Defense health officials say they are making inroads in improving beneficiaries’ access to health care and services and proposed changes to military health care in the fiscal 2017 budget should enhance those efforts.
Dr. Jonathan Woodson, assistant secretary of defense for health affairs, and Defense Health Agency director Navy Vice Adm. Raquel Bono told Congress this week that the Defense Department must ensure the readiness of its military hospitals and clinics as "full-service platforms” to make sure medical personnel preserve their trauma, disease and non-battlefield-injury treatment capabilities.
But at the same time, they added, the Tricare program and the military hospital system must be tweaked to be more responsive to patients.
"We enter 2016 confident that the reforms in the military health system and the health benefit can be further strengthened through a combination of legislative and operational reforms," Woodson told the personnel subcommittees of the House and Senate Armed Services committees during two separate hearings.
Among the reforms proposed in the DoD's $48.8 billion health budget is an effort to streamline Tricare into two programs: a health-maintenance organization similar to the current Tricare Prime that is limited to areas around military hospitals and clinics, and a hybrid of Tricare Extra and Standard that would allow beneficiaries to use civilian doctors.
Both programs would require higher fees for those who prefer civilian care, and military retirees and family members who are not eligible for Medicare would pay annual enrollment fees regardless of which program they selected. Currently, the non-Medicare-eligible group of beneficiaries pays cost-shares but no annual enrollment fees to use Tricare Standard.
Woodson said the proposals and other initiatives will help alleviate the biggest complaint from patients, especially those at MTFs: they can’t get appointments.
“We’ve heard loud and clear from our beneficiaries that access to primary and specialty care needs attention, particularly at our military treatment facilities,” Woodson said.
Active-duty troops and their families would not be required to pay annual fees for health care. They would also be able to continue using military hospitals or clinics for free, and those in the civilian provider option, would have no network co-payments with a referral but would make co-payments without a referral. The amount of the co-pay would depend on what type of care is needed.
Responding to a question on what beneficiaries would receive for their higher payments, Woodson said the new Tricare includes a “modest fee increase that gives better freedom," and with the preferred provider organization option, the referral requirement, what Woodson described as a "major dissatisfier to our beneficiaries," would go away.
Woodson said the average active-duty family of four would see its share of total health care costs rise from about 8 percent to 10.4 percent. He added that the new program would have catastrophic caps below industry averages and offer a second-payer option that would allow beneficiaries to use Tricare as a supplement to other private insurance.
“What you have to say is helpful, but we have to find ways of doing it in a quicker elevator speech so people understand immediately how it affects their families,” ranking member of the House Armed Services personnel panel Rep. Susan Davis, D-Calif., said. “People are concerned about the increases and they want to know they are getting something for it.”
Congress has held four hearings since December on defense health reform, with an eye toward optimizing the benefit now and creating a sustainable one in the future.
The Military Compensation and Retirement Reform Commission last year recommended several major changes to the defense health system, to include consolidating the three individual service medical commands under one readiness command and moving all beneficiaries who are not on active duty to private health care programs.
The commission also recommended improved collaboration between the Defense and Veterans Affairs departments, with commission members saying joint health care could be accomplished and would be more cost-effective.
This collaboration already is underway at some facilities, where active-duty troops, veterans and family members get their care side by side. Most notably, the James Lovell Federal Health Care Center in Chicago is a fully integrated, joint DoD-VA facility that Woodson said has served to illustrate that the two departments can benefit from interoperable care.
Military retiree and Rep. Mike Coffman, R-Colo., was having none of it. Coffman said he will work to ensure that military and veterans facilities remain separate.
"We need to reform the VA, but until it is reformed, I don’t want to see them taking care of active-duty or our active-duty families. The departments have different standards and different standards of care," Coffman said. "If I have to get this into the [National Defense Authorization Act], I will. It would be wrong for our military families."
Battlefield medical care
During the Senate subcommittee hearing Tuesday, the service surgeons general said their priority is to preserve readiness in order to maintain the high standard of battlefield medical care set in the last 15 years of war.
This means preserving the military hospital system and treating active-duty families at these facilities, said Air Force Surgeon General Lt. Gen. Mark Ediger.
“Our success in support of deployed operations is inexplicably linked to the care we provide in our hospitals, our clinics and our many partner institutions. The bedrock of our readiness is the military hospital," Ediger said.
“Reforms must not degrade our combat-tested system or readiness in an environment where we must remain rotationally focused and surge-ready [because] the next large-scale deployment could be tomorrow,” Army Surgeon General Lt. Gen. Nadja West said.
Noting that a Navy corpsman was awarded the Silver Star two weeks ago for defending fellow troops and treating casualties inside a kill zone, Navy Surgeon Gen. Vice Adm. Forrest Faison said the Navy is committed to reform to improve patients' experience and their health.
"More needs to be done and none of us underestimates the effort required to improve our peacetime health care services," Faison said. "However, we must do so without putting at risk the very system which has yielded such unprecedented survival."
