department does not have any data on women being 
deterred from joining the military for fear of being stationed at an 
installation or base in a State or nation that has restrictive abortion 
laws.

    86. Senator Budd. Secretary Cisneros, as previously requested, 
please inform the Committee of what actions, if any, the Department 
would take against a commander that refused to approve leave or travel 
to facilitate the abortion of an unborn child in keeping with their 
sincerely held religious beliefs.
    Mr. Cisneros. While leaders are expected to display objectivity, 
compassion, and discretion when addressing all health care matters, 
should they be uncomfortable approving requests for non-covered 
reproductive health care, they may discuss with their chain of command 
whether they can refer such requests to a higher echelon of command for 
approval.