She has three appointments to coordinate.
One child.
One referral.
One prescription.
None of it is simple.
 
In military families, care is not managed at the individual level.
It is managed at the household level.
And in most cases, that responsibility falls to a spouse.
Care is not a single appointment.
It is coordination.
 
85% of active duty spouses are women.
67% have children under 18 at home.
81% have experienced a Permanent Change of Station move, resetting providers, networks, and access.
44% report difficulty accessing care, often tied to provider availability or TRICARE acceptance.

For families seeking care for children:
42% cannot find a provider when needed
44% face wait lists or scheduling barriers
 
Someone has to make the system work.
Find the provider.
Navigate coverage.
Track appointments.
Make the call to move forward.
And that decision is rarely just clinical.

It is financial.
It is logistical.
It is immediate.
When care breaks, the household absorbs it.
 
At the Medic Now Foundation, this is where the gap becomes clear.
The Healthcare Cost Assistance Program (HCAP) focuses on the final step, helping families complete care when small, time-sensitive costs stand in the way.
Because care is not just accessed.
It has to be executed.
 
The strength of a military family is not just in service.
It is in the person who makes sure care actually happens.
 
Sources
Department of Defense
Blue Star Families
Defense Health Agency
Military OneSource
RAND Corporation

A 100-year-old patient, care paused by cost
​Healthcare coverage continues to expand, but cost pressure at the point of care is rising.
This is where care decisions are increasingly being made, not at enrollment, but at execution.
 
A Real Case, Last Week
A 100-year-old woman in Massachusetts had an approved care plan that could not move forward.
Her daughter, her caregiver and healthcare proxy, did not start with the medical issue.
She started with the numbers.

$57 left each month.
After everything else was paid.
The care plan was clear:

• A hospital bed
• A low-pressure air mattress
• Standard prevention for pressure ulcers

She secured the bed.
But the mattress, the part that makes the care plan medically effective, required about $1,300 out of pocket.
That is where the plan paused.
Not because care was unavailable.
Not because the system failed.
Because of cost at the moment care was supposed to happen.

What This Signals
The care existed.
The prescription existed.
The system existed.

Completion still required an additional step.
Without the mattress:

• Pressure ulcers become more likely
• Infection risk increases
• Hospitalization becomes more likely

At 100 years old, those risks carry weight.
 
The Pattern Behind the Story
This is not an isolated case.
Across our Healthcare Cost Assistance Program, most care interruptions occur at much smaller dollar amounts, often under $75.
​But higher cost gaps like this still surface at time-sensitive points in care, particularly when durable equipment or specialized support is required.

The pattern is consistent:
Care does not typically break at the point of access.
It breaks at the point of completion.
 
Why It Matters
Significant investments continue to expand healthcare access, coverage, and infrastructure.
But those investments do not guarantee that care is carried through.
The final step, whether care is actually completed, remains financially exposed.
 
The Outcome
In this case, the missing piece was filled.
The care plan moved forward.
 
The Takeaway
The system delivered care.
Completion still had a cost.

A closer look at what happens after care begins

Nearly half of women veterans have canceled a medical appointment because of childcare
Not because care wasn’t available.

Not because they didn’t seek it.

Because something outside the clinical setting got in the way.

For years, the conversation has focused on access:
How do we get people into care?
But for many women veterans, especially mothers, the challenge begins after the appointment is already scheduled.

Eight in ten women veterans report satisfaction with the care they receive
Access has improved.

Trust is high.
And yet, care is still being interrupted.
One of the most consistent reasons is not clinical.

It’s logistical.

Childcare.

42% of women veterans ages 18–34 and 36% ages 35–44 require childcare during medical appointments
40% report difficulty finding childcare for those appointments
46% have canceled a medical appointment in the past year because of it

These are not access failures.
They are completion breakdowns.
Care was scheduled.
Care was needed.
Care did not happen.

This pattern extends beyond any single barrier.

Approximately 4 in 10 U.S. adults report delaying or skipping recommended medical care due to cost, Kaiser Family Foundation

Even among insured populations, a significant share still forgo care due to out of pocket expenses, The Commonwealth Fund

Different barriers. Same outcome.