Article from Military Times
Showing posts with label Tricare. Show all posts
Showing posts with label Tricare. Show all posts
Wednesday, March 2, 2016
Monday, February 15, 2016
Health care hikes for retirees in Pentagon budget proposal
The Pentagon’s 2017 budget calls for changes to the Defense Department’s health benefit that would require all working-age retirees to pay annual enrollment fees regardless of which Tricare program they use or forfeit their health care for a year, according to Pentagon budget documents.
The budget calls for reorganizing the current system into two Tricare programs, with cost-savings for patients who use military hospitals and higher fees for those who choose civilian care.
The $48.8 billion health budget request, which includes $33.5 billion for health care programs, would revamp Tricare’s structure into two plans: Tricare Select, a health maintenance organization-type program similar to Tricare Prime that is limited to areas around military hospitals and clinics; and Tricare Choice, a Tricare Extra and Standard hybrid that covers care by civilian doctors with incentives to seek network care.
The new system would require all military retirees and their family members to pay annual participation fees, regardless of which program they choose. Currently, this group of beneficiaries pays cost-shares but no annual enrollment fees to use Tricare Standard. According to budget documents, the changes are designed to entice more beneficiaries to use military hospitals and clinics by continuing to offer care at these facilities at no cost to patients and curb the rising costs to DoD of private care.
In the past several years, the Pentagon has proposed changes to the Tricare health benefit to include program consolidation but much of the reform has been focused on increasing co-payments and cost-shares for beneficiaries.
Health officials say this year’s proposal will help curb health care costs but also will improve performance, especially at military treatment facilities.
“Simply revising the cost-sharing structure of Tricare will not meet beneficiaries' concerns or resolve access to care issues. Instead, the department must commit to institutional health care reform,” Pentagon officials wrote in the fiscal 2017 budget request overview.
Under the new plans, co-payments would depend on beneficiary category and place of care.
Military retirees and family members who are not Medicare eligible — those referred to as "working-age retirees — would see the biggest changes.
They would be required to choose between the MTF-based Tricare Select and Tricare Choice civilian care program, paying an annual participation fee of $350 for an individual or $700 for a family for Tricare Select, or $450 for an individual or $900 for a family under Tricare. Visits to military hospitals or clinics for retirees would continue to be offered at no cost but beneficiaries would pay $20 for a primary care visit in-network with a referral or $25 co-payment for primary care at a network doctor without a referral.
They also would pay $30 or $35 for a specialty care visit, depending on whether they had a referral. A visit to a network emergency room would cost $75 for those in Select and $90 for those in Choice.
Active-duty troops and their families would not be required to pay annual fees for health care. They would also be able to continue using military hospitals or clinics for free, and those in Select would have no network co-payment with a referral. For those in Choice, they would pay a $15 co-payment for primary care at a network physician, $25 for specialty care or $25 for urgent care visits. An ambulance ride would cost $15 and a network emergency room visit would require a $50 co-payment.
All Choice beneficiaries would still be able to see out-of-network providers, with active-duty families paying cost shares of 20 percent of the Tricare allowable charge and retirees and their family members paying 25 percent.
Also new this year, and similar to civilian health plans, Tricare would implement open-season enrollment for working age retirees — all would be required to enroll and pay the annual participation fee or forfeit coverage for the plan year.
The budget also proposes increases to catastrophic caps for beneficiaries. Active-duty families would see theirs rise to $1,500 for network care, up from $1,000, while retirees would see theirs increase from $3,000 to $4,000. Participation fees would not count toward the caps.
Medically retired members and their families, as well as survivors of those who died on active duty would be treated the same as active-duty family members, with no participation fees and lower cost shares.
The budget also proposes significant changes for future users of Tricare for Life, the military health system’s wrap-around program to Medicare. Users would begin paying an enrollment fee for the program based on a percentage of gross retired pay — 0.5 percent in 2017 — and capped at $150 a year for a family and $200 for retired flag and general officers.
By 2021, TFL enrollees would pay a fee amounting to 2 percent of gross retired pay, up to a maximum of $632. Retired flag officers would pay up to $842 by 2021.
One proposal that would touch all Tricare users would be future hikes in co-pays for generic prescriptions purchased through retail pharmacies and increases in brand name drugs, both at retail pharmacies and by mail.
Prescriptions would continue to be filled free at military treatment facilities and generic drugs also would be available at no charge through Tricare's mail-order system until 2020, when a 90-day generic prescription cost would rise to $11.
Generics would cost $10 at a retail pharmacy in 2017 and would remain at that level through fiscal 2019, when they would rise to $11.
Brand name medications at retail and mail order would cost $28 and would rise incrementally through 2026, when they could be higher than $45 per prescription.
According to Pentagon estimates, the average active-duty family of three averages $13,965 in medical costs per year, with the military bearing $13,778 of the expense while the family picks up $189, or about 1.4 percent.
Under the new plan, active-duty families would pay an average $30 more a year, or roughly 1.6 percent of their overall health costs.
A working-age retiree's family of three accrues $16,982 in medical costs per year, according to DoD, and pays $1,360, or 8 percent of the cost. Under the plan, they would pay an average of $1,768, or 10.5 percent, of their estimated annual costs.
