Castro, Casar, and Warren Urge Military to Improve Access to Medical Debt Relief for Civilian Patients
“We are deeply concerned the proposed rule inappropriately restricts DoD’s authority to waive these [debts], as intended by Congress.”
WASHINGTON – Congressman Joaquin Castro (TX-20), Congressman Greg Casar (TX-35), and Senator Elizabeth Warren (MA) have submitted a comment letter urging the Defense Health Agency (DHA) to strengthen a proposed rule to create a Military Health System Modified Payment and Waiver Program that would limit costs for civilian patients at military hospitals, including at San Antonio’s Brooke Army Medical Center.
Brooke Army Medical Center (BAMC) is one of two Level I Trauma Centers in San Antonio. The facility treats thousands of civilians annually under a special agreement with the Bexar County Hospital District designed to allow military providers to strengthen their battlefield medical skills through hands-on trauma care. Despite this agreement, BAMC’s payment systems have not been optimized to work with civilian insurers, and the hospital does not maintain a charity care program for patients in need. As a result, civilian trauma patients in San Antonio have faced five-, six- and seven-figure medical bills after treatment at BAMC.
In response to these concerns, Congressman Castro and Senator Warren authored a 2020 amendment to the National Defense Authorization Act (NDAA) to provide the Department of Defense (DOD) with the authority to waive civilian medical bills incurred at BAMC or other military hospitals. Despite this authority, a 2022 report from the nonpartisan Government Accountability Office (GAO) found that military hospitals do not consistently use or communicate options for financial relief for civilian emergency patients. To address these concerns, Congressman Castro secured an additional amendment to the FY2023 NDAA requiring DHA to implement a modified payment plan based on a sliding-scale discount program for patients. The comment letter released today urges DHA to strengthen the proposed implementation of this FY2023 amendment, expressing concerns that the current iteration of the proposed rule would “improperly narrow [DOD’s] authority to provide relief to civilians, contrary to Congressional intent.”
In the letter, lawmakers specifically press DHA to:
- Amend the proposed rule to prioritize debt waivers, expand debt relief options for civilians, and reduce bureaucratic hurdles that prevent patients from receiving financial relief.
- Align DOD financial assistance programs with state-level programs by providing free care for patients with income at or below the 300% federal poverty line (FPL) and reduced fees for patients with income up to 600% FPL, while simplifying the process for patients to request and receive financial aid.
- Suspend collections of debt while patient relief applications are pending and continue debt suspension during the rule implementation process.
- Work with the Treasury Department to prevent patient medical debt from being considered taxable income.
The lawmakers note that waiving patient fees would be more cost-effective for DOD. Currently, the DOD is required to refer delinquent bills to the Treasury Department, which has historically recovered just one percent of such debts.
Once finalized, the proposed rule will apply to non-beneficiary patients who received medical care provided on or after June 21, 2023.
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