Care is interrupted.

This is not a question of motivation.
It is not a question of awareness.
And it is not a reflection of system quality.

The issue is something else:
The conditions required to complete care are not always in place.

Where MNF Fits
The Medic Now Foundation focuses on what happens between scheduling care and completing it.
For many women veterans, that gap is not clinical.

It’s practical.
Childcare is one example.
Out-of-pocket costs are another.

These are small, time-sensitive barriers, but they can determine whether care happens at all.
Healthcare systems perform best when patients are able to complete the care they begin.
Care that is started but not completed is still lost care.

The challenge today is no longer just access.

It’s completion.

Sources
Study of Barriers for Women Veterans to VA Health Care, 2023–2024, U.S. Department of Veterans Affairs
Advisory Committee on Women Veterans, 2024 findings, U.S. Department of Veterans Affairs
Kaiser Family Foundation
The Commonwealth Fund

Access to healthcare does not guarantee completion of care.

More than 2 million women veterans live in America today.
Yet too many still face a barrier in healthcare that often goes unseen.
Finishing it.

For many women veterans, the hardest part of service has sometimes been simply being seen.
Women have always served.
They have flown combat missions.
Led intelligence teams.
Maintained aircraft.
Provided lifesaving care as military medics.
Commanded units.
Supported operations across the globe.
What is changing today is visibility.

Women are now the fastest-growing segment of the veteran population, and their presence within the veteran community continues to grow. In 2000, women represented about 4% of the veteran population, and projections show that number could reach nearly 18% by 2040. The face of the veteran community is evolving.
Healthcare must evolve with it.

The Changing Face of Service
Women veterans represent one of the most diverse populations within the military community.
43% of women veterans using veteran health services are from racial or ethnic minority groups.
Most live in urban areas, though the rural population continues to grow.
The veteran community is not static. It is evolving, and healthcare must evolve with it.

Trust Matters in Healthcare
Research consistently shows that trust and comfort in healthcare environments influence whether patients follow through with treatment. When individuals feel supported and confident in their providers, they are far more likely to complete the care they begin. Completion, not access alone, is what ultimately drives health outcomes.

The Barrier Few People See
For many veterans, the challenge is not accessing care.
It is completing it.

Nationally, a meaningful share of prescribed care is never completed, often due to cost at critical points in the care journey.

• After a diagnosis.
• Before a follow-up test.
• During treatment.
• High deductibles.
• Unexpected co-pays.

Specialty care expenses.
Even when someone has already taken the important step of seeking care, those financial barriers can interrupt the process. Women who served this country should never have to fight a second battle just to complete their healthcare.

Helping Veterans Complete Their Care
At the Medic Now Foundation, we focus on a specific problem within the system:
removing targeted, last-mile financial barriers that interrupt care completion.

Through the Healthcare Cost Assistance Program (HCAP), the Medic Now Foundation works to remove financial barriers that can interrupt care for veterans, service members, and military families.
HCAP does not replace healthcare systems. It supports the patient.

HCAP is designed for time-sensitive, real-world cost interruptions that occur after care has already begun.
By helping remove financial obstacles, the program allows individuals to move forward with the care they need instead of postponing it.

For women veterans, that support can mean continuing with:
• specialized women’s health services
• mental health care
• follow-up care after diagnosis
Because healthcare works best when people are able to finish what they start.

Completing the Mission
Military culture is built around a simple principle. You complete the mission.
Healthcare should follow the same principle. Women answered the call to serve this country.
Ensuring they can complete their healthcare is not just a matter of access.

It is a matter of system performance.
And it is a problem that can be solved.


What barriers have you seen prevent veterans from completing care, even after they’ve taken the first step?

She has moved three times in five years.

Each time, she rebuilt everything.
A new job search.
A new school district.
A new childcare arrangement.
A new community.

Her spouse wears the uniform.
She carries the logistics.

When orders change, her career pauses. When relocation comes, seniority disappears. Each move resets momentum that took years to build.

There is no ceremony for that reset.
There is no medal for rebuilding stability.

