Feds Spend $7,540 for Cell Phones For President Obama's Trip to Ethiopia

     When the president of the United States travels, the White House and the Secret Service bring along a tremendous amount of communications equipment. Not only does the Secret Service set up a command post to coordinate communications for the visits, but secure connections are also needed for the president to keep in touch with Washington and the military around the world in case of emergencies. Despite all of these arrangements, however, a total of $7,540 was spent for foreign-made cell phones for President Obama's recent trip to Ethiopia.
     The phones were obtained via a contract signed on July 13, 2015 with a company in Ethiopia identified only as "Miscellaneous foreign awardees", the typical identifier for many overseas contracts with the US government. The contract was handled by the State Department through the US embassy in Addis Ababa, the capital of Ethiopia. A compilation of screenshots from the contract is shown here:

     It remains unclear exactly who used the cell phones during the Ethiopia visit, or what happened to the phones when the visit was over. After an initial response from the press office of the State Department about the contract, a state department spokesperson subsequently deferred to the White House, saying, "After speaking with my colleagues we think you should contact the WH Press Office for any comment on the President’s trip to Ethiopia."
     The White House press office did not respond to a request for an explanation of the cell phone contract.

Note: A version of this post first appeared at The Weekly Standard.

Clintons' Caribbean Vacation Cost Taxpayers At Least $211K

     Bill and Hillary Clinton vacationed in the Dominican Republic around New Years, visiting at least two exclusive resorts, Punta Cana and the Casa de Campo. The once-and-possibly-future first couple spent the week, of course, under the watchful eye of the U.S. Secret Service, but the security required for the trip didn't come cheap. Five contracts for the Secret Service for lodging and vehicles totaled more than $211,000, not including food or transportation to and from the island for the agents on duty.
    The trip was first reported by THE WEEKLY STANDARD in April, but since that time more contracts have come to light, one as recently as June. The initial contract for hotels rooms for SS agents was $104,093, as shown in this composite screenshot of contract details:

     However, a second contract was subsequently posted, this one for $87,786.  This contract specifically mentions the hotel at Punta Cana, one of the resorts where the Clintons stayed:

     Besides the hotel contracts, there were three separate contracts for vehicles, one for $1,430, a second for $5,530, and a third for $12,560, bringing the vehicle total to $19,520. The description for each of the vehicle contracts reads "VEHICLE RENTAL FOR US SECRET SERVICE (FPOTUS/ FFLOTUS CLINTON)". Total hotel and vehicle costs came to $211,399.
     The Clintons each appeared in some photos during the trip, Mrs. Clinton at Punta Cana and Mr. Clinton at Casa de Campo:

     Mrs. Clinton reportedly discussed her decision to run for president during the Clintons' Caribbean vacation during a meal with sugar tycoons the Fanjul brothers and businessman Rolando Bunster, friends of the Clintons and participants (Alonso Fanjul and Bunster) in the Clinton Foundation’s Future of the Americas conference in New York in December 2014.


Note: A version of this post first appeared at The Weekly Standard.

Cost of Healthcare.gov Exceeds $2.2B After Latest Contract Award

    With the announcement Monday of a five-year, $563 million contract award to Accenture, the Healthcare.gov contractor that rescued the Obamacare marketplace after 2013's disastrous launch, the total cost of the site will well exceed $2.2 billion. The new award is on top of the $1.7 billion in contracts reported by the inspector general (OIG) of the Department of Health and Human Services (HHS) in August.
    Accenture was first hired in January after HHS replaced CGI Federal, the original contractor. Accenture reported the new award on its website, noting that not only will the company maintain current services, but is expanding its work to include the small business health plans marketplace (SHOP), and will also assist those state-based exchanges that have decided to transition to the federal site:

As the 2014 enrollment period closed successfully with Accenture’s support, work began to prepare for the 2015 enrollment. Accenture focused on simplifying the process for issuers to update plans, and implemented tools and processes to expedite the resolution of citizen inquiries.  At the same time, Accenture worked with CMS to find new ways to streamline and improve the customer experience. CMS later expanded Accenture’s scope of work to include enhancements and additional functionality of the FFM, the SHOP and state-based exchange transitions.  All of these efforts helped create a successful launch of the 2015 Open Enrollment season that continues through February 15, 2015.

