Community Health & Wellness

Military medicine cutbacks put strain on civilian health care system — as well as service members and retirees

Posted on April 1st, 2025 By: Conor Wilson

Sitting in the living room of his Silverdale home, wearing a tube in his nostrils, Al Pinkham watches the evening news while recovering from a bad case of flu.

During his 24-year career in the Navy, Pinkham never worried much about health care. He knew that the military would look after him, as well as his wife and children, providing exactly “what a sailor needed” to focus during long deployments.

Yet as a retiree, Pinkham, 78, has almost no relationship with the military health system he once relied on. His latest illness was treated at St. Michael Medical Center in Silverdale. He no longer goes to Naval Hospital Bremerton, a once-thriving military hospital that has served the West Sound in some form for over a century.

Al Pinkham in his Silverdale home on March 3.

Retirees forced out of military system

Over the last decade, the hospital has been gutted, leaving a major gap in the local health care sector and bogging down local providers. As military retirees and beneficiaries are forced out of the military system, they increasingly find themselves searching for care in an overburdened civilian sector desperately short on providers and struggling to provide access to routine care.

And there remains little sign the bleeding will stop soon. Earlier this year, the hospital announced it was transfering nearly 700 internal medicine clinic patients, who are mostly retirees, to civilian providers amid staffing shortages. The decision raises questions about exactly what primary care services are left at the hospital.

A spokesperson for the hospital did not make a member of its leadership available for an interview to discuss staffing levels, despite multiple requests over the last month. A list of questions sent over email also went unanswered by press time Tuesday.

“This downsize is part of a continuous trend in the declining quality of care at [Naval Hospital Bremerton],” Sen. Patty Murray, D-Washington, wrote in a letter following news of the Internalist clinic. Murray went on to say that the hospital has continued to experience staffing shortages but outlined no plans to address them. She also questioned the given reasons for those shortages.

“This pattern of declining care and personnel mismanagement at one of the largest Naval bases in the nation suggests a lack of attention to the healthcare needs of servicemembers, veterans, and their families in Kitsap County,” she wrote.

‘Should not have been a surprise’

Retired Air Force officer Jim Chapin was at the Jan. 31 town hall when officials at Naval Hospital Bremerton announced it would be transferring patients from its Internal Medicine Clinic to providers in the community. In a new release, the hospital said retirements and permanent change-of-duty orders had left them only one physician for over 2,000 patients.

“We did not make this decision lightly,” Capt. Molly Jenkins, the hospital’s executive officer, said during the town hall, according to the release. We “have been studying this issue for months.”

Standing in the hospital’s cafeteria, filled with “an awful lot of old people,” Chapin said that announcement “should not have been a surprise to anybody.” Over the last several years “it’s been quite obvious that there were not enough naval doctors.”

When Chapin and his wife, who live in Bremerton, first started going to the hospital about 16 years ago, it was often so busy in the morning you would have to park down by the water on Ostrich Bay. In the last five years or so, he has always been able to park right out front.

“I talked to some of the people I knew at the hospital. They said ‘they’re just cutting back because they don’t have the personal,” he said.

Shortages in civilian system

Both Chapin and his wife still use the hospital’s urgent care and pharmacy, but after the latest cut no longer have a primary doctor there.

Patients were offered help every Tuesday morning at the hospital to search for a new doctor. That could be tough for some. Kitsap County has a shortage of primary care providers, with about half as many per capita as the state average in 2023, according to Washington Health Care Research Center

Chapin was able to find primary care at the Veterans Affairs Clinic in Silverdale. But his wife, who is ineligible for VA care, is still looking for a new physician.

“It’s easy for me,” he said of the search. “For my wife, she can’t get VA benefits. She has to find a doctor she wants to go to. And as I’ve said, we’ve always relied on the Navy for the last 16 years.”

Budget cuts and military readiness

Reductions at Naval Hospital Bremerton over the last decade come as the Department of Defense has reduced spending on health care. As part of a major realignment designed to shed costs, it has prioritized operational readiness for wartime missions and care for those on active duty over that of beneficiaries and retirees.

The military health system has faced mounting financial pressure over the last two decades after expanding benefits to retirees and increased demand from two wars, Dr. Terry Adirim, a former assistant secretary of defense for health affairs, wrote in a 2019 report. That caused Department of Defense spending on health care to more than double during the 2000s.

By 2010, then-Defense Secretary Robert Gates remarked that health care costs were “eating the [DoD] alive,” and urged officials to find cuts and redirect savings to combat forces. Several initiatives helped reign in spending, including formation of the The Defense Health Agency.

