Service members, veterans and their families who live in rural areas in the U.S. are struggling to access medical care as hospitals and facilities continue to build back systems that were ravaged by the COVID-19 pandemic, according to lawmakers.
At a House Appropriations Committee hearing March 20, senior enlisted leaders were questioned on the loss of labor and delivery care -- along with other medical services -- near Naval Air Weapons Station China Lake in Ridgecrest, California, following the partial closure of local Ridgecrest Regional Hospital's labor and delivery wing.
"This loss in care means that our service members will now need to drive almost two hours to the next closest labor and delivery unit, which places an incredible hardship on our service members and their families," Rep. David Valadao, R-Calif., said during the hearing.
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The Defense Department previously pushed back on the claim that the pandemic impacted service member and veteran care through a report compiled in 2022, specifically when it came to those who live in areas of the country where health care may be difficult to access anyway.
"After reviewing data on rural hospital closures near a military base and the impact on access to care, the closures of rural hospitals during the FY 2016-2021 period had negligible impacts on readiness and access to care for Tricare beneficiaries," said the report, which was completed as part of the Fiscal 2022 National Defense Authorization Act.
Although closures that impacted maternity and emergency care were noted near military installations such as Coast Guard bases in Kodiak and Sitka, Alaska, and the Army's Fort Leavenworth in Kansas, the number of Tricare beneficiaries impacted per closure averaged only dozens per year.
But as closures continue, the problem has drawn the attention of senior military leadership, with decreased readiness considered an issue.
Master Chief Petty Officer of the Navy James Honea told the committee last week that his service has been discussing the issue with the Defense Health Agency, which utilizes military personnel and provides medical care across all branches of the Defense Department.
"We're looking at [China Lake] like we would any other remote location, or overseas location where medical services are restricted," Honea said. "We will have to restrict assignments to those locations until we can provide that medical care, perhaps relocate service members who need that type of care so they can deliver somewhere else, and that's going to have to be across the board until we can get this all solved."
In addition to China Lake, Honea said similar issues are being seen for service members at Naval Base Kitsap in Bremerton, Washington.
"We used to have somewhere in the neighborhood of about 15 clinics that someone could go to," Honea said. "Now, there are three on that peninsula that are no longer accepting any new Tricare patients."
He said sailors and their loved ones there will have to drive to Joint Base Lewis-McChord -- around an hour and a half away -- to receive covered labor and delivery care.
The post-pandemic loss of health care due to decreasing patient numbers, staffing shortages and low reimbursement rates shuttered almost a dozen hospitals last year alone. A 2023 study by the Center for Healthcare Quality and Payment Reform suggested that there are more than 600 rural hospitals at risk of closing due to financial pressures, accounting for almost 30% of all rural hospitals across the U.S.
Because of similar shortfalls within the military's own medical system, the Defense Department announced a plan in December to return military members, veterans and their families to the military medical care community.
The goal is to review current staffing issues within military medicine, potentially shift care providers around as needed, and bring back Tricare beneficiaries who were pushed toward private-care options during a 2017 medical system overhaul, according to a memo sent by Deputy Defense Secretary Kathleen Hicks to senior defense officials and obtained by Military.com.
The Defense Health Agency provided a comment on China Lake but could not immediately provide additional information on potential access shortfalls at other locations, despite a request from Military.com.
"China Lake is considered a medically underserved area. Low numbers of providers and transportation challenges make access to health care challenging to all population segments, including Tricare beneficiaries," Peter Graves, a DHA spokesperson, told Military.com in an email.
Sergeant Major of the Army Michael Weimer said his branch is already in talks with Hicks to shuffle its medical personnel around between clinics, hospitals and their units to best ensure care while staying combat ready, but so far it isn't working.
"We're struggling in this space," Weimer told lawmakers.
The issue is that the DHA's plan hinges on the availability of community-care options, which are disappearing. Ridgecrest Regional Hospital in California is one of 55 critical care hospitals -- facilities federally designated to receive certain reimbursements due to their importance within rural communities -- across 31 states within 40 miles of a U.S. military base.
"The transformation of the Defense Health Agency has relied largely on being able to access medical care outside of our military fence lines," Honea said during the hearing. "That transformation was based on assumptions that existed prior to COVID. ... Many of those assumptions are either no longer viable or no longer exist outside of our military fence lines, and that has manifested itself in different ways in different locations."
It remains unclear whether the solution lies with Congress, the Defense Department or both, but health care should be a guarantee regardless of where one serves, Valadao told Military.com in an interview.
"I just wanted to make sure that the folks in the military know that us as members of Congress are paying attention that they better make decisions wisely, so that we don't put ourselves in a bad situation," he said.
Editor's note: This story was updated with additional information on the Defense Health Agency's response.
