In a move that has sent thousands of families scrambling, the Pentagon announced over Christmas that civilian employees in Japan — such as teachers and IT professionals — will be mostly restricted from using military health care facilities. Composite by Coffee or Die.
For every five US soldiers, airmen, Marines, or sailors stationed in Japan, the Pentagon has one civilian supporting them. Over 10,000 civilian defense workers, plus their families, live in Japan, many serving full careers as Pentagon employees as their active-duty counterparts cycle home on rotations.
But a decision last month by the Defense Health Agency has left all 10,000 with almost no access to health care, mostly barring US civilians from the military health care system they’ve used for decades.
And many are now finding that the Japanese hospitals and clinics they are now expected to use cannot — or will not — take them on as patients.
Rules implemented by the Defense Health Agency have left the approximately 10,000 civilian employees of the Department of Defense in Japan mostly locked out of the military health care system they’ve used for decades. They now must seek “Space Available” appointments for acute care and use Japanese hospitals for chronic issues.
The new rule, issued in December, ends US Department of Defense civilian employees’ access to US facilities for continuing care of long-term conditions, and limits them to a few “space available” appointments for urgent care.
For the thousands of Pentagon workers in the country — most of whom are Americans and many of whom have worked for the military for a decade or more in Japan — that means the end of vital access to care.
Treatment of any chronic conditions — gone.
Prescriptions for medications — gone.
The EpiPen for children with allergies — gone.
Routine gynecological and obstetric care — gone.
MH-60R Sea Hawk helicopters assigned to the “Warlords” of Helicopter Maritime Strike Squadron 51 from Naval Air Facility Atsugi conduct flight operations near Mount Fuji, Japan, on Nov. 16, 2022. US Navy photo by Mass Communication Specialist 2nd Class Rafael Avelar.
The new rule applies to DOD workers that military members interact with every day, including teachers in Pentagon-run schools, IT specialists, and countless technical positions in the maintenance and logistics chains behind active-duty units.
On Jan. 25, Sen. Elizabeth Warren sent a letter to the DHA, demanding answers on how they plan to address civilian access to care in Japan. Her letter points out that the 2023 National Defense Authorization Act requires the Department of Defense to notify Congress in advance of any changes to medical care at military facilities, including a transition plan for the continuity of health care.
“I expect to receive this formal notice and this transition plan as rapidly as possible so that affected civilians receive the support they need after this loss of care,” Warren wrote. “Providing the best possible services to support service members and civilians deployed overseas enhances readiness, retention and morale.”
A sign posted in a Japanese health care facility this month. As Pentagon civilians seek local care, many local facilities are turning them away. Photo courtesy of Japan Civilian Medical Advocacy.
Affected DOD employees in Japan who spoke to Coffee or Die said the sudden change has upended lives.
“They put this marketing out on the 23rd of December, a day before Christmas, telling people that, ‘Oh, hey, we have space available but only for acute, nothing for chronic,’” one DOD civilian employee told Coffee or Die. “‘You have eight days to figure it out over a holiday period after open season had ended for insurance.’”
The employee, who requested to remain anonymous due to their position working for the US military, has a chronic autoimmune condition. Attempting to do something as simple as refill a prescription through the Japanese medical system suddenly became an enormous burden.
“In order to get the medication for my autoimmune disorder, I spent three working days establishing care by going to three different (Japanese) facilities for three different letters,” the employee said. “I had to take off work completely to do all these things. And then every 30 days I get to go back to the hospital for a day just to get a refill.”
Marines with Marine Heavy Helicopter Squadron 462 fly three CH-53E Super Stallions from Marine Corps Air Station Futenma to MCAS Iwakuni, June 8, 2019. US Marine Corps photo by Lance Cpl. Ryan Persinger.
The employee said they felt lucky just to have the chance to get their medicine refilled.
Tanya Calcagni, a federal project manager at Yokota Air Base, said that others have been less lucky as clinics and hospitals off base are now turning Americans away.
“Off-base facilities that used to take foreign patients, that have worked with us [...] those hospitals aren’t going to take us anymore, because they weren’t given any warning that tens of thousands of patients were going to be flooding their economy,” Calcagni told Coffee or Die.
Calcagni is a member of Japan Civilian Medical Advocacy, a group formed to advocate for civilian employees.
“There was no communication between the US and the Japanese government saying, ‘Hey, you guys are going to have to care for these people now,’” Calcagni said.
US civilians seeking care off base have no real legal footing.
