Gilbert Cisneros Jr., left, undersecretary of defense for personnel and readiness; Seileen Mullen, center, acting assistant secretary of defense for health affairs; and Army Maj. Gen. Joseph Heck answer questions about civilians' access to medical care at Yokosuka Naval Base, Japan, Tuesday, Jan. 31, 2023. (Akifumi Ishikawa/Stars and Stripes)
YOKOSUKA NAVAL BASE, Japan — Defense Department civilian employees facing reduced health care options in Japan jeered Pentagon officials who provided few clear answers and no immediate solutions during a town hall Tuesday at the home of the Navy’s 7th Fleet.
More than 500 people gathered for an hour at the Fleet Theater to hear from Gilbert Cisneros Jr., undersecretary of defense for personnel and readiness; Seileen Mullen, acting assistant secretary of defense for health affairs; and Army Maj. Gen. Joseph Heck, the Defense Health Agency’s Indo-Pacific Region director.
Cisneros and Mullen appeared at a more reserved meeting of DOD civilians Monday at Yokota Air Base, an airlift hub in western Tokyo. They are scheduled for more town halls this week at other U.S. bases in Japan.
At the naval base, dozens lined up to question DHA’s decision to significantly limit health care access at U.S. bases in the Indo-Pacific by DOD civilian employees, their families and anyone, including veterans, not covered by Tricare Prime, the highest tier on the military health plan.
“I’ve been away from my family for 24 of the last 32 months, and I get treated as ‘less than’ than the military personnel,” Donald McKnight, workforce support superintendent for Puget Sound Naval Shipyard, said at the microphone. “I’ve worked for the Department of Defense for the last 40 years, so why am I considered less than military personnel?”
Gilbert Cisneros Jr., left, undersecretary of defense for personnel and readiness; Seileen Mullen, right, acting assistant secretary of defense for health affairs; and Army Maj. Gen. Joseph Heck answer questions about civilians' access to medical care during a town hall at Yokosuka Naval Base, Japan, Tuesday, Jan. 31, 2023. (Akifumi Ishikawa/Stars and Stripes)
Cisneros responded that “no individual is any less than anyone else” and that both civilians and uniformed personnel are supporting the military’s mission in Japan.
The audience responded with disdain, and several people shouted, asking why civilians are limited to space-available appointments.
Since Jan. 1, DOD civilians at U.S. installations in Japan are limited to same-day, space-available appointments at facilities like Yokosuka Naval Hospital for family medicine, internal medicine, pediatric and gynecology services. Services are also limited to episodic or acute conditions that can be treated on a same-day basis.
In October, Heck advised DOD civilians, such as teachers in Defense Department schools, contractors, analysts and retail employees, to seek health care from Japanese providers.
Mullen at the meeting said DHA is “asking now” whether the Japanese health care system can handle several thousand new U.S. clients, but “we don’t think 5-6,000 people would stress a health care system that accommodates the number of people it does now.”
The audience erupted in laughter.
Japan anticipates a shortage of nearly 1 million health care and welfare workers by 2040 as its population ages and the number of working-age people declines, according to a September report from Japan’s Ministry of Health, Labor and Welfare.
A woman asks a question about civilians' access to health care during a town hall meeting at Yokosuka Naval Base, Japan, Tuesday, Jan. 31, 2023. (Akifumi Ishikawa/Stars and Stripes)
A woman asks a question about civilians' access to health care during a town hall meeting at Yokosuka Naval Base, Japan, Tuesday, Jan. 31, 2023. (Akifumi Ishikawa/Stars and Stripes)
A man asks a question about civilians' access to health care during a town hall meeting at Yokosuka Naval Base, Japan, Tuesday, Jan. 31, 2023. (Akifumi Ishikawa/Stars and Stripes)
Some meeting attendees voiced concerns that employee recruitment and retention would suffer without access to health care on U.S. military bases in Japan. Others pointed out the complexities of the Japanese health care system and that Japanese medical providers may deny anyone care, even in an emergency.
A woman who identified herself as the spouse of an active-duty service member and the mother of two children with disabilities, said DHA’s changes reach beyond civilian employees.
“How and when are you planning to change this unacceptable situation?” she asked during the meeting. “The lack of civilian health care is affecting our children’s education and the lack of trauma care and the denial from Japanese hospitals affect everybody, active duty included.”
Cisneros, Mullen and Heck attended another town hall later Tuesday at Camp Zama, the headquarters southwest of Tokyo of U.S. Army Japan, where they heard similar questions.
The officials are scheduled for town halls on Okinawa at Kadena Air Base on Wednesday and at the Marine Corps’ Camp Foster on Thursday.
“To be honest, I don’t have all the answers for you right now,” Cisneros said Tuesday at Yokosuka. “We want to hear what you have to say, we want to know what you’re having to deal with, so we can go back to the working group and work out solutions.”
Mullen said a working group at the Pentagon is “doing their best” to find medium- and long-term solutions for the situation, but she couldn’t speak to any immediate or short-term solutions.
Gilbert Cisneros Jr., undersecretary of defense for personnel and readiness; Seileen Mullen, acting assistant secretary of defense for health affairs; and Army Maj. Gen. Joseph Heck answer questions about civilians' access to medical care at Yokosuka Naval Base, Japan, Tuesday, Jan. 31, 2023. (Akifumi Ishikawa/Stars and Stripes)
After the Yokosuka meeting, Cisneros told Stars and Stripes he could not elaborate or provide an example of the solutions being considered.
“Right now, we’re just working on solutions and we’re going to have things that we can hopefully present to the secretary [of defense] soon as kind of a way forward,” he said.
Sen. Elizabeth Warren, D-Mass., a member of the Senate Armed Services Committee, wrote Mullen and the recently appointed DHA director, Army Maj. Gen. Telita Crosland, on Jan. 23 questioning the motive and asking the agency to justify cutting DOD employees in Japan out of the military health care system.
Cisneros said a response to Warren is being prepared. He said Warren is so far the only member of Congress who has contacted the Pentagon on the health care question.
