 The Crisis Before the Crisis
What the VA Is Teaching Us About Prevention One of the most underreported success stories in veteran services is happening right now. While homelessness across the United States increased in 2024, veteran homelessness declined by approximately 7.5%, according to the U.S. Department of Housing and Urban Development (HUD) and the Department of Veterans Affairs (VA). That did not happen by accident. It happened because organizations across the veteran support ecosystem are increasingly focused on identifying risk before a crisis becomes visible. For years, homelessness programs were largely designed to respond after housing had already been lost. Today, the conversation is evolving. The question is no longer simply how to help a veteran once they become homeless. The question is whether we can recognize the warning signs early enough to prevent homelessness from occurring in the first place. Looking for Risk Before Housing Is Lost The VA has invested heavily in shifting from crisis response to early detection. According to a 2025 VA Office of Inspector General audit, the Veterans Health Administration screened more than 2.4 million veterans between January and June of 2024 using its Homelessness Screening Clinical Reminder. During that six-month period, 31,149 veterans were identified as homeless or at risk of homelessness. Think about what that means. The VA was not waiting for veterans to lose housing. The VA was actively looking for signs that a veteran's stability may be at risk. The goal was simple: identify potential problems early enough to connect veterans with support before housing is lost. That distinction may be one of the most important lessons in modern veteran services. What Researchers Are Discovering This shift toward prevention is now being reinforced by emerging research. A 2026 study analyzing healthcare and social data from approximately 4.27 million veterans found that incorporating social and behavioral information significantly improved the ability to identify veterans at elevated risk for future homelessness. Researchers were not claiming that homelessness can be predicted with certainty. Instead, they reached a different conclusion. Social and behavioral indicators can help identify elevated risk long before a housing crisis occurs. Other veteran-focused research has reached similar findings. Studies examining homelessness risk among veterans have identified factors such as depression, PTSD, and trauma exposure as important risk indicators that may appear well before housing is lost. The emerging lesson is straightforward: Homelessness may not be the first sign of a crisis. It may be the last. The Warning Signs Before the Warning Sign The most important takeaway from both VA prevention efforts and recent research may not be about housing at all. It may be about learning to recognize vulnerability before it becomes visible. Financial strain. Transportation challenges. Behavioral health concerns. Housing insecurity. Reduced engagement with support systems. These factors do not guarantee a future crisis. But they may signal increasing risk. This reality helps explain why the VA continues to invest in homelessness screening, peer specialist programs, staff education, and Motivational Interviewing techniques designed to strengthen engagement before a crisis escalates. Recognizing risk is only the first step. Acting on it is what matters. A Lesson Beyond Housing At the Medic Now Foundation, this research resonates because it reinforces a broader lesson that extends beyond homelessness. Major challenges are often preceded by smaller signs of instability. In healthcare, those signs may appear differently. A delayed prescription. A missed appointment. A transportation barrier. An out-of-pocket expense that interrupts care. A patient who begins disengaging from treatment. Each event may seem minor in isolation. Yet each may represent an opportunity for intervention before a larger problem develops. The most important lesson emerging from the VA's work is that successful prevention begins long before a veteran loses housing. The earlier instability is recognized, the greater the opportunity to respond before consequences become more severe. The Crisis Before the Crisis The most important lesson emerging from the VA's homelessness prevention efforts may not be about housing. It may be about prevention itself. By the time a veteran loses housing, the warning signs may have already been present for weeks or months. The opportunity for intervention may have already existed. The question facing healthcare providers, veteran service organizations, policymakers, and communities is becoming increasingly clear: Can we learn to recognize vulnerability before the crisis becomes visible? Because if we can, we may not simply become better at responding to homelessness. We may become better at preventing it. Sources
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 How small healthcare costs can create much larger healthcare consequences.
Most healthcare conversations begin with access. Do people have coverage? Can they see a provider? Can they get into the system? Those questions matter. But an equally important question receives far less attention: What happens after care begins? Because for millions of Americans, the challenge is no longer gaining access to healthcare. The challenge is successfully carrying care through to completion. And the numbers suggest this challenge is larger than many realize. America's medical debt burden is estimated at approximately $220 billion, making medical debt one of the largest sources of financial strain facing households today. At the same time, healthcare affordability remains a significant concern even among insured individuals. National surveys continue to find that roughly one in four adults report difficulty affording healthcare or prescription medications. Research published in JAMA Network Open has also shown that prescription abandonment rises significantly as out-of-pocket costs increase. In some cases, patients never begin treatment despite having access to a prescribed therapy. These statistics point toward an important reality: Healthcare access and healthcare completion are not always the same thing. A patient can have insurance. A treatment plan. A referral. A prescription. An appointment. And still encounter barriers that interrupt care. When that happens, the consequences often extend beyond the individual healthcare encounter. Conditions remain unmanaged. Treatment plans are delayed. Additional healthcare services may become necessary. What began as a manageable issue can become a more complex and costly healthcare event. As conditions progress, patients may require additional healthcare services, including urgent care visits, emergency department visits, hospitalization, or more intensive treatment interventions. When patients eventually return to the healthcare system, they often require more complex care than was originally needed. The consequences extend beyond the patient. What This Means for Families Healthcare challenges rarely affect only one person. Within military and veteran families especially, healthcare decisions often affect entire households. When affordability interrupts care:
Why This Matters in Military Healthcare This challenge exists within military healthcare as well. The Defense Health Agency identifies retail network pharmacies as one of the primary access points for TRICARE beneficiaries. For many patients, the final step in a treatment plan occurs not in a hospital or clinic. It occurs at the pharmacy counter. Coverage helps reduce the financial burden. It does not eliminate it entirely. Care is prescribed. Cost is introduced. Completion becomes uncertain. The gap between access and completion is where affordability barriers often emerge. What We Are Seeing in Practice At the Medic Now Foundation, this pattern is not merely theoretical. Through the Healthcare Cost Assistance Program (HCAP), support is most frequently used in small, targeted amounts at routine healthcare touchpoints, particularly pharmacies and other healthcare-related expenses. The observation is straightforward: Many healthcare disruptions are not caused by the absence of care. They occur after care has already been authorized, prescribed, or made available. In many cases, relatively small out-of-pocket expenses become the barrier that prevents the next step from happening. When those barriers are removed, care can continue. The Final Mile of Care The Medic Now Foundation's Healthcare Cost Assistance Program focuses on what might best be described as the final mile of care. The program does not replace healthcare systems, insurance coverage, or clinical providers. Instead, it provides targeted support designed to help military-connected individuals complete prescribed care when affordability barriers create disruption risk. Because healthcare success is not measured solely by whether care is available. It is measured by whether care is completed. America's $220 billion medical debt problem is ultimately more than a financial issue. It is a reminder that access alone does not guarantee completion. And for many patients, the final mile of care remains one of the most important challenges in healthcare today. Sources
 Coverage gets people into care. Completion gets people through care.
