Japan Civilian Medical Advocacy Talk — Q&A Session (September 12)
Edited for length and clarity. Q = audience questions, A = Alexandra (JCMA), H = Dave (host), T = Terese (DA Global Veterans and Military Families Caucus).
Base Pharmacy Access and the Sasebo Situation
Q: Is it true that prescriptions for civilians aren't being filled at the base pharmacy? We were told this after moving to Japan a month ago.
A: Officially, no — Electronic Prescription access means any prescription from a licensed American doctor should be filled at the military pharmacy. However, getting prescriptions filled has specifically been a problem in Sasebo, which I've been working on for the last couple of weeks. Both DHA and the head of medical staff for U.S. Forces Japan confirmed this shouldn't be happening. If you're affected, message JCMA on Facebook — I can help get it addressed directly.
Sasebo's branch clinic has been telling patients, including on its own appointment page, that it only supports acute (not chronic) care. That's not accurate under current DHA policy, and there's a recent Stars and Stripes article on it. This is now being discussed at leadership levels, but every two years a change in command brings new leadership who sometimes try to cut civilian and space-available care outright — "that's how we did it in Germany" — and DHA policy has to be re-explained to them each time. JCMA supports anyone denied care like this.
Q : The problem isn't limited to civilians. Active-duty members and their spouses are waiting two to four months for referrals to Japanese healthcare facilities, even for follow-up appointments. The Sasebo clinic is down to two or three providers for the whole base and dependents. Is anything being done about staffing, or about designating Sasebo an unaccompanied duty station (meaning that Active Duty service people would not be able to bring their families, have shorter tours of duty, and get family separation pay)?
A: That's a question for the military, but USFJ has previously floated making stations unaccompanied when they can't provide adequate care. Sasebo's medical facility is simply too small and understaffed — that's our position. DHA maintains it's fully staffed with no problems, and held that position until DoD OIG and GAO reports said otherwise. Active-duty personnel speaking up is the only way this changes; anonymous reports still count, and we keep pushing them to Congress and the Pentagon. Ultimately this needs Congress and the Pentagon to agree on more resources, especially given how restrictive care access in Japan already is.
Q: Japanese host-nation providers are charging American patients a premium — 150% up to as much as 500% of what a Japanese citizen would pay. Is anything being done about that?
A: That's a sensitive issue, since it's a market-pricing choice by private Japanese providers, and most legal protections (including malpractice law) are built around Japan's National Health Insurance system, which SOFA patients aren't part of. We can't dictate what providers charge. Some of it reflects real added cost — translation, longer visits, different expectations of care — but we've also documented mark-ups of 200–400%, and that's concerning. Part of the underlying issue is SOFA patients' reputation for not paying bills, which carries a lot of cultural weight in Japan; if reliable payment becomes the norm, we're hopeful costs will come down. This is something we continue to raise with Congress and the Pentagon.
Interpreters and the Medical Support Pilot Program
Q: Are people hiring their own interpreters, or are any available? Is this pilot program only at certain bases — we've never heard of it in Sasebo.
A: It exists everywhere, including Sasebo, though Sasebo currently has no volunteers for it (if you're interested in volunteering, let JCMA know). There's a hotline — posted on JCMA's Facebook page — that works like the Tricare model: you describe your medical issue and the type of provider you need, and the hotline finds a nearby provider and sets up the appointment. Payment is guaranteed by the Pentagon, which makes providers more willing to accept SOFA patients. This should be described to eligible employees via HR, though HR communication on it has been inconsistent.
Billing and the Medical Debt Waiver
Q : I'm sitting on roughly $6,000 in unbilled charges from the past three years. Is there a timeline for when billing will actually start?
A: They were supposed to start in March. JCMA knows of only four people who've received mailed bills so far — MTFs (Military Treatment Facilities) have historically been too disorganized to bill properly, which is actually why civilian billing was paused in the first place. Federal law bars charging insurance for a bill sent more than a year late, and Senator Warren, Representative Castro, and others pushed DHA to fix its billing policies before resuming — those policies were released around March–May.
There's now a medical cost waiver program (details on JCMA's website) that requires opt-in. If your MTF claims it has no record of your bills, request written confirmation that you owe nothing. If a bill wasn't submitted to insurance on time, you can submit the information yourself and will only be held responsible for what you'd have owed if it had been billed correctly (e.g., a copay) — effectively waiving the rest. Whether MTFs ever actually send the bills is unclear; JCMA has flagged this to Congress.
Political Advocacy and Getting Involved
A (on Congressional engagement): JCMA acts as a direct channel to Congress and to the head of medical care at USFJ — Congress has said it gets better information from JCMA's volunteers than from DHA itself. If you share your zip code, JCMA can set up a direct meeting with your member of Congress. Things have improved somewhat since 2023, which has quieted engagement, but more voices are still needed. Contact JCMA via jcmadvocacy.org, its info@ email, or Facebook.
Q (Mark Leighton, president of the Bremerton Metal Trades Council): I wanted to echo that JCMA has been a strong advocate, and I get a lot of my information from them, alongside my union work at the Puget Sound Naval Shipyard. Congress often doesn't get good information directly from DoD — agencies have reportedly been barred from sharing it, and staff who defy that risk being fired. Unions have filled that gap. I have contacts in Congress and am glad to help amplify anything JCMA shares.
A: We'd welcome staying connected with unions and will share information however we can — we're consistently told our data is better and more timely than what the Pentagon and DHA provide, to the point that we've had to produce documentation after DHA denied something happened.
H (Dave): This is ultimately a political issue that needs a political solution. Everyone is strongly encouraged to request their ballot and vote — VoteFromAbroad.org is non-partisan and will help with registration and ballot requests. Deadlines are approaching, and anyone in a mail-ballot-return-only state (roughly half the states) should also send a backup ballot. On Senator Warren's office: Alexa has reached out for a current status update, but hasn't yet received a response. Democrats Abroad represents Americans from all 50 states and DC, and DAJ's leadership plans to raise this issue at next year's Democrats Abroad convention in DC, where members meet with legislators and staff in person.
T (Terese, DA Global Veterans and Military Families Caucus https://www.democratsabroad.org/vmf ): Get your ballots in. If you haven't requested an absentee ballot yet, there may still be time — ballots go out starting September 19. Anyone in a mail-return state should also send a backup ballot, since the regular ballot may not arrive in time. (Backup ballot information: VoteFromAbroad.org FAQ, or https://www.votefromabroad.org/faqs/fwab-what-is-backup-ballot.)
Closing
A: JCMA is reachable via Facebook, jcmadvocacy.org, and [email protected]. The news section of the site hasn't been updated since December due to a site migration, but new articles are coming. Volunteers are especially needed in Sasebo, where several past volunteers have had to leave due to medical issues, leaving newer arrivals unaware of the programs available to them.
H: Thank you all for joining. We'll continue this work, particularly on the political side, together with JCMA and VoteFromAbroad.org.