“DHA holds all of its contractors to the highest standards of performance and compliance with their contractual obligations. When a contractor falls short of those obligations, DHA employs the full range of remedies available under the contract to ensure adequate performance is restored. We do not hesitate to use those tools when and where they are needed,” the statement continued. “Though we do not take any option off the table, DHA is not currently planning to recompete the West Region Managed Care Support contract early.”

A similar scenario played out more than a decade ago, when the Defense Health Agency — which was previously called the Tricare Management Activity office — oversaw an earlier transition between benefits administrators.

According to a 2014 report on the transition from the Government Accountability Office, the agency’s “inadequate guidance and insufficient oversight contributed to problems with health care delivery.” The new contractor at the time, UnitedHealth, “experienced difficulty in meeting some of its requirements early on, disrupting continuity of care for some beneficiaries and potentially resulting in unnecessary costs.”

The GAO outlined a series of steps for the Defense Health Agency to take to ensure future transitions went smoothly. By 2016, the GAO said, all of the steps had been successfully implemented.

In January, Shoemaker returned to the speech pathology clinic to take a swallow test. He had stopped going in for regular therapy sessions in August.

His cancer treatment led to scarring that thickened the muscles in his throat and made swallowing difficult. He carries a cup with him because his salivary glands have dried up, creating mucus and phlegm in his throat, and he undergoes periodic dilations to expand his throat.

If Shoemaker loses his ability to swallow, he risks aspiration — when food, liquid or stomach contents enter the airway. It can lead to pneumonia, which can be deadly.

Katrina Jensen, his speech-language pathologist, threaded a tube with a small camera on the end up Shoemaker’s nose and down the back of his throat to watch him swallow several foods with different consistencies.

Each time, Shoemaker aspirated when he swallowed. More concerning, Jensen said, was that he wasn’t even aware of it sometimes.

“The safest thing would be,” she said, “for you to get a feeding tube.”

Shoemaker looked up at the ceiling. His expression changed. He had had one for about six months at the beginning of his cancer treatment, when he was doing radiation. “Not a fan,” he said.

Jensen said he wouldn’t be at this point if his treatment hadn’t been paused for so long. “They’ve been denying care,” she said of TriWest.

“It’s frustrating,” Shoemaker said. “I don’t want to say the term or use the phrase often that says ‘I’m owed.’ But the reality of it is, I am owed. I mean, I held up my part of the bargain. Now the other side needs to hold up their part of the bargain.”

At home after the appointment, Shoemaker put on a brave face in front of his family.

“I want to keep them optimistic — Dad is Dad now, and he’s going to get better, right?” he said.

But privately, he feared the worst. The swallow test results and the feeding tube, he said, meant he was going in the wrong direction. “I guess you could always say you think you have more time,” Shoemaker said. “Maybe this is telling me I really don’t have that much time.”

Shoemaker’s problems with TriWest still aren’t resolved: He said he’s facing a new denial, once again linked to other health insurance.

“I need constant care, and I need the care to be flawless. I can’t have somebody questioning everything that I need,” he said.

If he were still an Army recruiter, he said, he’d have to change his pitch. It would no longer be guaranteed healthcare for life.

“Ever since I went in, I love the Army. And I enjoyed it. I loved recruiting. I mean, I was proud to be able to put people in and watch them ship off and get a better life,” he said. “And now all of a sudden, the thing that you love your whole life, it’s almost like they’re turning their back on you.”