March 07, 2023

Castro, Warren Demand Answers from DOD on Continued Surprise Medical Billing at Brooke Army Medical Center

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

View the full letter

WASHINGTON – Last night, Congressman Joaquin Castro (TX-20) and Senator Elizabeth Warren (Mass.) sent a letter to the Department of Defense Assistant Secretary for Health Affairs Dr. Lester Martinez-Lopez and Director of the Defense Health Agency Lieutenant General Telita Crosland demanding answers about why the Defense Health Agency has delayed implementation of legislation authored by Castro and Warren that would allow the Defense Health Agency to waive medical debts incurred by civilians at Military Treatment Facilities (MTF), including Brooke Army Medical Center in San Antonio. Brooke Army Medical Center is one of two Level I Trauma Centers in San Antonio and serves nearly half of the civilian patients treated by MTFs.

“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 Congressman Castro. “Treating civilian patients is necessary to maintain BAMC’s Level I Trauma Center designation and accreditation for graduate medical education, and experience with civilian patients helps BAMC 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.”

In 2020, Congressman Castro and Senator Warren authored Section 702 of the Fiscal Year (FY) 2021 National Defense Authorization Act, which provides the DOD with the authority to waive medical bills incurred by civilians for care at MTFs. Last year, Castro also secured additional language in the FY 2023 National Defense Authorization Act requiring the Director of the DHA to implement a modified payment plan based on a sliding-scale discount program for civilians who are underinsured or at risk for financial harm from medical bills incurred at MTFs.

Despite this flexibility, ongoing reports indicate that the DOD has made little progress in providing financial relief to civilians. In July 2022, a report from the non-partisan Government Accountability Office (GAO) found that military hospitals do not “consistently use or communicate options for financial relief for civilian emergency patients.” The report also found that DOD failed to accurately track debts collected from civilians. Two-thirds of the civilian emergency patients who received treatment did not have insurance, leaving them highly vulnerable to massive medical bills. Of the 26,696 civilian medical debt cases GAO reviewed, only .1% had their debt reduced.

In yesterday’s letter, the lawmakers offer a series of suggestions to help the DOD determine if a patient qualifies to have their medical debt waived, including adopting the DOD’s existing frameworks, waiving debts for Supplemental Nutrition Assistance Program (SNAP) recipients, or adopting the Internal Revenue Service (IRS) Collection Financial Standards. In addition to their recommendations, the lawmakers are requesting a briefing on the issue from DOD no later than March 31, 2023.