Pandemic Response Demands a New Look at the Restructuring of Military Medicine

Ansbach Army Health Clinic personnel train in emergency medical techniques at Ansbach Army Health Clinic.
Ansbach Army Health Clinic personnel train in emergency medical techniques at Ansbach Army Health Clinic, April 16, 2020, at Urlas Kaserne, Germany, April 16, 2020. (U.S. Army/Eugen Warkentin)

Clare Helminiak is a member of the Military Officers Association of America's Board of Directors and former chief medical officer for the U.S. Public Health Service.

What can military medical policymakers learn from the outbreak of, and national response to, the novel coronavirus? It is a question that could take years to answer and touch every part of the military health system.

So, as those lessons are learned, and changes are made based on the analysis of the whole of government response, why would the Defense Department continue with reforms set in motion years before the pandemic?

For now, at least, it isn't. The Pentagon has assured the Military Officers Association of America (MOAA) that reform plans calling for dozens of clinics and other facilities to stop seeing retirees and military family members -- or close entirely -- are on hold during the pandemic.

But once the COVID-19 crisis lowers to a simmer, those plans will be back in place. And so are plans to cut 18,000 medical billets included in the fiscal 2021 DoD budget proposal.

Before the pandemic, MOAA asked the DoD to ensure its reform efforts would not weaken the medical benefit earned by millions of service members past and present, and to provide ways for the 9.5 million beneficiaries to report problems with care or with access.

The reforms set to affect 48 military medical facilities are part of a process that began with the fiscal 2017 National Defense Authorization Act and rely on evaluations of the military health system that took place years before the COVID-19 pandemic.

Thousands of military medical personnel have taken part in the COVID-19 response, both within the existing Military Treatment Facility (MTF) framework and as part of the whole of nation response. Reserve-component members have been called into action. Some services have offered delayed retirement or sought volunteers in relevant specialties to return to duty.

The system has been strained, but not broken -- a familiar setting for many military members often asked to do more with less. Medical personnel of all stripes and of all uniformed services have risked their lives to fight this pandemic. To reorganize a military health system without fully understanding what future biosecurity crises or pandemics could mean for patient care does a disservice to their efforts.

As Congress begins its look at this year's NDAA, it must realize the error of relying on outdated calculations for future changes to medical billets and the Military Treatment Facility framework, and what those changes could mean to the millions of constituents who rely on MTF care -- not just during a pandemic, but in the years and decades to come.

Closing or downsizing MTFs means sending thousands of beneficiaries into the private sector for care with Tricare and Tricare for Life. What will be the financial impact and the availability of private care?

The DoD is required to assess capacity in the civilian sector and develop mitigation plans for care eliminated from MTFs, but that is impossible at the moment. Medical providers across the country -- both large hospital systems and independent practices -- are struggling with reduced revenues from canceled procedures and appointments. How many will be shuttered when the emergency passes?

The current circumstances dictate a pause to MTF restructuring and billet cuts, but that is not enough. The COVID-19 pandemic will yield many lessons learned for the entire medical system. It demands a new look at not only the DoD's role in the whole of government response to a national medical emergency, but also an updated analysis of the capacity within the military's direct care system of hospitals and clinics. Military medical readiness requirements must also be reassessed in light of this new information.

Lessons learned from COVID-19 should also inform plans for military medical research and development, as well as the DoD's role in future biosecurity crisis response and pandemic prevention efforts. We have very little visibility on how proposed medical billet reductions will impact these areas, but Army Secretary Ryan McCarthy has expressed concerns that medical end strength cuts could lead to degraded research and development capabilities.

MOAA has made this issue the centerpiece of its Virtual Storm event. We are mobilizing our 350,000-plus members and friends in an effort to cut through the rest of the pandemic fallout and make lawmakers aware of this critical issue for military retirees and families. Don't hesitate to add your voice to ours.

-- The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of If you would like to submit your own commentary, please send your article to for consideration.

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