When Matt and Helen Perry first met in 2010, he had been a U.S. Marine long enough to form two strong opinions. He didn't like the U.S. Army, and he didn't like officers — which he told her on their first date.
"And I was, you know, an Army medical officer," Helen recalls.
They got married anyhow, and Matt went on the last of his four combat deployments while Helen worked at Walter Reed National Military Medical Center outside Washington, D.C. Her worst fear — that she'd see Matt come in on a medevac — never came to pass. She did start to worry though, about the military medical system that was treating troops and their families. In 2013 the Perrys were stationed at Fort Stewart, Ga.
"They were looking at closing Winn Army Medical Community Medical Hospital," says Perry.
Winn Hospital cares for tens of thousands of troops and more than twice that many family members and military retirees living near Fort Stewart. But the Pentagon was abuzz with plans to cut military medical costs, especially on families and retirees, by outsourcing them to local private health care — much to the chagrin of local providers, Helen Perry recalls.
"I vividly remember them putting out an article in the newspaper that was like ... 'We cannot absorb your obstetrical care. We can't absorb your inpatient care. We do not have the resources to absorb the amount of care that you would then be pushing out into the community,'" says Perry.
Obstetrics may not spring to mind when people think about military medicine, but troops get to have families. With the Pentagon pushing them off base to find care, the military hospitals lost the patient base they needed to justify keeping specialty clinicians. It didn't make sense to Perry.
"I was saying, well, why don't we just get the services? Why don't we get cardiology? We had it at one time, why did we lose it? Oh, well, we weren't seeing enough patients," she says.
The business end of cost-cutting
To Perry it looked like a death spiral — downsizing to the point where the military hospital is no longer viable. She even suspected some of the hospitals were attempting to avoid closure by keeping hold of patients they couldn't actually treat, to keep up numbers and justify staying open. When Perry asked questions, as a critical care nurse and junior officer, no one wanted to hear it.
"It's like, 'Lt. Perry, that's beyond you. Do your job. Stay quiet,'" she says.
She wasn't wrong though. She was just on the business end of a decades-long realignment, where the four branches of the military combined their medical services under one health agency and tried to cut costs. This year the Department of Defense has finally admitted that it's not going as planned.
"All these challenges and changes have created and affected our ability to generate and sustain a medically ready force and a ready medical force," says Dr. David Smith, deputy assistant secretary of Defense for health.
Smith is talking about two of the three missions of military health. A "medically ready force" means keeping the country's army in good health. A "ready medical force" means training up enough doctors and nurses to keep that army healthy and treat the wounds of war. There's a third part though: taking care of all the military family members who get dragged across the country every time a service member gets ordered to a new base.
The Pentagon has been trying to outsource the less war-related parts, says John Whitley, former acting secretary of the Army.
"We don't want to go back to the days of ... not having the trauma surgeons, the emergency medicine physicians, the critical care physicians we need, and instead having a force of pediatricians and obstetricians and family practice docs," he told NPR.
Of course, troops might not agree that keeping their families healthy is a lower priority.
"As if it doesn't matter to the war fighter whether or not their family members can access quality care," says Karen Ruedisueli with the Military Officers Association of America.
"If they're hearing from the family back home that they're struggling to get medical care, they can't focus on the mission," she says.
"And then my husband started having seizures"
Americans join the military for patriotic, but also practical, reasons and the quality of health care affects recruiting. In recent years, surveys show that health care is a growing concern for active duty families and also retirees as Helen and Matt Perry soon discovered.
"I stayed for two years at Fort Stewart, and I was seeing the results of families not having good access to care. And then my husband started having seizures," she says.
Matt's seizures hit in July of 2014, six years after a series of blast injuries in Afghanistan had left him with a traumatic brain injury.
"We knew he had a TBI. He got blown up three times in Afghanistan in 2008, like big booms. And we knew things were a little bit harder to learn for him after that. He was a little bit more forgetful. I mean, he had all of the classic sort of early TBI stuff that we see from, from most of our guys who've been blown up, but we just didn't know how bad it was," she says.
His first seizure lasted several minutes and he stopped breathing. A few hours later, he seized again and Helen took him to the nearest emergency room.
"He woke up in the ICU. He didn't know me, didn't know his name, didn't know anything," she says.
"We were not at a military facility. So they kept asking me like, did he ever have infantile seizures as a child? I would say, he got blown up really bad. And they would say, you know, all those explosions you see on television, that's not really how it happens," she says.
Matt's debilitating injuries sent the Perrys on a painful odyssey of seeking care within the military, trying to get Helen's Army superiors to assign her near the Marine base where Matt could get treated, and finally getting Matt the right medical discharge and the benefits he'd earned. Helen eventually left active duty and became his full-time caregiver.