Military mobility supports readiness and mission effectiveness. It is part of how a modern force operates.
But inside the household, the impact is personal.

There is no relocation bonus for the spouse who resigns again. No adjustment to a résumé that never has time to root. Each move resets seniority, networks, and career progress while the mission continues.

Over time, that reset compounds.
Expectation does not eliminate impact.

The Military Family Lifestyle Survey published by Blue Star Families consistently reports that military spouse unemployment remains significantly higher than the national average, hovering around 21 percent in recent years. Even among those employed, roughly one third report underemployment, working below their education or experience level.

Behind those numbers are repeated restarts.
A résumé reflecting multiple cities in short succession.
Certifications requiring new approvals.
Professional progress paused every few years.

For National Guard and Reserve families, mobility may be less frequent but still disruptive. Activation cycles shift income streams and employment stability. Civilian employment adjusts. Benefits shift. Household budgets adjust again.

In conversation, what stands out most is not complaint. It is calculation.
Budgets are recalculated.
Career timelines are recalculated.
Savings goals are recalculated.

These pressures rarely make headlines. They are structural realities of military life, and they are largely invisible.
When discussions focus on supporting service members and veterans, attention often centers on visible systems, benefits, programs, eligibility, policy.

Less visible is the economic weight carried inside the household that supports the uniform.
The weight of interrupted careers.
The weight of licensing barriers.
The weight of mobility that resets financial progress.

These are not failures of any one institution. They reflect the complexity of sustaining a mobile force.
But complexity does not remove consequence.
Economic stability within military families strengthens readiness, supports retention, and contributes to long term resilience after service.

If we care about the strength of the force, we must also care about the stability of the household behind it.
At the Medic Now Foundation, we believe strengthening systems requires understanding the full environment military families operate within.

​Sustainable stability is built through coordinated partnership, disciplined execution, and long-term commitment to reducing structural friction where it appears.

The uniform represents service to the nation.

Stability at home sustains that service.

Some burdens are visible.

​Others are carried quietly.

It is worth seeing both and building systems strong enough to support both.

​
Sources
• Blue Star Families, Military Family Lifestyle Survey, 2023 and 2024 reports
• U.S. Department of Defense, Demographics Profile of the Military Community

Why Completion Matters
Most health care conversations focus on access.
Are people insured?
Are providers available?
Are appointments scheduled?
Those are important questions.

But there is another question that matters just as much.

Was the care actually completed?
Having insurance does not automatically mean treatment moves forward without interruption. Even when coverage exists, out of pocket costs and medical debt can influence decisions at critical moments.
National data show that affordability pressures remain real for millions of Americans.
​
In 2025, the Kaiser Family Foundation reported that 44 percent of adults say it is difficult to afford health care costs. More than one third reported delaying or postponing care because of cost.
In 2026, The Commonwealth Fund reported that 41 percent of working age adults are managing medical bill problems or medical debt.

These numbers reflect the broader health care economy. Veterans and military families live within that same economy.

Many veterans receive care across multiple systems, including Department of Veterans Affairs facilities and community providers. The U.S. Government Accountability Office has described the administrative and coordination complexity involved in managing care across these environments. Research from the RAND Corporation has examined patterns of veterans receiving care across both Veterans Affairs and community systems.

Guard and Reserve families may also transition between TRICARE and employer-based coverage depending on duty status.

When care crosses systems, financial exposure can surface in different ways.
And when care is postponed, the impact is not always immediate, but it is real.

Peer reviewed research indexed in the National Library of Medicine has found that delayed medical care is associated with worsening health and, in some cases, higher health care costs later.

What begins as a postponed prescription or deferred procedure can become more complex over time.
At the Medic Now Foundation, our Healthcare Cost Assistance Program operates within this affordability gap.

HCAP does not replace Veterans Affairs, TRICARE, or employer coverage. It strengthens existing systems by addressing verified out of pocket barriers and qualifying health care related debt that can interrupt prescribed treatment.

Coverage is essential.
Completion is critical.
​
Ensuring that care is fully delivered helps protect both health outcomes and the investments already made in our health care system. It reinforces the systems already in place.