Sen. Elizabeth Warren listens to testimony by US Air Force Gen. Paul J. Selva, vice chairman of the Joint Chiefs of Staff, during a Senate Armed Services Committee hearing on Capitol Hill in Washington, July 18, 2017. DOD photo by US Army Sgt. James K. McCann.
All US defense employees, either civilian or active duty, fall under a Status of Forces Agreement (SOFA) between the US and Japanese governments. The SOFA does not require Japanese medical facilities to accept patients, and Japan is facing an overwhelmed health care system because of its aging population.
The members of Japan Civilian Medical Advocacy, including the employee who wished to remain anonymous, worry that this new policy will destroy the DOD’s ability to fully staff appointments overseas. “Japan already has this stigma of people not wanting to come because of how they handled COVID, so it was already hard enough to hire,” the employee told Coffee or Die. “As a supervisor it would be improper of me not to inform them of what’s going on.”
The employee even said some brand-new civilian employees are arriving in Japan with no early notice. “Not all employers are informing their personnel,” they said. “We’re getting people boots on the ground, first day at work, co-worker mentions something — and then our group gets a message of, ‘Holy moly, what am I supposed to do?’
An Air Force C-12 Huron assigned to the 459th Airlift Squadron flies over Yokota Air Base, Japan, during a training mission, April 6, 2022, above blooming sakura trees. US Air Force photo by Yasuo Osakabe.
“You’re doing people dirty, letting them come out here not knowing what the situation is.”
“Some people are like, well, you can just leave,” Randi Wilson, a DOD analyst at Yokota, told Coffee or Die. "We hear that a lot from military. But everything is out of pocket if you leave before a certain time. So they’re literally like, ‘OK, can we make it 12 months without having an emergency or needing care so that we don’t have to pay $10,000 to move back home?’”
One DOD employee at Marine Corps Air Station Iwakuni expressed those exact thoughts to Coffee or Die. “You had a slew of people volunteer and sacrifice to be a part of the OCONUS team for the government,” said the Marine veteran, who lives at Iwakuni with his wife and children. “The government changes policy and fucks their health care, and now they are being forced to return to nothing. How the fuck am I supposed to break even if the savings I made from selling my home isn’t enough to get another home or new cars due to inflation? They are effectively putting every DOD civilian over here 10-15 years back in finances, if not putting them in the poor house altogether.”
Cpl. Bryan Hernandezrodriguez, a Hialeah, Florida, native and rifleman assigned to Bravo Company, 1st Battalion, 3rd Marine Regiment, travels across a rope bridge at Camp Gonsalves, Okinawa, Japan, July 7, 2017. US Marine Corps photo by Cpl. Aaron S. Patterson.
Military bases across Japan have rushed to hold town halls in recent weeks. One was at MCAS Iwakuni, a remote base where those assigned receive hardship duty pay, a pay granted to military members and employees in “extraordinary arduous living conditions.” According to Stars & Stripes, the air station commander, Col. Richard Rusnok, said during a Jan. 13 town hall, “In the world we live in right now and the threats that we face, this is not something that we necessarily wanted to be dealing with right now.”
Leadership at MCAS Iwakuni did not respond to Coffee or Die’s request for comment. Neither did US Indo-Pacific Command, which oversees all Japanese bases. The DHA did respond with an email.
“Federal law requires the DHA-IP to prioritize access to health care to active duty service members and TRICARE Prime beneficiaries within MTFs,” Peter Graves, chief of media operations for the DHA, wrote. “The Department of Defense is working diligently to explore additional options to support our civilian workforce needs.” He declined to comment on concerns about recruiting and retention.
In a video of a Personnel and Readiness Town Hall held by the Army at Camp Zama on Jan. 31, a woman made the dilemma faced by civilian employees starkly clear.
“Once long ago, I was young and healthy,” she told a panel of Army and Medical Department Activity-Japan officials, explaining that she has taught math to teenagers in DOD schools for over 20 years. “Thirteen years ago, I developed a chronic condition. If I don’t have my medication, I have about a week before I die. I have had my prescriptions written for me by the base hospitals for the last 13 years. I have one more refill.”
On the verge of tears, she asked the panel, “I am almost 100% certain I am not going to be able to get my medications refilled. My question to you is, what am I supposed to do?”
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Maggie BenZvi is a contributing editor for Coffee or Die. She holds a bachelor’s degree in political science from the University of Chicago and a master’s degree in human rights from Columbia University, and has worked for the ACLU as well as the International Rescue Committee. She has also completed a summer journalism program at Northwestern University’s Medill School of Journalism. In addition to her work at Coffee or Die, she’s a stay-at-home mom and, notably, does not drink coffee. Got a tip? Get in touch!
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