DoD is moving forward with planned military treatment facility (MTF) closures following a COVID-19 related pause, according to a recent Military.com article, and MOAA will continue its multiyear effort to protect beneficiary access.

No final decisions have been made regarding MTF closures or downsizing, but as the process continues, MOAA will advocate for robust analysis of civilian care availability, thorough mitigation planning, and rigorous congressional oversight.

Dr. David Smith, who is performing the duties of Assistant Secretary of Defense for Health Affairs, told Military.com the Defense Health Agency (DHA) has “modified its plans to take into account lessons learned during COVID-19.” DHA will submit the modified plan to Congress in the coming weeks, Smith said.

The modified plan Smith references is a reporting requirement MOAA fought for and achieved in the FY 2021 National Defense Authorization Act (NDAA) with the help of MOAA members who took the issue to Capitol Hill as part of MOAA’s 2020 spring advocacy campaign.

Section 718 of the FY 2021 NDAA added rigorous requirements to DoD’s MTF restructuring plans related to access and quality of care available in the civilian provider network. It requires DoD to certify to the congressional defense committees that beneficiaries affected by MTF restructuring will have access to civilian care through the TRICARE program.

This provision also prohibits DoD from moving forward with MTF restructuring for 180 days following submission of implementation plans and certification of civilian care availability.

[ADVOCACY IN ACTION 2022: Visit MOAA.org/AiA]

MOAA does not oppose changes intended to improve uniformed provider readiness – the plan to downsize some smaller MTFs and consolidate specialty providers in military medical centers of excellence will provide many uniformed providers with higher caseloads, access to patients with more complex needs, and opportunities to cross-train with Level 1 trauma centers and other civilian medical centers.

MOAA’s goal is to ensure these plans only move ahead after DHA has confirmed availability of care for beneficiaries impacted by MTF downsizing. DHA has often acknowledged that all downsizing will be “conditions-based” – that is, contingent on availability of quality medical care in the local community and that some locations slated for downsizing will be struck from the list pending additional analysis.

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A Different Health Care Landscape

The civilian health care system is in a much different place today than it was in 2017, when MTF restructuring plans were originally envisioned. Two years of relentless uncertainty and demands from COVID-19 have left experts fearing a civilian health care workforce crisis. In a recent letter to Congress, the American Hospital Association called workforce challenges “a national emergency that demand immediate attention from all levels of government.” 

Meanwhile, in a recent webinar hosted by U.S. News and World Report, the American Nurses Association said the nation will need an additional 1.2 million nurses by next year to meet the growing demand for their services and replace those leaving.

This does not sound like a health care system prepared to absorb military families transitioned out of shuttered or downsized military hospitals and clinics.

As we wait for the release of the Section 718 report, MOAA continues to build awareness on the Hill regarding instability in the civilian health care workforce, DHA limitations on measuring access to care, and the potential cost increases to DoD associated with shifting care to the civilian sector. When the updated MTF restructuring plan is released to Congress, we will leverage that to keep the momentum going on this effort. Please watch The MOAA Newsletter for opportunities to support our efforts by sharing concerns with your elected officials.