"That's where we started to kind of find out all of the challenges with Tricare," she says.
Tricare is the military health care program for troops, families and retirees - which used to mean just going to almost any doctor and Tricare paid for it. In recent years the cost to military families has shot up, and millions of troops rely on Medicaid in addition to Tricare. And as the Perrys discovered, it's gotten harder to find doctors who accept it. They moved to Daytona Beach for a nursing job Helen landed, but it didn't work for Matt's care, or Helen's, or their newly arrived baby boy in 2021.
"We could not find anyone to accept Tricare, period. I work in health care so I knew all the people, so I was calling around trying to find a primary care provider," says Helen.
But the answer was consistent.
" 'Sorry, we don't take Tricare.' 'Sorry, we're not open to new patients.' We couldn't find a pediatrician for our son. Same thing — 'Sorry, we don't take Tricare,' " she says.
Not only is there a nationwide shortage of health care professionals after that pandemic, but, like Medicaid, Tricare reimburses at a lower rate than private health insurance. Helen says doctors told her they just couldn't afford to take Tricare patients. And she was hearing the same thing from other military caregivers nationwide.
"I got onto our little online forum, and I said, is anybody else having problems finding providers accepting Tricare?"
The replies came in a tidal wave.
"Can't find anybody to take us, we're commuting two hours, we're commuting five hours," she says.
The Perrys moved to the Jacksonville area in large part because that's where they found providers. In the meantime though, Helen was making lists of military communities where people can't find care, including many bases located in federally designated health care shortage areas.
NPR contacted a dozen families with similar complaints. Notably, the majority declined to be interviewed on the record, out of concern they'd get in trouble with their command. They told the same stories: They can't get care on base, and they can't find Tricare appointments in town. A Pentagon Inspector General Report echoed their complaints.
"Well, you can't get care at the military, so now you're gonna get care through Tricare. When they both fail, which is what they're currently doing, where are service members expected to go?" says Helen Perry.
Pentagon about-face on private care
David Smith, the deputy assistant secretary of Defense, says the Pentagon has realized the private sector doesn't have any extra capacity to lean on, and after a decade of pushing private care, the Pentagon will now do the opposite.
"We're having difficulties with access across the system. And so what we've concluded is bringing more into our system will actually have the best benefit. I think that's part of the epiphany," he told NPR.
That epiphany took the form of a recent DOD internal memo titled "Stabilizing and Improving the Military Health System." The memo looks back at a decade's worth of downsizing and outsourcing and concludes, "This has resulted in increasing overall health care costs for the Department and missing readiness opportunities for the Force."
The memo calls on the Military Health System to grow and attract more patients back on to base for their health care. Smith says the Pentagon will train or hire more doctors and nurses to re-fill its clinics. The memo directs the Pentagon to review all medical staffing levels by June 30th. It may be the start of another long and monumental attempt to change military health care.
New memories
Helen Perry is glad to hear a fix is coming, but she hasn't seen any sign of that memo in action yet. Matt is making new memories with their son and now a baby daughter. He's seems at peace with the memories that he's lost.
"Stuff from way, way back there, that's kind of wiped clean. That hard drive's gone," he says.
That's a blessing in one way. Matt doesn't remember his time at war, so he doesn't have PTSD. When he gets frustrated, he calls one of his Marine battle-buddies. They remember.
"When I get a lot of anxiety or I just need to get away, I talk to them. I used to see a ... therapist. And that was OK, but they don't understand what I went through. Once I started talking to my buddies, man, that is the best therapy you can have right there. And it's free," says Matt.
Matt knows his biggest champion is Helen. Now retired from the reserves, she does aid work in conflict zones, like Ukraine, as a critical care nurse. Still, Matt worries that he's holding her back.
"There's a lot of stuff I wish was different. Like I know she wanted to become a doctor. I know she wants to do a lot more humanitarian work, but ... there's always that worry that something happens to me while she's gone," he says.
They juggle their two young kids between them, but being Matt's caregiver can be a full-time job. That, along with having been an Army nurse and a Tricare patient gives Helen some expertise she thinks the Pentagon and Congress might lack.
"I can speak to it from an active duty officer, from a reserve officer ... I can speak to it as a medical provider currently working in the health care system, and as a caregiver. I can speak to it from every angle, and I want to know that they know because I don't think that they do. Because I think if they did, they would be doing different things," she says.
Recently, Matt's condition has gotten unstable again. That means they are looking, again, for a new medical team that accepts Tricare.
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