March 21, 2024

Senators Warren, Kaine, Rep. Burgess Press DoD on Continued Issues with Access to Medical Care for DoD Civilians and Contractors in Japan

“The IG report indicated that lack of access to healthcare in the INDOPACOM [Indo-Pacific Command] region is having a serious and negative impact on the lives of service members and DoD civilians, causing many to leave their assignments in Japan… These tragic incidents highlight the toll that the lack of access to medical care has on service members and civilians and explain why they feel compelled to leave the region.”  

Text of Letter (PDF) | DoD Response to Senator Warren’s January 2023 Letter

Washington, D.C. – Senators Elizabeth Warren (D-Mass.), Tim Kaine (D-Va.), and Representative Michael Burgess (R-Texas) sent a letter to officials in the Department of Defense (DoD) and Defense Health Agency (DHA) expressing serious concern over DoD civilians and contractors continuing to face problems with access to medical care and its impacts on morale and retention. 

In September 2022, the U.S. Naval Hospital Yokosuka announced it would cease to provide care to DoD contractors and other civilians, leaving around 4,000 individuals uncertain about their access to health care, often turning to off-base locations for care. This off-base care did not meet the needs of DoD-affiliated civilians, and in March 2023 DHA announced that they would continue to offer care for civilians with chronic conditions. A November 2023 report from the DoD’s Inspector General (IG) revealed that there are still “significant challenges for civilians using off-base medical care, including language barriers, difference in how medical care is provided overseas compared to the United States, and lack of availability for some U.S. prescription medications in Japan.” The lawmakers are concerned that DoD has not done enough to address gaps in access to care, especially in light of the November 2023 DoD IG report revealing that many gaps remain. 

In late 2023, after the release of the IG report, DoD officials took several actions to address this issue. The INDOPACOM Commander issued an order to the U.S. Forces Japan and subordinate units to improve access to emergency medical care in Japan, including identifying public hospitals in the vicinity that provide emergency medical care, enhancing access to public hospitals offering tertiary care, and equipping Status of Forces Agreement (SOFA) - status personnel with a list of local tertiary care hospitals and Japanese language medical cards that orient Japanese first responders to the nearest Military Treatment Facility (MTF).  The order included instructions on how to improve routine access to medical care, by identifying high risk individuals, evaluating methods to reduce risk, conducting adequate pre-assignment medical screening, and adequately informing prospective civilian hires of the MTF limitations on medical care.  

The lawmakers are also concerned that the lack of access to health care in the region is having serious and negative impacts on the lives of service members and DoD civilians, causing many to leave or consider leaving their assignments in Japan. A Japan Civilian Medical Advocacy Group survey from January to March 2023 found that “42 percent [of survey respondents] were actively in the process of finding a new job in order to access healthcare, and 60 percent were considering changing jobs or turning down an extension in order to access healthcare.” In June 2023, Air Force officials in Japan reported that eight civilians had requested a shorter tour due to these concerns, two chose to depart due to lack of care for their pregnant spouses, and three declined a job offer because of concerns with access to medical care, all within the last six months. The lack of health care access has resulted in “significant negative impacts to school operations at multiple locations in Japan” and “15 DoD Education Activity educators have resigned” since the start of the 2022-2023 school year, citing “access to [health] care” as the reason.

The lawmakers requested a status update about DoD’s December 2023 Military Health System Strategic Plan and DoD’s progress in addressing ongoing problems with ongoing access to health care in Japan and the INDOPACOM region by April 1, 2024. 

Senator Warren has been a leader in ensuring the Department of Defense is providing equitable access to health care for DoD civilians and contractors: 

  • In January 2023, Senator Warren sent a letter to the DoD, raising concerns about the decision to stop providing care to civilians in the U.S. Naval Hospital Yokosuka and asking about the services being provided to help support the transition of care and when space to provide care to civilians might open up again.

  • In August 2022, Senator Warren and Representative Castro (D-Texas) sent a letter to Secretary of Defense Lloyd Austin raising concerns that the Department of Defense (DoD) may be misleading or misinforming civilians about debt they incur when they receive emergency medical care at military health care facilities, and calling for improved billing practices to protect patients.

  • The FY 2021 National Defense Authorization Act (NDAA) included Senator Warren's provision, based on the Financial Relief for Civilians Treated at Military Hospitals Act, to give DoD the authority to waive medical debt when the civilian is unable to pay the costs of the care provided and the care enhances the knowledge, skills, and abilities of military health care providers.

  • Senator Warren originally introduced the Financial Relief for Civilians Treated at Military Hospitals Act in June 2020 and reintroduced the legislation with Representative Castro in December 2022.

  • In January 2020, Senator Warren sent a letter to DoD and the Treasury Department requesting information about the collection of military hospital debt from low-income, civilian patients.

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