VA officials considering expansion of community care services should be well aware of struggles faced by the TRICARE civilian-care system, experts from MOAA and other groups said during a recent RAND-sponsored panel discussion.

“Many of the lessons TRICARE learned, VA needs to pay attention to,” said Dr. Ken Kizer, a professor emeritus at the University of California, Davis School of Medicine and a former VA undersecretary for health, during the May 7 online event, adding that some Defense Health Agency assumptions regarding civilian care networks “turned out not to be sound.”

Among the issues raised by the panel, which included Karen Ruedisueli, MOAA’s director of Government Relations for Health Affairs:

Civilian Care Unreliability

“Together VA and [the military health system (MHS)] serve more than 18 million patients, and both of these systems are looking to transition more care into the civilian sector which … is having a lot of instability,” Ruedisueli said. “Our patients will be competing with commercially insured patients who are more lucrative to providers, and so I think the question is – where is this capacity that everybody is counting on?”

Ruedisueli focused on MOAA’s enduring priority to ensure access to high-quality medical care. She highlighted the situation in Fort Drum, N.Y., which does not have a military hospital. Tens of thousands of beneficiaries – including family members and retirees – rely on a civilian hospital whose parent company recently filed for Chapter 11 bankruptcy.

“That has caused a lot of concern about how that might impact access in the Fort Drum area,” Ruedisueli said. “The MHS is not in control of that, and if that hospital goes away, that will most certainly cause some access problems for Fort Drum families.”

[RELATED: Big Changes to Military Health Care Budget … But What About Beneficiaries?]

Old or Incomplete Data

The webinar, part of a RAND-sponsored series on veteran health care, looked at the mixed findings from an April 2026 report on what expanded community care eligibility could mean for veterans in New York state.

Some veterans could see shorter travel times if closer care options were made available, but a lack of data on community care wait times made it unclear whether veterans would see providers sooner. Any advantage from a shorter wait among community-based providers, for example, could be erased by the influx of veterans into the system, which could boost wait times to equal or surpass those in the VA system.

The study relied on wait-time data from 2018 to 2021, which researchers said not only could be overcome by changes to the health care landscape, it also contains variables brought on by COVID-19 concerns. Quality-of-care data was also mixed across the spectrum, with wide variance by provider and facility.

[MILITARY CARE ACT FAQ: How This Bill Will Make a Difference for Many TRICARE Beneficiaries]

“Overall, we need just better data analysis to understand this,” said Claire O’Hanlon, a RAND policy researcher.

Where Is the Access?

With the Defense Health Agency now pushing to bring back many of the patients who’d transferred to community care, the Pentagon is finding it “difficult to reverse course,” Ruedisueli said. “After you shift people out into the civilian network, when you want to bring them back into the direct care system, for whatever reason, that can be a challenge. Their care was disrupted when they had to move from direct care to purchased care. Now you’re asking them to come back.”

Along with patient challenges, the military system has struggled to rebuild some portions of its staff after previous rounds of cuts.

Kizer emphasized potential impacts on VA’s roles in providing surge capacity.

“VA has multiple statutorily required missions, one of which is contingency support for the military as well as the private sector, which was well demonstrated during the COVID pandemic,” Kizer said. “Right now, more than 80% of VA’s intensive care unit care is being provided by the community. That has quite significant implications for the VA’s ability to provide contingency support going forward, but I see no attention being paid to better understanding this and what the ramifications might be.”

[RELATED: MOAA's TRICARE Guide]

MOAA’s Role

Community care plays a critical role in providing the service-earned health benefit, whether through TRICARE or the VA system. MOAA works with researchers like RAND alongside fellow advocacy groups, as well as Pentagon and VA officials, to ensure any expansion or contraction of community care offerings puts the beneficiary first.

One constant throughout both health care systems is the need for accurate data to make informed decisions on patient options. That’s one of the reasons MOAA supports the Military CARE Act, a bipartisan bill which would establish a patient-facing data system at military treatment facilities (MTFs) allowing individual beneficiaries to find the support they need while aggregating access-to-care issues for wider use in the decision-making process.

Learn more about this ongoing push, as well as other MOAA advocacy priorities, by visiting our Legislative Action Center.