     Although the transition from CGI Federal to Accenture appears to have been successful, the government is still struggling with other aspects of the marketplace. Although Hewlett-Packard was selected to replace Verizon (Terremark) in June 2013 as the host for Healthcare.gov, Verizon was awarded an emergency contract just four weeks before the current open enrollment period began, extending its contract into 2015. The new Hewlett-Packard system is acting only as backup system and a "development environment" for the current open enrollment period.


Note: A version of this post first appeared at The Weekly Standard.

Update on Obama's Australia Trip: Five Hotels, $2.1M

    When President Obama visited Brisbane, Australia in November for the G-20 summit, the entire delegation required multiple hotels and thousands of "room nights" for the length of the stay, though the president himself spent only one night in his hotel. Initially, as first reported by THE WEEKLY STANDARD, it appeared a total of three hotels and 4,096 room nights were booked. However, additional contracts posted last week bring the total to 5,146 room nights and $2.1 million.
    In addition to the Marriott, the Urban and the Adina hotels, the state department also contracted with the Watermark and the Traders hotels in Brisbane. The Traders contract was for $224,776.66 to cover 503 room nights plus function space, while the Watermark was $175,263.67 for 547 room nights. An attempt was made to confirm that no more hotel contracts were issued for this trip, but after an initial response acknowledging the inquiry, no answer was forthcoming.
    Each of the contract documents states that "Senior High Level USG Principal traveling with a delegation inclusive of support elements in: Security, Communications, Logistics and Operations." Despite the 5,000-plus "room nights" in the contracts, the number of persons on the trip could be considerably less since advance security teams, diplomatic personnel and others may arrive in advance and stay multiple days or even weeks. The state department has been reluctant in the past to reveal details about the size of the delegations accompanying the president on such trips, and the Australia trip is no exception. The state department did not respond to a request to clarify, even broadly, the number of US government personnel that were involved in this trip.

Note: A version of this post first appeared at The Weekly Standard.

Feds: Cost of Healthcare.gov Estimated $1.7 Billion

    The federal government issued sixty contracts from 2009 to 2014 in efforts to build the federal insurance marketplace. According to a report issued today by the inspector general (OIG) of the Department of Health and Human Services (HHS), the government had already paid out just under half a billion dollars by February 2014, five months after the beginning of open enrollment. The government is already under obligation for another $300 million, and the estimated value of the sixty contracts totals $1.7 billion. The OIG provided a summary of its findings:

The 60 contracts related to the development and operation of the Federal Marketplace started between January 2009 and January 2014. The purpose of the 60 contracts ranged from health benefit data collection and consumer research to cloud computing and Web site development. The original estimated values of these contracts totaled $1.7 billion; the contract values ranged from $69,195 to over $200 million. Across the 60 contracts, nearly $800 million has been obligated for the development of the Federal Marketplace as of February 2014. As of that date, CMS had paid nearly $500 million for the development of the Federal Marketplace to the contractors awarded these contracts.

    A few familiar names appear on the list of contracts, such as Northrop Grumman and Lockheed Martin. Also appearing are CGI Federal, widely blamed for the botched roll out of the site last October, and Accenture Federal Services, which has taken over for CGI in hopes this year's open enrollment will go better than 2013.
    The inspector general presented the report on the contracts largely with commentary, instead noting that "[i]n the coming months, OIG will be issuing additional, indepth audits and evaluations that look more closely at contracting for the Federal Marketplace and will include, when appropriate, recommendations to resolve vulnerabilities we identify and/or build on promising approaches."


Note: A version of this post first appeared at The Weekly Standard.

$908K for Vehicles for Biden's World Cup Trip--On Top of $2.2M for Hotels

    Vice President Biden's trip to Brazil in mid-June for the USA versus Ghana World Cup game and meetings the following day with the president and vice president of Brazil required rental of vehicles for Biden and his entourage costing over $900,000.  Added to the $2.2 million cost of hotels we reported a few weeks ago, the total costs of local lodging and transportation for the trip topped $3.1 million.
    The documents indicate two companies were used for vehicles and drivers:

    The $908,147 estimate far outstrips the $321,665 spent in February 2013 for a vice presidential trip to Paris. The documents for the World Cup trip do not contain enough details to explain why the cost for this trip is comparatively high, but asserts that the "anticipated cost to the Government will be fair and reasonable" and that the rates are comparable to "the rates charged for similar services during this season." The documents that accompanied the Brazil hotel contract posting noted that due to the World Cup, hotel rates were up anywhere from 75 to 365 percent, but a similar statement is not included in the vehicle documents.
    The State Department, the agency that handles arrangements for VIP trips, explained the reasons for the short notice and lack of full competition in awarding the contracts:

Security and logistics are the Department of State’s primary considerations when procuring vehicles rental. The Department of State must be able to provide a safe and secure vendor for VIP visitors. Frequently VIP visits are not announced or confirmed in sufficient time to conduct a competition, creating an urgent and compelling need.

