Bridging history and policy: Ensuring equitable access for military families in the U.S. Military Health System

Over the past two centuries, the U.S. Military Health System (MHS) has gradually expanded health care access for military spouses and families, yet eligibility has long been historically shaped by branch affiliation, rank, and gender. Gender-based restrictions persisted until the late twentieth century, and inequities in service coverage were common. Legislative milestones, including the Army Appropriations Act (1884), Navy Personnel Act (1899), Naval and Marine Corps Dependents Hospitalization Act (1943), and Dependents’ Medical Care Act (1956), mark turning points in this uneven trajectory. This article examines the historical evolution of dependent health care and considers how these patterns inform contemporary policy debates. Recent initiatives, such as the 2023 Department of Defense directive to reattract care to military treatment facilities, seek to strengthen readiness, optimize staffing, and improve access. Understanding the patterns of systemic exclusion and health inequities is vital to advancing transformative reform efforts. Lack of research on medical mistrust of military families within the MHS is a barrier to determining whether a historical legacy of exclusion contributes to the broader lack of trust in the current health system. Recommendations include targeted legislation to mitigate systemic volatility resulting from shifts between direct care and purchased care, and deliberate integration of military spouses who are health care workers into military treatment facilities to build a workforce representative of the modern military family.