Massive budget cuts and sequestration, from current funding into the foreseeable future, could not have come at a worse time for Department of Defense (DoD) and Department of Veterans Affairs (VA) healthcare programs.

While the battlefield mortality rate for the past 12 years of war in Southwest Asia has been the lowest in human history, advanced far-forward medical care, high incidence of traumatic brain injury (TBI) and improvised explosive device (IED) blast damage to the face and extremities have resulted in survivors with a higher-than-average rate of amputations and other long-term disabilities for DoD.

Pressure from more than 300 Veterans Service Organizations (VSOs) advocating on behalf of nearly 23 million U.S. veterans helped convince Congress to insulate the VA from recent budget cuts and sequestration, but DoD was hit harder than most parts of government.

Much of the burden of care of those personnel has been turned over to the VA, increasing a veteran population already expanding due to service downsizing and the added health problems of an aging Vietnam-era cohort. That group, who served from roughly 1960 to 1975, now comprises about one-third of all U.S. veterans, roughly equal to the massive influx from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) and the first Gulf War, Operation Desert Storm, in 1991.

Pressure from more than 300 Veterans Service Organizations (VSOs) advocating on behalf of nearly 23 million U.S. veterans helped convince Congress to insulate the VA from recent budget cuts and sequestration, but DoD was hit harder than most parts of government. Any decrease in active-duty care – including National Guard, Reserve, and Coast Guard personnel deployed to Southwest Asia – or DoD-sponsored medical research and development (R&D) will transfer new burdens to the VA.

Nor is there any guarantee the VA will continue to receive special treatment once the last U.S. combat troops return home from Afghanistan in 2014 and the nation’s longest war – already a minor issue in voter surveys – fades even further from public attention.

Each year a number of the largest VSOs work together to draft an independent budget proposal for the VA and DoD, the IB-VSO, which they present to Congress as a unified representation of veteran needs and concerns. In testimony concerning the IB-VSO before this year’s Senate Armed Services Committee hearing on Military Personnel, Compensation and Healthcare Matters, four co-chairs of The Military Coalition (TMC), a consortium of 33 VSOs and Military Service Organizations (MSOs), challenged claims of military personnel costs “rising out of control,” especially with respect to healthcare.

“Those charges have proved unfounded,” TMC told lawmakers. “Defense spending as a percentage of GDP during wartime is much lower than during past conflicts. Personnel and healthcare costs today are the same share of the defense budget – less than one-third – that they’ve been for more than 30 years … [and] a lower share of the budget for DoD than for many most-similar corporations – 61 percent for UPS, 43 percent for FedEx and 31+ percent for Southwest Airlines.

“At 10 percent of the defense budget, DoD healthcare costs are a bargain compared to the health cost share of the federal budget (23 percent), the average state budget (22 percent), household discretionary spending (16 percent) and GDP (16 percent). Far from ‘exploding out of control,’ Pentagon documents show military healthcare account surpluses have been raided to fund other programs – $708 million diverted in FY12 and a total of nearly $2.5 billion over the last three years. [A] reprogramming document acknowledged retiree health costs went down 2.5 percent for FY12. DoD projections of future defense health care costs have declined steadily for the last three years and will decline further based on recent law/policy changes.”

Barry Jesinoski, executive director of Disabled American Veterans (DAV), one of the oldest and most active of the VSOs, told Defense Media Network that the VSOs are working around the clock and across the nation to ensure veterans – and active-duty wounded warriors – receive everything they are owed for service to their country in time of war.

“We’ve been promised by Congress, the president, and secretary of Veterans Affairs that the VA will not be subject to sequestration. Of course, that could change. Our first line of defense is our legislative team, which doesn’t end in Washington; that staff stays on top of the issues and identifies a plan of action that then activates our grassroots lobbying campaign. So we are very proactive in ensuring veterans maintain the rights they have and obtain additional benefits to which we believe they are entitled but are not yet on the books,” he said.

“If that failed for some reason and some parts of the VA became subject to sequestration, it’s very hard to say what would happen because we don’t know what would be affected first. If it impacted medical care, then that would draw more people into the civilian medical system, where they then would face Obamacare. If the VA begins losing parts of itself – and right now the VA healthcare system is the largest and arguably the best in the nation in providing a full range of services – it will seriously impact veterans.”

“If Obamacare effectively forces an employer to provide healthcare coverage to all of his employees and some portion of those are service retirees who also qualify for TRICARE, it would become difficult for the service retiree – if DoD does focus on those benefits – to claim they don’t have access to healthcare from civilian sources,” he said.

Heritage Foundation defense analyst Baker Spring said veterans have the same constitutional right as any citizens to ask for a redress of grievances, “but military culture doesn’t play that hand.”

“As more of a cultural matter, the military healthcare program is suffering from the same problems that exist, in a far larger scale, in the economy and American population as a whole – an insurance mechanism that essentially tells the benefit recipients that healthcare is a free good. But if it is perceived that way, then the possibility for cost control is near zero,” he said.

Foundation policy analyst Michaela Dodge added that Defense Secretary Chuck Hagel and his two immediate predecessors – Leon E. Panetta and Robert M. Gates – all have called for reform in the Pentagon’s healthcare system.

“That hasn’t progressed far, but sequestration might change that because personnel is one of the fastest growing elements in the DoD budget,” she said.

Spring predicted the top Pentagon candidate for “discipline” in military healthcare outlays will be one of the groups the VSOs are seeking to protect – veterans and their families and survivors who already are eligible for private-sector healthcare coverage under their post-service employees. The major problem with that, he added, is the uncertainties surrounding the costs and specifics of the Patient Protection and Affordable Care Act (PPACA) – aka, Obamacare.

“If Obamacare effectively forces an employer to provide healthcare coverage to all of his employees and some portion of those are service retirees who also qualify for TRICARE, it would become difficult for the service retiree – if DoD does focus on those benefits – to claim they don’t have access to healthcare from civilian sources,” he said.

“What we need is a systemic reform of the healthcare system. But sequestration is imposing incremental nicks in the military healthcare budget during a nine-year period, which will not give service members a real opportunity to look at different ways to provide their healthcare.”