    The two companies chosen were able to handle communications requirements and were accommodating to the security needs of the vice president's entourage.


Note: A version of this post first appeared at The Weekly Standard.

$1.5M Hotel Contract for President's One-Day Visit to Brussels

    In late March, President Obama took a week-long trip through Europe which included a stop of less than 24 hours in Brussels, Belgium for meetings with the European Union and NATO.  The president stayed at The Hotel, a twenty-seven story hotel in the center of the city.  The estimated cost for the president's stay, including about two weeks for an advance team, was $1,522,646.36.

    Despite reports that the president travelled with an entourage of 900, the Justification and Approval documents only indicate a need for "283 Lodging Rooms."  However, sometimes more than one hotel is used during VIP trips.  For instance, when the president travelled to South Africa for Nelson Mandela's funeral, five different hotels were used.

    Contracts for lodging have not yet been posted for the president's other stops during his European trip which included the Netherlands and Rome, Italy.


Note: A version of this post first appeared at The Weekly Standard.

Healthcare.gov Extends Verizon Contract: $58M for Seven Months

    Late last year the Wall Street Journal reported that Hewlett-Packard was replacing Verizon's Terremark subsidiary as the host of the federal government's Obamacare website, Healthcare.gov, when Terremark's contract expired in March 2014.  However, the Department of Health and Human Services recently awarded a $58 million, 7-month "Cloud Computing Logical Follow On" contract to Terremark to aid in the transition to Hewlett-Packard, saying that "[f]ailure to award this order will greatly jeopardize the Marketplace program anbd result in system performance issues of healthcare.gov."
    HHS documents explain the need for the extension as follows:

    The documents justifying the Limited Source contract were signed by Centers for Medicare and Medicaid Services contracting officers in late January, and were ultimately approved by new Chief Operating Officer Tim Love on February 19.
    The award to Terremark is the latest in a string of contracts and contract modifications for the company related to Healthcare.gov.  The most recent was reported just weeks ago that increased the value of Terremark's original contract to $60 million.


Note: A version of this post first appeared at The Weekly Standard.

U.S. Delegation to Mandela Funeral: Five Hotels, Transportation Cost $19M

    Documents recently released by the government show that the value of hotels and local transportation contracts for the U.S. delegation to Nelson Mandela's funeral in December were considerably higher than previous estimates.  On December 19, THE WEEKLY STANDARD first reported the cost at about $11 million. However, rather than two hotels and one vehicle contractor, additional contracts have been disclosed bringing the total to five hotels and two vehicle contractors.
    The transportation contracts include passenger vehicles, SUVs, vans, buses, pickup trucks, box trucks, and "larger capacity vehicles," but do not include the cost of travelling from the U.S. to South Africa and back.  The combined total estimated cost of the two contracts is $12,521,851.
     The five hotel contracts estimated a total of 10,275 "lodging room nights" spanning December 6, 2013 to January 20, 2014.  The Johannesburg-area hotels include the Radison Blu Sandton, Radison Gautrain, Holiday Inn, Park Inn, and the Michaelangelo.  A sixth contract for the DaVinci hotel was subsequently canceled.  The total estimated cost of the remaining contracts is $6,489,627.  Adding the $12.5 million in transportation contracts brings the grand total for lodging and local transportation to $19,011,478.
   When asked for an explanation of the 6-week date range of December 6 to January 20 for the hotels, a State Department official replied via email:

Due to high demand during that time period, all hotels in the area had a requirement to book for a minimum of 15 nights.   The date span was written into the contract to give flexibility, but we did not pay for 45 days.

    When asked to explain why 45 days was written into the estimates when only a 15 day minimum was required, the official did not respond, nor was there any response to a follow up inquiry about how accurate the cost estimates turned out to be.


Note: A version of this post first appeared at The Weekly Standard.