Breaking Barriers Brief
Why is care increasingly breaking down at the moment it is needed most, even for people who are insured?
When Coverage Exists, but Care Breaks Down

The Question
Why are more insured households unable to complete prescribed care, even as coverage rates remain high?

The Human Signal, Lived Reality
A parent with employer-sponsored insurance schedules a specialist visit after weeks of worsening symptoms. The appointment is approved. When they arrive, they are told a several-hundred-dollar copay is required before the visit can begin. The visit is postponed. The prescription that follows is never filled. Nothing dramatic happens. Care simply pauses, then slips out of reach as other bills take priority.

This is not a rare event or a crisis that draws attention. It is a quiet decision made under financial pressure, repeated across households and care settings.

What We’re Seeing, Verified Signal

• On January 1, 2026, enhanced Affordable Care Act premium subsidies expired, resulting in higher premiums for millions of insured households
• National research shows that rising out of pocket costs are associated with delayed care, skipped prescriptions, and abandoned treatment plans, even among insured populations
• Hospitals and health systems are operating under sustained financial pressure, including rising unpaid balances and longer payment delays
• In response, providers are increasingly relying on higher deductibles, increased copays, and more frequent upfront payment requirements before care begins

Coverage exists. Authorization exists. Financial friction emerges at execution.

What This Means, Interpretation
This pattern reflects a growing category of households that are insured on paper but financially constrained at the moment care decisions are made. The issue is not access in the traditional sense. It is affordability at the point of care.

At the system level, these dynamics are not driven by a lack of commitment from providers. Health systems are balancing rising operating costs, reimbursement pressure, and margin erosion while continuing to deliver care. Cost-sharing mechanisms are rational responses to structural constraints.

At the patient level, however, these same mechanisms introduce friction that quietly interrupts care pathways.

Why It Matters, Implications
When prescribed care is delayed or abandoned due to cost pressure

• Health outcomes worsen
• Downstream utilization increases
• Public and private healthcare investments underperform
• Preventable complications become more expensive to treat

Care rarely fails because it is unavailable. It fails incrementally, one postponed decision at a time.

This pattern is now visible across regions, coverage types, and care settings, making it a national execution risk rather than a localized coverage issue.

What’s Being Tested or Learned
Hospital-based financial navigation teams, nonprofit healthcare affordability organizations, and select provider groups operating under value-based or risk-bearing arrangements are testing targeted last-mile affordability interventions designed to prevent treatment interruption without expanding utilization.
These efforts typically focus on verified cost barriers such as copays, deductibles, prescriptions, or care-related travel, combined with rapid intervention and disciplined assistance tied directly to prescribed care plans.

Importantly, these approaches are not standardized, nationally coordinated, or consistently evaluated. Most operate as localized pilots or operational workarounds rather than formal system-level solutions. The open question is whether such interventions can be implemented with sufficient precision and accountability to improve care completion while maintaining cost discipline and scalability.

Bottom Line
As cost sharing rises, care completion, not coverage, has become the defining execution challenge in healthcare.
​
Sources
Advisory Board, ACA premiums skyrocket after enhanced subsidies expire, Jan 7, 2026
Advisory Board, Hospital finances are suffering. Here’s why, Dec 10, 2025
Kaiser Family Foundation, Patient Cost Sharing in the U.S. Healthcare System, 2024
Healthcare Financial Management Association, Upfront collections and financial clearance, 2024 to 2025
Kaiser Family Foundation, Americans’ Challenges with Health Care Costs, 2024
 

​​
​For this edition of the Breaking Barriers News Blog, we interviewed Kelly Durkee-Erwin. Kelly works for the Boston VA Healthcare system as an Individual Placement and Support (IPS) Specialist, this program aims to move veterans experiencing homelessness and mental health or substance use disorders into competitive employment rapidly as part of an integrated treatment approach.

A MILITARY FAMILIES CALL TO ACTION
Kelly is also the Senior Vice President of the VFW Auxiliary-Post 2394 in Melrose. In her spare time, Kelly hosts the show “Kelly’s Heroes” on The Waltham Channel (WCAC-TV) which provides the local community with information related to Veteran issues and highlights the stories of Veteran Servicemen.
Kelly is a Gold Star granddaughter, a Purple Heart Family Member (two times), and a Blue Star Sister (three times). Kelly is also active in local and State planning and serves on Waltham and Massachusetts housing Boards, as well as the Board of the Waltham Arts Council.