Launched in 2013, the agency was first created to manage services shared between the Army, Navy and Air Force. Military health has been historically fragmented, with each branch operating its own facilities. Establishing a single agency was thought to be the best strategy to sustain combat readiness while reducing costs and increasing efficiency of federal spending.

Congress directed the DoD in 2017 to consolidate administration of its health care facilities of the three branches under the control of the Defense Health Agency. At the same time, the DoD announced plans to move nearly 2 million beneficiaries into the civilian health system.

Naval Hospital reductions

Exactly how this federal restructuring has directly impacted Naval Hospital Bremerton is unclear. But the hospital lost or reduced many of its services since the Defense Health Agency was created.

Naval Hospital Bremerton shuttered its 24/7 emergency room in 2013, replacing it with an urgent care that now opens just eight hours on weekdays. The hospital – which once delivered a quarter of Kitsap’s children – also put its labor and delivery services on divert status in 2022.

Dr. Gib Morrow, Kitsap County’s top public health official, said the community had seen “first-hand” the impact of the Defense Health Agency. Since its formation, the naval hospital has experienced closures of inpatient, emergency, critical and obstetric services, he said during a meeting last year.

In an email to the Kitsap Sun last month, Morrow wrote that the “The Kitsap Public Health Board has advocated for strengthening the military healthcare workforce and services available in Washington state and specifically at Naval Hospital Bremerton.”

In a joint letter the health board sent to DoD leaders last May, they wrote that care shortages left the “community, including those employed by and affiliated with the Department of Defense, face[ing] an ongoing health crisis.”

Caring for beneficiaries

Civilian providers say they are increasingly shouldering the load left by the Navy. The result is worse access across the board for primary, maternal and speciality care for all residents, including those not connected to the military. Shortages are driving up hospital bills, as more people depend on emergent care, and likely leading to worse outcomes for Kitsap patients.

Virginia Mason Franciscan Health, which operates St. Michael Medical Center in Silverdale and St. Anthony Hospital in Gig Harbor, has seen “increased demand as military health care facilities have adjusted their offerings over the years,” St Micheal President Chad Melton wrote in an email.

Peninsula Community Health Services, a federally designated community health center serving the Peninsula, found a nearly 40% increase in the number of self-identified veterans at its clinics between 2023 and 2024, according to agency CEO Jennifer Kreidler-Moss.

Until the last 20 years or so, if you had TRICARE — health insurance for military members and their families — you went to the military hospital for care, said Kreidler-Moss, who is a beneficiary of military insurance. That was how it worked.

“That is definitely not the case anymore,” she said. “Now you know you are going to seek care in the community.”

TRICARE clashes with civilian system

Civilian providers often have a hard time treating patients on TRICARE effectively, because they need prior authorization for most treatments. That means doctors are often forced to look at their patients in a vacuum and offer substandard care.

“This is a regular dilemma. A patient will come in for hypertension that they have authorization for,” Kreidler-Moss said. “If during that visit because they have lab work, [and] our provider figures out that they also have diabetes, we don’t get paid for the visit if we bill for diabetes and not what their conditions were . . . which is just not how medicine works.”

VMFH and the Kitsap Public Health District say they have an ongoing relationship with the Navy. But Kreidler-Moss said PCHS gets no advanced warning when a carrier is coming or going, which can have a large sway on health care demand.

A few decades ago, when an aircraft carrier arrived into Bremerton, both its active-duty members and their beneficiaries were sufficiently cared for by the military system. Today, many of those beneficiaries cannot get care at Naval Hospital Bremerton, Kreidler-Moss said. Local providers see a sudden and often unexpected increase in demand that can be difficult to staff for.

“The Navy tends to say the carrier takes care of itself, because it has its own health care,” she said. “That’s true for active duty people. It’s not true for the surge who come with the carrier.”

Professional service

Chapin, the retired Air Force officer, said doctors at the naval hospital have always been professional. He credits the physician there for seeing a sign of testicular cancer and referring him to a urologist that prevented it from spreading.

“If it wasn’t for that Navy Doctor telling me that maybe I had a problem I would’ve never known,” he said. “The [civilian] urologist just kept saying I don’t understand why you’re here. You have no symptoms.”

Pinkham, the Navy retiree, insists, even amid the reductions, he doesn’t want to “bad mouth” the Navy. He does not go to Naval Hospital Bremerton anymore, but the providers have always delivered good service. And, more importantly, his wife is alive today because of Navy doctors, he said.

Still, he agrees Navy medicine used to be simpler; easier to access, but states plainly that “things have changed.”

“Medicine is different now,” he said. “The Navy is different now.”