Education Secretary: If You Don't Graduate High School, 'You're Basically Condemned to Poverty and Social Failure'

    Secretary of Education Arne Duncan, on Air Force One en route to New York for the president's education bus tour, had some strong words to say about the prospects of those who do not attend college.  While answering a question about the cost of college and whether the administration might be exaggerating those costs, Duncan said [emphasis added]:

But, again, if you look at polls of the public -- this isn't me -- if you look at polls, the vast -- it’s like two-thirds of the American public think college is for the wealthy today.  There is something dramatically wrong with that picture.  Some form of higher education -- four-year universities, two-year community colleges, trade, technical vocation training -- some form of higher education training has to be the goal for every single young person in this country. 

Again, we know the long-term economic benefits, dividends are just tremendous -- more than doubling long-term salaries.  So if you drop out of high school today, you’re basically condemned to poverty and social failure.  There are no good jobs out there. If you have a high school diploma, there’s almost nothing for you.  College has to be the goal, has to be the aspiration.

UPDATE: It turns out Duncan has been using this line since at least 2010.  In a speech to the Council on Foreign Relations, he said:

Just as troubling, about one in four -- about 25 percent -- of high school students in the United States drops out or fails to graduate on time. That's almost 1 million students each year leaving our schools for the streets. That is economically unsustainable and is morally unacceptable. As all of you know, high school dropouts today are basically condemned to poverty and social failure.

Note: A version of this article first appeared at The Weekly Standard. 

High Cost of VIP Travel: Biden's $665,545 Hotel Bill in Moscow, Obama's $450,000 Warsaw Tab

    The Washington Times reports that the cost of President Obama's Africa trip, estimated as high as $100 million, is overshadowing President Obama's agenda.  If past trips are any indication, lodging and local transportation would represent only a fraction of $100 million, yet those costs would likely dwarf those of the average citizen traveling abroad.  Revelations in late March of Vice President Joe Biden's $321,000 limo bill and $585,000 Paris hotel bill for his trip to Europe earlier this year caused a stir even among veteran White House observers such as CNN's Wolf Blitzer.
    While the amounts spent were deemed fairly ordinary by current and former government insiders, the fact that the closely-held information was found on a publicly available government website had some speculating that perhaps the postings had been inadvertent.  However, further investigation has revealed that the information is not as rare as previously supposed.
    For example, Vice President Biden's trip to Moscow in 2011.  The contract was awarded to the Moscow Ritz-Carlton on February 24, 2011 and , according to the accompanying Justification and Approval (J&A), the estimated cost for 1,778 room nights was $665,545.  As has been noted before, contracts for travel for high level government officials are not subject to the same requirements for competitive bidding as other government contracts due to security concerns:

The vice president's visit to Moscow lasted two days and was said to focus on economic issues and missile defense concerns.

    Although Vice President Biden's foreign travel costs have received most of the attention lately, some details for at least two of President Obama's trips from his first term are available online.  The first was a trip to Warsaw, Poland in May 2011.  The J&A estimated the cost for 2,114 lodging room/nights at the Warsaw Marriott at $450,000.  Due to the special needs of the president and his entourage, the costs included extras such as "Removal and storage of furniture from standard rooms":

The stop in Poland was part of a week-long swing through Europe that included stays in Ireland, Great Britain, and France.  Details of lodging arrangements for the other stops on the trip were not available  The president spent one night in Warsaw. 

    Details of an earlier presidential trip to Prague in 2010 are also available.  At $163,000, the Prague contract  with Marriott initially appears to be a bargain compared to other trips.  However, a closer look shows that the Marriott was being used "simultaneously with the Hotel Hilton (which was the main hotel for the event...)"  The J&A for the Marriott was for only 287 nights (with more than 40 late check-out fees), but also included rentals of three plasma TVs, a pin-board, and a FAX machine:

    The contract for the main hotel, the Hilton, were not found on the website.  The president spent one night in Prague.

