Congressional negotiators are pushing for stricter oversight of the Defense Department’s plans to reorganize military hospitals and clinics. The draft fiscal 2026 NDAA would require the Joint Chiefs and service surgeons general to review proposed facility changes for impacts on readiness and force the DHA director to explain how beneficiaries would access care. It also extends a ban on reducing uniformed medical billets through 2032, lowers the travel-reimbursement threshold from 100 to 75 miles, and orders studies on cancer among rotary-wing aircrew and the mental health of drone operators.
Congress Tightens Oversight of Military Health Restructuring in Draft 2026 NDAA
The proposed defense authorization bill calls for more eyes on proposed modifications to military treatment facilities. (Tech. Sgt. Alexis Wade/Air National Guard)
Members of Congress are pressing for closer supervision of the Defense Department’s plans to reorganize, shrink, or reconfigure military hospitals and clinics, proposing new review requirements and extending restrictions on reductions to uniformed medical personnel.
The draft fiscal 2026 National Defense Authorization Act would require the Joint Chiefs of Staff and each service surgeon general to review any proposed changes to military treatment facilities and report whether the changes could harm operational readiness. The bill also directs the director of the Defense Health Agency (DHA) to explain how service members, families, retirees and other beneficiaries would continue to receive care if facility changes reduce access.
What The Bill Would Do
Readiness Reviews: Any proposed restructuring, realignment, or modification to military medical treatment facilities must be coordinated with appropriate Department of Defense stakeholders to ensure operational readiness is not jeopardized.
Transparency From DHA: The DHA director must detail access plans for beneficiaries affected by facility changes, describing alternatives and mitigation steps if services are reduced or consolidated.
Extension Of Hiring Freeze On Medical Billets: Congress would extend an existing restriction on cutting uniformed medical billets by five years, pushing the prohibition from 2027 through 2032.
Benefits And Access Changes: The draft also lowers the travel-reimbursement threshold for specialty care from 100 miles to 75 miles, potentially increasing reimbursement eligibility for beneficiaries who travel long distances for care. Lawmakers are also requiring the Defense Department to reopen closed base chiropractic clinics that previously provided at least 400 appointments per month.
Background And Contested Changes
When the DHA was created, it received authority to manage the services’ hospitals and clinics and to reconfigure staffing and consolidate facilities. An early DHA proposal aimed to realign about 50 facilities (38 of them serving only military personnel) and reduce roughly 12,800 military health billets. That plan could have shifted an estimated 200,000 active-duty family members and retirees to civilian providers through the TRICARE program. Reforms were paused at the start of the COVID-19 pandemic and later adjusted to restore capacity at some sites and improve training opportunities.
In 2023 DHA published a revised list of 32 facilities slated for realignment. Several lawmakers have since raised objections about additional hospitals that they fear could lose inpatient, emergency, or surgical services—most notably Keller Army Community Hospital at West Point, a full-service hospital under construction at Fort Leonard Wood, and Eisenhower Army Medical Center at Fort Gordon.
"We expect that any proposed restructuring, realignment, or modification to military medical treatment facilities will be conducted in collaboration with the appropriate Department of Defense stakeholders … to ensure that operational readiness is not impacted by any proposed changes," congressional negotiators wrote in a statement accompanying the bill.
Acting DHA director Dr. David Smith wrote this month that the review is ongoing and no final decisions have been made. "There are significant pressures on the Defense Health Program for Fiscal Year 2026 and beyond," he wrote, noting the department is evaluating where to assign military medical personnel to maximize quality, safety and readiness while working to mitigate access and capacity challenges.
Acting Assistant Secretary of Defense for Health Affairs Dr. Stephen Ferrara described the review as "fluid," likening it to a corporation periodically evaluating where to dedicate resources across a large network of facilities.
Other Provisions And Studies
The final draft drops several proposals that had been discussed earlier: a provision that would have allowed beneficiaries to switch to TRICARE Select upon becoming pregnant and a pilot to cover midwife services from non-nurse providers.
The bill does require new health studies, including research into cancer rates among rotary-wing pilots and aircrew and a study of the psychological health of combat drone operators.
Overall, the draft NDAA seeks to balance the DHA’s authority to reorganize military medical assets with added congressional oversight and transparency to protect readiness and beneficiary access to care.
