Congress to require greater oversight of military health restructuring

Members of Congress are seeking to more closely monitor the Defense Department’s plans to modify or downsize military hospitals and clinics by requiring more oversight and adding years to a ban on reducing the services’ number of medical personnel.

The proposed fiscal 2026 National Defense Authorization Act released this week calls for the Joint Chiefs of Staff and service surgeons general to review any proposed changes to military treatment facilities to determine whether they would affect military readiness.

Under the legislation, the Defense Health Agency director also will have to explain how service members, families, retirees and other beneficiaries would receive medical care if changes to military facilities affect their access to medical care.

In a statement accompanying the bill, House and Senate negotiators said they were concerned about the effects that downsizing facilities or personnel could have on operations.

“We expect that any proposed restructuring, realignment, or modification to military medical treatment facilities will be conducted in collaboration with the appropriate Department of Defense stakeholders … to ensure that operational readiness is not impacted by any proposed changes,” they wrote.

The provisions follow a flurry of questions from Congress this year over the Defense Department’s plans to reorganize the military health system, to include downsizing or modifying some military treatment facilities.

When the Defense Health Agency was created, it was given responsibility for managing the military services’ hospitals and clinics as well as the authority to reconfigure staffing and consolidate facilities.

The agency originally planned to realign 50 facilities, including 38 that would serve military personnel only, while the services aimed to cut roughly 12,800 military health billets. Under the plan, an estimated 200,000 active-duty family members and retirees were to be shifted to nonmilitary providers managed by the Tricare health program.

A list of the affected facilities was published in 2020, but the reforms were paused early in the COVID-19 pandemic. Later, the plan was adjusted to build capacity at some facilities by bringing back patients and improving training opportunities for medical personnel.

In 2023, another list was published of 32 facilities slated for realignment, and lawmakers have since raised concerns regarding several hospitals that weren’t on that list.

Rep. Pat Ryan, D-N.Y., said in July that Keller Army Community Hospital at West Point would lose its inpatient beds, downsized to a clinic.

Sen. Josh Hawley, R-Mo., sought protections in the Senate defense spending bill for a full-service hospital currently under construction at Fort Leonard Wood following rumors that it would open next year as an ambulatory clinic.

And Sen. Jon Ossoff, D-Ga., demanded answers regarding the Eisenhower Army Medical Center at Fort Gordon amid concerns that it, too, was slated to lose its inpatient, emergency room and surgical services.

Ossoff wrote Dr. David Smith, acting DHA director, asking for more information on the organization’s plans for the hospital. Smith responded this month, saying the review is ongoing and no final decision has been made.

“There are significant pressures on the Defense Health Program for Fiscal Year 2026 and beyond,” Smith wrote in a letter published Tuesday by WRDW/WAGT in Augusta, Georgia.

“The Department as a whole is undertaking a comprehensive review of where to optimally assign its military medical personnel in order to achieve the best outcomes in quality, safety and readiness of the force and is working with the Military Departments to mitigate access to care and capacity challenges,” Smith wrote.

During a conference on military policy issues hosted by the Military Officers Association of America on Oct. 28, acting Assistant Secretary of Defense for Health Affairs Dr. Stephen Ferrara said the review process is fluid.

“I think there is always a lot of rumors about whether there’s a report that’s going to come out, and that’s not the case. It’s like if you looked at any corporation that has 100 hospitals or stores, they should be looking at them to see where it makes sense to dedicate their resources,” Ferrara said.

As part of the reform process, the military services had originally planned to reduce the number of uniformed personnel serving in military hospitals and clinics. The proposed bill extends a restriction placed by Congress on this effort by five years, stretching it from 2027 through 2032.

In addition to the provisions addressing military health facilities, beneficiaries could see more money in their pockets regarding travel reimbursement for specialty care. Currently, travel costs are only reimbursed for those who must go 100 miles or more for care; the bill reduces the distance to 75 miles.

The bill also directs the Defense Department to reopen chiropractic clinics that have been closed on installations. While chiropractic care is not covered by the Tricare health program, some hospitals and clinics contained clinics that treated active-duty personnel. Congress wants the DOD to reopen any clinics that were closed and provided at least 400 appointments per month.

For expecting mothers who had hoped to see broader childbirth options, the final bill does not include a provision that would have let beneficiaries switch to Tricare Select when they became pregnant. It also dropped a pilot program that would have covered midwife services from providers who are not nurses.

In terms of service members’ health, the bill requires the Defense Department to conduct a study of cancers among rotary-wing pilots and air crew and a study on the psychological health of combat drone operators.