    Lodging and transportation costs for First Lady Michelle Obama's ill-fated trip to Copenhagen in 2009 to bolster Chicago's bid to host the Olympics were found online as well.  The costs for this trip have already garnered some attention after it took the State Department 26 months to respond to a Freedom of Information Act request by Judicial Watch.  While the documentation finally released to Judicial Watch was fairly extensive, it turns out at least some of the information was posted at FBO.GOV as early as November 25, 2009.  According to the J&A (Justification and Approval), the estimated cost for 103 rooms at the Scandic Copenhagen hotel was $430,285.70:

    On January 19, 2010, a contract for the same trip was posted for vehicles & buses provided by Copenhagen Limousine Service for $200,629.  According to the J&A, the trip included a possible visit from the president as well.  The document also includes some interesting insights about the scheduling of such trips and the security-related restrictions (and related increased costs) that are imposed in these cases:

    The president did end up traveling to Copenhagen to join his wife in her efforts and to address the International Olympic Committee, but arrived in Copenhagen and returned to Washington on the same day, Friday, October 2, 2009.  The first lady spent two nights in Copenhagen, arriving on Wednesday of that week and departing to Washington with her husband on Friday.


Note: A version of this article first appeared at The Weekly Standard.

W.H. Retweets Article on Rising Insurance Costs

    Today, the White House retweeted a link to an OregonLive.com story on competition among healthcare insurers purportedly instigated by ObamaCare:

Worth a RT. Obamacare beginning to work the way it was intended. Insurers lowering rates because of competition. oregonlive.com/health/index.s…
— David Simas (@Simas44) May 11, 2013

    The story is entitled "Two Oregon insurers rethink 2014 premiums as state posts first-ever rate comparison" and begins as follows:

This is what competition looks like: One health insurer wants to charge $169 a month next year to cover a 40-year-old Portland-area non-smoker. Another wants $422 a month for the same standard plan.
The new health insurance marketplace envisioned by federal health reforms doesn't formally kick in until fall. But it already is taking shape – and consumers for the first time can compare, premium by premium, identical plans by different insurers.

    Some of the insurance players in Oregon give at least partial credit to the new "marketplace" instituted by ObamaCare for lowering the projected 2014 rates for Oregon health insurance consumers:

"Posting rate comparisons company-by-company is a taste of what is to come," says Cheryl Martinis of the Oregon Insurance Division. 

Judging by the reaction, there's already an impact. 

Providence Health Plan on Wednesday asked to lower its requested rates by 15 percent. Gary Walker, a Providence spokesman, says the "primary driver" was a realization that the plan's cost projections were incorrect. But he conceded a desire to be competitive was part of it.

    However, one gets the idea that perhaps the White House retweeted the link without reading the entire article.  Further in the story comes this [emphasis added]:

The easy rate comparison is only one of the changes consumers who buy their own insurance can expect in 2014. 

Another is higher premiums in the 2014 individual market, though for many people they'll be offset by tax credits. The higher rates are because people with pre-existing conditions can no longer be denied coverage. Also, plans have to offer stronger benefits than they used to, leading to higher premiums. 

The changes have spawned much speculation, with some predicting "rate shock" for people who buy their own policies. Now consumers can see for themselves what premiums could be available, at least for certain plans. 

    This might appear to be a classic case of burying the lead.  Competition, yes, but higher rates?  And due to the Affordable Care Act?  However, the article quickly adds the saving grace that may have tipped the scales in the White House retweet decision.  Federal government income-based subsidies of the higher rates :

Meanwhile, at least half the potential customers who buy their own insurance will qualify for a sliding scale of income-based tax credits that could more than-eliminate any price hikes. Nearly 400,000 Oregonians are expected to purchase their own insurance as tax credits lure previously uninsured consumers. 

In addition to comparing insurance plans, Cover Oregon can enroll people and qualify them for tax credits. 

     So, the Obama administration pushed through a 2,800 page piece of legislation that cut consumer choice (I mean "simplified the health insurance system") and raised rates by forcing companies to accept sick customers (I mean "eliminated unfair exclusions for pre-existing conditions") and to offer benefits that not everyone wants or needs (I mean "offer stronger benefits".)  But not to worry.  The government will kick in the difference.  And lower the deficit.  And improve health outcomes.

    What could possibly go wrong?


Note:  This article first appeared at The Weekly Standard.

Department of Defense Rejects GAO Recommendation Regarding "Sexual Assault Victimization" in the Military

    On January 23, news broke that outgoing Defense Secretary Leon Panetta had issued a directive that the military's ban on women in combat would be lifted.  The New York Times reported that his decision was in response to unanimous agreement among the Joint Chiefs of Staff as expressed in a letter to Panetta:

Mr. Panetta’s decision came after he received a Jan. 9 letter from Gen. Martin E. Dempsey, the chairman of the Joint Chiefs of Staff, who stated in strong terms that the armed service chiefs all agreed that “the time has come to rescind the direct combat exclusion rule for women and to eliminate all unnecessary gender-based barriers to service.”

