March 07, 2023

Warren, Castro Urge Department of Defense to Waive Civilians’ Medical Debt Incurred at Military Treatment Facilities

“These aggressive debt collection practices are particularly pernicious and create an undue hardship for low-income patients”

Text of Letter (PDF)

Washington, D.C. – U.S. Senator Elizabeth Warren (D-Mass.), Chair of the Personnel Subcommittee of the Senate Armed Services Committee, and Representative Joaquin Castro (D-Texas) sent a letter to the Department of Defense’s Assistant Secretary for Health Affairs Dr. Lester Martinez-Lopez and Director of the Defense Health Agency Lieutenant General Telita Crosland, urging the agency to waive civilian patients’ medical debts incurred at military treatment facilities, using statutory authority established by the lawmakers’ provision in the Fiscal Year 2021 National Defense Authorization Act (NDAA).

The provisions expanded DoD’s ability to waive medical debt for civilians when they are unable to pay the costs of the care provided and the care enhances the knowledge, skills, and abilities of military healthcare providers. More than three years after the law was passed, DoD has made little progress in implementing this provision.

“For patients that cannot pay their medical debts, DoD refers debt collection to the Treasury Department, which can withhold patients’ wages, tax refunds, or up to 15 percent of their Social Security benefits,” wrote the lawmakers. “These aggressive debt collection practices are particularly pernicious and create an undue hardship for low-income patients.”

Between 2016 and 2021, the Government Accountability Office (GAO) found that DoD had billed over 60,000 civilian patients and just “0.1 percent of debt cases reviewed by the GAO were reduced.” In addition to including provisions in the FY 2021 NDAA, Rep. Castro secured an amendment in the FY 2023 NDAA providing the Director of the Defense Health Agency with additional authority to reduce medical debt if a civilian “is underinsured, or has a remaining balance and is at risk of financial harm.”

“The Department of Defense enhances its medical readiness and benefits from treating civilian patients,” said Senator Elizabeth Warren. “Receiving lifesaving emergency care should not result in financial ruin, and it’s long past time for the DoD to use its authority to waive this burdensome medical debt and provide needed relief to patients.”

“More than two years ago, Senator Warren and I passed an amendment to the FY2021 National Defense Authorization Act to give the Defense Health Agency (DHA) flexibility to waive extraordinary medical bills for civilians treated at San Antonio’s Brooke Army Medical Center (BAMC) and other Military Treatment Facilities. Instead of using this flexibility, the DHA has slow-rolled implementation and continued to saddle trauma patients with five and six-figure medical debt. My office has been helping San Antonians with unreasonable BAMC bills for years, and it’s past time for the DHA to get moving on this problem,” said Representative Joaquin Castro. “Treating civilian patients is necessary to maintain BAMC’s accreditation for graduate medical education, and experience with civilian patients at BAMC helps military medical personnel develop the skills to save lives on the battlefield. San Antonio is proud to be Military City USA and our city is grateful for the Level I trauma services that BAMC provides, but these ongoing billing issues are unacceptable. I look forward to hearing promptly from DHA leaders about their plan to bring down medical costs for all civilians who receive care at Military Treatment Facilities.”

The lawmakers are offering a series of suggestions to help DoD determine if a patient qualifies to have their medical debt waived, including adopting DoD’s existing frameworks, waiving debts for Supplemental Nutrition Assistance Program (SNAP) recipients, or adopting the Internal Revenue Service (IRS) Collection Financial Standards. It also asks for a briefing updating our office on its implementation plans.

“DoD has no excuse for inaction on this important provision that would release thousands of civilians from burdensome medical debts incurred at military facilities,” concluded the lawmakers.

In addition to their recommendations, the lawmakers are requesting a briefing from DoD to provide updates on the provisions’ implementation no later than March 31.

Senator Warren has long fought to ensure affordable access to healthcare for all and that the government’s aggressive debt collection practices don’t unfairly target patients:

  • In December 2022, Senator Warren and Representative Castro (D-Texas) introduced the Financial Relief for Civilians Treated at Military Hospitals Act, legislation that would ensure that Military Treatment Facilities (MTFs) run by the Department of Defense (DoD) can continue to enhance military readiness without racking up huge bills for civilians receiving emergency medical care.
  • In August 2022, Senator Warren and Rep. Castro 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 healthcare providers.
  • Senator Warren originally introduced the Financial Relief for Civilians Treated at Military Hospitals Act in June 2020.
  • 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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