Thank you for making time to speak with us today, Kelly. Could you explain a little bit about the work that you do with the VA and the IPS employment services?
I work for the Boston VA Healthcare through the Tuscaloosa VA. They funded the research that we did, which just became a program, that proves to the VA that Individual Placement and Support in Supported Employment (IPSSE), is not a fad. It helps get our veterans back to work, for some people, it is just helping them write their own, or fill out a job application. Many of our veterans, when they're transitioning out of the military, are injured and they are unable to perform their former job. Everyone says you're back from the military, just go back to work. Well, being in a combat situation and being in a civilian situation isn't the same, and not everyone transitions the same.

So, the VA, after four years of intense research and study, has turned their research into a program, and they're now expanding it nationwide, New England has already embraced it and will be moving to Rhode Island soon. This program is helping service members immensely.

Each IPS has about a 20-to-25-person caseload. We help them to return to civilian work. But if you can't do the job that you did before, because it depended on that limb that's missing, or for whatever reason, we work in partnership with Vocational Rehab Employment (VRE), with Mass hire, the Easter Seals Job placement program, and the mass Rehab Commission. We work together to get the veterans to the best job, to fit their current whole health (https://www.va.gov/wholehealth/ ) because there are some jobs you do in the military you can't do in the civilian world. All the employment specialists in each of these groups have a bit of a niche.

Is this service available to all veterans or just veterans with disabilities?
It used to be. It was originally a program that was developed for the disabled, and the spine injured so they would not just be kept at home or in Group homes with no future. Because they can contribute, right? In this specific program that I work with, there are other IPSs that help veterans with other disorders, but we focus on veterans with specific obstacles to employment, not necessarily combat-related. It can be from a car accident or something else in your life. It used to be when we first started it was only combat-related because that's how the original funders wanted it to be, but now it can be anything.
 
Are there Incentives for employees to hire veterans or veterans with disabilities?
There are and I'm glad you asked because there's a whole tax incentive program that we send the form to employers when they hire a veteran. If they are unfamiliar, we try to tell the veteran to bring it up in their interview as well.
To learn more:  https://www.military.com/hiring-veterans/resources/tax-credits-for-hiring-veterans.html
 
What are some of the things that you're seeing veterans struggling with, whether it be access to health care or non-healthcare-related issues? What are some of the things that need attention that really are hard to address?
Number one, I'd say the transition from military to civilian life. The way that Veterans are transitioned out has changed drastically in the last 20 years with the Transition Assistance Program (TAPS) that they have now. However, the transition is still difficult from military to civilian life. Especially when you have a military injury, and you thought the military was going to be your whole career. Then they process you out, and then what do I do? It's about not having enough resources. I think the VA's embracing that. That's why they did this study, and why they're starting to roll it out nationally. They know there's a need to help people transition from the military.
Financial assistance provided by the Medic Now Foundation Inc. is also needed. This is a program that nowhere else in the country is being offered. Someone gets sent to a dentist and the military doesn't cover it.

The big three in my opinion would be housing, finance, and transition. I think those things increase the stress in their lives, then add PTSD into the mix, with everything that they have seen in combat, and some of these young men and women have seen things that I can never imagine right? That’s why they call us civilians with a capital C on some days because we don't understand. I don't need to have seen what they've seen to be able to try to help them. Another thing is the misconception of post-traumatic stress. It doesn't matter what people say. Oh, well, you flew a drone, so you can't have it. People need to embrace the fact that service members didn't all go through the same thing, but they all served, and it’s stressful.

As you know our Healthcare Cost Assistance Program (HCAP), gives them the flexibility to manage their healthcare where and when they need it. With your background and experience, how do you see that mission impacting military members the most?
I'm going to say your highest needs in dental because the VA only covers people who are 100% Combat-related to cover dental work. I know service members who haven't seen a dentist in years because you get your routine checkup they get once a year and that's it. It doesn't matter what else is wrong with you, and you don't have the money to pay for it, especially if you're a Guardsman or reservist. I'm sorry, but they just don't have the money to pay for it.