     The Times article said it was unclear why the Joint Chiefs decided to act now after years of discussion, although there is speculation that recent threats of legal action may have played a role.  However, a Government Accountability Office report issued on January 29 raises some questions about the timing of such a monumental change in policy.

    I first reported the GAO report in a January 31 blog post at The Weekly Standard where I addressed the fiscal impact of allowing women in combat positions.  However, the broader focus of the report is spelled out in its title: "DOD Has Taken Steps to Meet the Health Needs of Deployed Servicewomen, but Actions Are Needed to Enhance Care for Sexual Assault Victims." An explanation of the special focus on sexual assault victims appears early in the report [emphasis added]:

The roles for women in the military have been expanding and evolving, particularly since the Persian Gulf War more than 2 decades ago. Formerly, servicewomen served primarily in supportive roles in overseas U.S. military operations. Today, servicewomen are integral to combat support and counterinsurgency operations, and they serve in many roles they previously did not hold. In late 2011, for example, women began serving aboard Navy submarines. In early 2012, the Department of Defense (DOD) announced that changes to its assignment policies would result in more than 14,000 additional positions being opened to women, including positions in select direct ground combat units. Further, while sexual assault victimization is not unique to women, the presence of women in new roles suggests that continued vigilance with respect to this issue is needed. Given the expanding and evolving role of women in the military, the health and wellness of servicewomen plays an important role in overall military readiness. 

    According to the National Defense Authorization Act for 2012, this report was originally due by December 31, 2012.  As mentioned above, the report was released on January 29, but given that the paragraph above does not mention the lifting of the women in combat ban, the GAO report was apparently finalized prior to Panetta's announcement. This policy change, much more far reaching that even the change opening "14,000 additional positions" in early 2012, exponentially increases the need for "continued vigilance" regarding "sexual assault victimization" that the GAO calls for.  Therefore, the timing of the announcement lifting the ban and the DOD's reaction to the GAO report recommendations is curious.

    The GAO made two recommendations at the conclusion of its inquiry regarding "sexual assault victimization":

To enhance the medical and mental health care for servicewomen who are victims of sexual assault, GAO recommends that DOD (1) develop department-level guidance on the provision of care to victims of sexual assault; and (2) take steps to improve first responders' compliance with the department's requirements for annual refresher training. DOD did not concur with the first recommendation, but cited steps it is taking that appear consistent with the recommendation. DOD concurred with the second recommendation.

     In this short summary of the DOD's reaction to the draft report, which the DOD reviewed before the GAO prepared and issued the final version on January 29, the GAO notes that the DOD "did not concur with the first recommendation, but cited steps it is taking that appear consistent with the recommendation." This summary sounds sanguine about the steps the DOD is taking to conform to the GAO's first recommendation, but it fails to convey the lengths to which the DOD appears to have gone to avoid concurring and to avoid fully cooperating with the GAO staff conducting the review.  Here is the full paragraph from the body of the report discussing the DOD's recommendations.  It is quite lengthy, but I have taken the liberty of highlighting all the references to the DOD's reticence to fully engage the GAO:

In written comments on a draft of this report, DOD stated in its cover letter that, overall, the department did not concur with the report's findings and conclusions. However, DOD's cover letter did not provide an explanation for this comment. In an enclosure to its letter, DOD stated that it did not concur with our first recommendation that the Assistant Secretary of Defense for Health Affairs develop and implement department-level guidance on the provision of medical and mental health care to victims of sexual assault that would specify health care providers' responsibilities to respond to and care for sexual assault victims, whether in the United States or in deployed environments. DOD's justification of its assessment, however, did not make clear why the department did not concur. Instead, DOD provided examples of steps it has been taking that may help to address the findings in this report. Specifically, DOD stated that, while the second version of DOD Instruction 6495.02, entitled "Sexual Assault Prevention and Response (SAPR) Program Procedures" has been in coordination for nearly 2 years and is not yet published, the revised instruction will be comprehensive and will contain two medical enclosures. According to DOD, the first medical enclosure will address health care provider procedures and direct the Surgeons General of the military services to carry out responsibilities related to the
coordination, evaluation, and implementation of care, while the second medical enclosure will address health care providers' responsibilities related to Sexual Assault Forensic Examination kits. During the course of this review, we met with DOD officials who had knowledge of and were involved in the instruction's revision, but these officials did not discuss or share their draft revisions with us when we presented our findings to them. We cannot verify, therefore, whether the enclosures referenced in DOD's comments will address our recommendation. However, we plan to review the instruction when DOD finalizes it to determine whether it meets the intent of our recommendation. Finally, DOD stated that the department meets its oversight responsibilities with regard to sexual assault response through training in graduate medical education and through monitoring and oversight of the process that governs credentialing and privileging of providers.  However, it is not clear why this statement is applicable to our recommendation. We did not address these points in the finding that led to this recommendation, and our recommendation is focused on the need for additional guidance. 

