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50% of U.S. military bases are in a health care desert, NPR probe finds

A MARTÍNEZ, HOST:

The U.S. military has its own healthcare system for troops and their families. NPR has been reporting this year about how the Pentagon has tried to outsource much of that care to civilian providers. But an NPR investigation found 50% of U.S. military bases are located within what's called a federally designated health professional shortage area. Basically, a health care desert - NPR's Quil Lawrence is here to explain. Quil, so how did you come to that conclusion and that statistic, 50%?

QUIL LAWRENCE, BYLINE: Yeah, so each year the government identifies these nationwide, where the healthcare is hard to find. And along with NPR's Brent Jones, we mapped these so-called health care deserts for primary care, mental health care and maternity care, and then we just put that map on top of a map of all the military bases in the U.S. And what we found is that half of the Army, Navy, Air Force and Marine Corps bases listed there are in at least one of these health care deserts, and some are in all three. You can find this map at npr.org.

MARTÍNEZ: But don't these bases - don't they have military hospitals and clinics of their own?

LAWRENCE: Yeah, some do. They're really expensive. I mean, there's a joke that the Pentagon is actually just an HMO that sometimes fights wars.

MARTÍNEZ: Oh, jeez.

LAWRENCE: But in the past decade, for this reason, the military was trying to downsize and outsource to private civilian care, especially for family members. You know, maternity care, pediatrics are not exactly what you think of when you think of troops, but I don't know if you see the problem. A, have you tried to get a new doctor lately?

MARTÍNEZ: Yeah, and it's been a chore.

LAWRENCE: Yeah, took me six months after my doc retired or left, and...

MARTÍNEZ: Yeah.

LAWRENCE: ...There's basically no slack in civilian health care. And so when these families are told to go off base for their care, for many of them, there is no care.

MARTÍNEZ: Wow. So what does the Pentagon say?

LAWRENCE: Defense Health Agency sent us a statement when they saw this map, and they said that when care isn't available, they try to use telehealth, or they'll pay for patients to travel or doctors to travel to the patients.

But an internal Pentagon memo that we obtained this year has acknowledged that the downsizing has gone too far. The Pentagon knows it needs to reverse course and hire more clinicians on base, recruit more doctors and nurses. But that's going to take time.

And a big issue they have is that TRICARE, which is the insurance that military families and retirees use when they go to pay for the civilian care - it pays at Medicare rates. So doctors and hospitals are kind of reluctant or just plain can't afford to take TRICARE patients.

MARTÍNEZ: Then what's it like as a military family trying to get health care right now?

LAWRENCE: I've been hearing them for years from all over the country. I reached out to a dozen families at Fort Drum, for example, in upstate New York, right on the Canadian border. Here are a few of them.

SAMANTHA DAVIDSON: So if you need to see an OB-GYN and you're not pregnant, it's not going to happen because they just refer you to someone who tells you that they don't have appointments.

NICK SIDMAN: Our middle son is getting evaluated for autism. But for him just to see a neurologist, it was - what? - a three-, four-month wait.

DAVIDSON: Behavioral health here - they either aren't taking new patients, or they do not take TRICARE because TRICARE - it's not paying enough.

ELIZABETH SIDMAN: 'Cause we've been - like, I've been through two pediatricians since we've been here. I've been through three primary care doctors 'cause they just keep leaving or whatever.

DAVIDSON: Here, they think that what I have is autoimmune, and the rheumatologist here will not take TRICARE, which would leave me having to drive to Buffalo or Utica or somewhere that's, you know, way over 2 hours away for treatment, which is just - it's not realistic.

LAWRENCE: So that was Nick and Elizabeth Sidman and Samantha Davidson. I spoke to many more who didn't want to be named because they were afraid they'd get in trouble, including one military wife who I met here in New York City because she drove seven hours from Fort Drum to see a pediatric specialist for her daughter.

MARTÍNEZ: Wow, seven hours - what does this mean then for the U.S. military as a whole?

LAWRENCE: Well, they need troops to stay healthy in order to fight conflicts, and they also need enough doctors and nurses and medics in case there is a war. But we're also in the middle of a recruitment slump, and military families increasingly say that health care is a concern. If you plan on having a family, it might really discourage you from joining or staying in the military if you're going to be ordered to live in a health care desert.

MARTÍNEZ: Is there any solution possible down the road, on the horizon, anything like that?

LAWRENCE: We're going to be looking into that. One thing is that Veterans Affairs, VA facilities have been combining with military facilities in some places, and some civilian military collaborations might be a solution. We're going to be reporting on those coming up next.

MARTÍNEZ: All right, that's NPR's Quil Lawrence. Quil, thanks.

LAWRENCE: Thank you, A. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Quil Lawrence is a New York-based correspondent for NPR News, covering veterans' issues nationwide. He won a Robert F. Kennedy Award for his coverage of American veterans and a Gracie Award for coverage of female combat veterans. In 2019 Iraq and Afghanistan Veterans of America honored Quil with its IAVA Salutes Award for Leadership in Journalism.
A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.