You come from a family with a distinguished record of military service. You are the sister of three combat veterans. Your grandfather was killed in action in World War 2. I assume this is the inspiration for you being a part of the VFW Auxiliary?

Yes, and my other grandfather, my father's father, also served. He was a combat veteran from World War One. My mother's father, John, died in combat in World War 2 in 1945. The war had just ended, and he was killed by troops who did not realize that the war was over.

His square is about 1/2 mile from Jamaica Plain VA. There is a placard on it. It's neat, and it's great to see it when I go to work in the VA once a week I pass by. My dad and his brother and several of my other uncles also served during Vietnam. My dad was a Captain in the army during Vietnam, so I guess we’ve always been a Gold Star, Blue Star, and Purple Heart family. I have a brother that's still active. I've had three in my lifetime. My grandfather got his (Purple Heart) posthumously, my youngest brother got his about 10 years ago and it has been very, very difficult coming home with a traumatic brain injury.

​I started in the auxiliary because I think I've always served veterans. It just wasn't a question in our house, everyone in my house has been a public servant. I think since my mother's father, my father's father, and my parents were public servants, that's just what I do, and veterans have a special place in my heart.

I’d like to ask what's the most rewarding thing about your participation.
It’s really my work, and I don't separate my work there from the work I do with the VA. It’s knowing that people are getting the help that they have earned. Our Veterans have said, “I will defend you even if you're anti-government, anti-military, anti-whatever, hateful, mean, grumpy.” The America that they fight for is everybody, including me, who's done nothing. They don't know me from a grain of sand, and they'll defend my right to be. If I want to be a jerk, they'll defend my right to be a jerk.

So, when they come home and they're in need, it offends me, morally, and personally, and it hurts my heart. I don't sleep at night when I talk to some of my veterans, and I listen to the pain they've been caused. Most veterans do not want help because they're the helpers. They don't want to ask for help. I just enjoy being able to help them. But organizations like yours, that say they help veterans, I like making them stand up to the words that they write on paper. Yours (Medic Now Foundation Inc.) is easy. You say it and you do it.

I feel a moral obligation based on my upbringing, to make sure the veterans get what they have earned, which is respect, and they should be able to live in this country without medical debt. We don't have enough mental health counselors in this country, and they deserve to get the help they need.

I wanted to talk a bit about your cable show Kelly’s Heroes.
That is my greatest guilty pleasure. I was so excited when they asked me. It's not work. It's such a joy. It's so much fun.

So how did It get started?
Well, in Waltham, the current Waltham Cable Access company executive director is Maria Sheehan, and we were at a Chamber of Commerce Event, and she said to me, “I want you to do a Veterans show”. A serious show that I could do once a month about Veterans. Then the show’s producer, who also produces the City Council show, who is my middle brother, who is also in the National Guard, and a city Councilor member, came up with a name for Kelly's heroes, Like after the movie. Also, there's another woman who's wanted to do a veteran show for a long time. This ended up being my Co-host, Carol Malone, who was my auxiliary president at the time, and I love her. She thinks about things I don't think of, and I think we make a great team due to her background. She talks about her husband’s experiences back when he just got home from Vietnam, and how the wives formed groups and talked to each other.

Things like this become important as veterans get older because I don't want to lose their stories. I know that Massachusetts, the VFW, and the American Legion just partnered with the National Oral History Project to collect some of those stories, and much like my dad, we got his story right before his Alzheimer's kicked in. I don't think he could tell his story today, but a year ago we were able to collect it.

How long have you been doing the show?
Well, I think this is our 4th year because we did our first in February 2020

My last question about your show is, is there something about the show that you've learned, some insight or is that something that you didn't expect?
Yes, the way it has inspired other people, and because it's also on demand on the Internet, my brother was able to watch my dad's interview in Denmark. WE’RE GLOBAL!
​
Thank you so much, for your one-on-one interview today, and for all your work for our military community every day.