Healthcare systems across the country are beginning to recognize something important: Access alone does not guarantee care completion. For years, much of the healthcare conversation focused on expanding access, increasing eligibility, and improving coverage. Those efforts matter. They helped millions of people enter the healthcare system. But healthcare leaders are increasingly confronting a second challenge: What happens after care begins? Across military and civilian healthcare environments alike, continuity, coordination, affordability, and follow-through are becoming operational concerns in their own right. Recent developments across the Military Health System reflect this shift. The Department of Defense is proposing structural changes to military healthcare budgeting amid rising cost pressures and long-term sustainability concerns. At the same time, Defense Health Agency leadership has emphasized reducing administrative burden and improving healthcare execution across the Military Health System. Federal oversight findings continue identifying challenges involving: • Specialty care scheduling • Referral coordination • Follow-through within increasingly complex healthcare environments These developments matter because healthcare disruption does not always begin with denial of care. Sometimes it begins later: • At the pharmacy counter • During a referral delay • After another out-of-pocket bill arrives • Between appointments, authorizations, transportation challenges, and the practical realities of carrying treatment forward over time Increasingly, the challenge is not simply whether care exists. It is whether care successfully continues. The Growing Pressure of Healthcare Costs Affordability pressure continues rising across the healthcare landscape. Updated 2026 TRICARE cost schedules show increasing beneficiary cost-sharing responsibilities across multiple areas of care, including retail pharmacy copays that now fall within ranges associated with increased prescription abandonment risk. Research published through JAMA Network Open found prescription abandonment rates rise significantly as patient out-of-pocket costs increase, particularly within approximately the $30–$75 range. Additional national reporting continues reinforcing the broader affordability environment: • Gallup reported that many Americans continue delaying or skipping healthcare because of cost. • KFF reporting similarly shows many individuals struggling with healthcare affordability even while insured. • Massachusetts remains one of the most highly insured states in the country, yet reporting from CHIA continues showing ongoing affordability strain and medical debt concerns. Together, these signals point toward an important distinction: Coverage does not always guarantee continuity. Where HCAP Operates At the frontline level, this is where the Medic Now Foundation's Healthcare Cost Assistance Program (HCAP) operates. HCAP provides small, targeted financial interventions designed to help military-connected individuals continue progressing through care when out-of-pocket healthcare expenses create disruption risk. The program does not replace healthcare systems, insurance coverage, or clinical care delivery. Rather, HCAP functions as a controlled continuity-support mechanism operating within the final stages of care execution. Through vendor-restricted controls and defined healthcare spending categories, HCAP supports healthcare-related purchases involving: • Pharmacies and Drug Stores • Health Facilities and Healthcare Centers • Dental and Vision Services • Healthcare-supportive household needs tied directly to care continuation Current HCAP observations continue suggesting that many affordability-related disruptions occur not at the point of healthcare eligibility. They increasingly appear during the practical realities of sustaining care over time. Importantly: This is not simply a military healthcare issue. It is increasingly becoming a broader healthcare systems issue. An Emerging Opportunity for Collaboration As healthcare environments become more operationally complex, the ability to sustain continuity through the final stages of care may become one of the defining healthcare challenges of the next decade. That creates an opportunity for collaboration. The future of healthcare support may require stronger coordination between: • Healthcare systems • Public agencies • Veteran-serving organizations • Frontline nonprofits • Continuity-support mechanisms capable of helping patients carry care through to completion The Medic Now Foundation believes programs like HCAP may represent one example of how this type of frontline support infrastructure can operate alongside larger healthcare systems in practical, measurable, and operationally supportive ways. Because ultimately: Healthcare access may begin the process. But whether care successfully continues and reaches completion may matter just as much. Sources & References • Department of Defense Military Health System budget discussions (FY2026) • Defense Health Agency FY2026 operational priorities • TRICARE 2026 cost and pharmacy updates • VA Office of Inspector General specialty care findings • Gallup healthcare affordability research • KFF healthcare affordability research • JAMA Network Open prescription abandonment research • IQVIA Institute healthcare affordability research • Massachusetts Center for Health Information and Analysis (CHIA)  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:
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:
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.
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? The Economic Reality for Military Families  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
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
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 |
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