    The DOD's lack of transparency and full cooperation with the GAO has certainly compromised the effectiveness of this report at the precise time when a huge policy change regarding women is emerging. Not only, as the GAO indicates above, will this require further follow up by the GAO, but it has prevented Congress from having complete information on an important aspect of the issue at a time when Congress must decide whether or not to act.  As the GAO report said:

Given the expanding and evolving role of women in the military, the health and wellness of servicewomen plays an important role in overall military readiness. 

    Implementing this policy change, unless Congress intervenes, will be the first order of business for Chuck Hagel or whoever ends up being confirmed as the next Secretary of Defense. And given the importance of the military readiness of the United States, the Department of Defense owes the GAO, Congress and the American people full disclosure when it comes to how it plans to handle one of the most significant changes to the armed forces in our lifetime.


Note: A version of this article first appeared on February 6, 2013 at The Weekly Standard.

Government Report: Women in Combat to Cost Money

Note: This article was originally published at The Weekly Standard.

    Ever since outgoing Defense Secretary Leon Panetta announced a week ago that the U.S. military would lift its ban on women in combat roles, the debate, which has been simmering for decades, boiled up again. Much of the argument has centered on cultural, social, and morale-related effects that such a change would bring about, though other practical issues have been raised as well. However, a Government Accountability Office (GAO) report released just this week may bring some other considerations to the fore, among them, the financial impact.

    According to the introduction to the GAO report, the National Defense Authorization Act For Fiscal Year 2012 charged the GAO with conducting “a review of the female-specific health care services provided by DOD to female servicemembers...”  Though not directly addressed by the GAO, the report raises a perhaps unanticipated consequence of lifting the ban on women in combat. With an increasing number of women in combat units, as well as presumably an overall increase in women enlisting in the service now that more positions will be open to them, there may be a corresponding increase in health-related costs. For example, the report says:

DOD has put in place policies and guidance that include female-specific aspects to help address the health care needs of servicewomen during deployment. Also, as part of pre-deployment preparations, servicewomen are screened for potentially deployment-limiting conditions, such as pregnancy, and DOD officials and health care providers with whom GAO met noted that such screening helps ensure that many female-specific health care needs are addressed prior to deployment.

    The “female-specific aspects” of health care are self-evident, but for confirmation, one need look no further than the Affordable Care Act with its 145 uses of the word “women” versus one use of “men.” Although women already serve in many areas of the military, the full (or near-full) integration will certainly impact the amount of “female-specific ” medical equipment, supplies, and expertise needed by each branch of the service to meet the increased demand. Examination rooms may need to be retooled and medics may need further training. Additionally, the “potentially deployment-limiting conditions, such as pregnancy” can be screened for, but will still affect associated costs, not to mention the readiness of units destined for combat, in a way that is not present with male-only units. The report implies this when it says:

Given the expanding and evolving role of women in the military, the health and wellness of servicewomen plays an important role in overall military readiness.

    The exact cost of women in combat is not revealed in the GAO report.

    But at a time when the defense budget is under increasing scrutiny, and with the threat of sequestration slashing the budget further, the likely increased healthcare costs associated with the lifting of the ban should be taken into account.

    Higher costs may not be the most important aspect of the policy change, but neither can they be ignored. The higher percentage of the defense budget that must be devoted to routine healthcare, the lower the percentage that is available for areas more directly related to keeping the U.S. military the best equipped, best trained fighting force in the world, ready at a moment’s notice to deploy whenever and wherever needed.