DoD officials say that when Tricare was implemented in 1996, retirees paid 27 percent of their total health care expenses. With them now paying less than 9 percent of their costs, the DoD health budget is unsustainable, officials argue.
“The internal savings initiatives and modest congressional fee increases are helpful but are not enough to curb the projected increase in health care costs, for the department,” officials wrote in the budget documents.
In the past three years, DoD has proposed various iterations of Tricare consolidation and new fees designed change beneficiary behavior and trim costs. Congress has largely rejected the Pentagon's reform proposals and currently is reviewing the entire military health system to determine what changes should be made.
In early 2015, the Military Compensation and Retirement Modernization Commission proposed moving all beneficiaries who are not on active-duty to private health care plans.
Article from Military Times
The budget calls for reorganizing the current system into two Tricare programs, with cost-savings for patients who use military hospitals and higher fees for those who choose civilian care.
The $48.8 billion health budget request, which includes $33.5 billion for health care programs, would revamp Tricare’s structure into two plans: Tricare Select, a health maintenance organization-type program similar to Tricare Prime that is limited to areas around military hospitals and clinics; and Tricare Choice, a Tricare Extra and Standard hybrid that covers care by civilian doctors with incentives to seek network care.
The new system would require all military retirees and their family members to pay annual participation fees, regardless of which program they choose. Currently, this group of beneficiaries pays cost-shares but no annual enrollment fees to use Tricare Standard. According to budget documents, the changes are designed to entice more beneficiaries to use military hospitals and clinics by continuing to offer care at these facilities at no cost to patients and curb the rising costs to DoD of private care.
In the past several years, the Pentagon has proposed changes to the Tricare health benefit to include program consolidation but much of the reform has been focused on increasing co-payments and cost-shares for beneficiaries.
Health officials say this year’s proposal will help curb health care costs but also will improve performance, especially at military treatment facilities.
“Simply revising the cost-sharing structure of Tricare will not meet beneficiaries' concerns or resolve access to care issues. Instead, the department must commit to institutional health care reform,” Pentagon officials wrote in the fiscal 2017 budget request overview.
Under the new plans, co-payments would depend on beneficiary category and place of care.
Military retirees and family members who are not Medicare eligible — those referred to as "working-age retirees — would see the biggest changes.
They would be required to choose between the MTF-based Tricare Select and Tricare Choice civilian care program, paying an annual participation fee of $350 for an individual or $700 for a family for Tricare Select, or $450 for an individual or $900 for a family under Tricare. Visits to military hospitals or clinics for retirees would continue to be offered at no cost but beneficiaries would pay $20 for a primary care visit in-network with a referral or $25 co-payment for primary care at a network doctor without a referral.
They also would pay $30 or $35 for a specialty care visit, depending on whether they had a referral. A visit to a network emergency room would cost $75 for those in Select and $90 for those in Choice.
Active-duty troops and their families would not be required to pay annual fees for health care. They would also be able to continue using military hospitals or clinics for free, and those in Select would have no network co-payment with a referral. For those in Choice, they would pay a $15 co-payment for primary care at a network physician, $25 for specialty care or $25 for urgent care visits. An ambulance ride would cost $15 and a network emergency room visit would require a $50 co-payment.
All Choice beneficiaries would still be able to see out-of-network providers, with active-duty families paying cost shares of 20 percent of the Tricare allowable charge and retirees and their family members paying 25 percent.
Also new this year, and similar to civilian health plans, Tricare would implement open-season enrollment for working age retirees — all would be required to enroll and pay the annual participation fee or forfeit coverage for the plan year.
The budget also proposes increases to catastrophic caps for beneficiaries. Active-duty families would see theirs rise to $1,500 for network care, up from $1,000, while retirees would see theirs increase from $3,000 to $4,000. Participation fees would not count toward the caps.
Medically retired members and their families, as well as survivors of those who died on active duty would be treated the same as active-duty family members, with no participation fees and lower cost shares.
The budget also proposes significant changes for future users of Tricare for Life, the military health system’s wrap-around program to Medicare. Users would begin paying an enrollment fee for the program based on a percentage of gross retired pay — 0.5 percent in 2017 — and capped at $150 a year for a family and $200 for retired flag and general officers.
By 2021, TFL enrollees would pay a fee amounting to 2 percent of gross retired pay, up to a maximum of $632. Retired flag officers would pay up to $842 by 2021.
One proposal that would touch all Tricare users would be future hikes in co-pays for generic prescriptions purchased through retail pharmacies and increases in brand name drugs, both at retail pharmacies and by mail.
Prescriptions would continue to be filled free at military treatment facilities and generic drugs also would be available at no charge through Tricare's mail-order system until 2020, when a 90-day generic prescription cost would rise to $11.
Generics would cost $10 at a retail pharmacy in 2017 and would remain at that level through fiscal 2019, when they would rise to $11.
Brand name medications at retail and mail order would cost $28 and would rise incrementally through 2026, when they could be higher than $45 per prescription.
According to Pentagon estimates, the average active-duty family of three averages $13,965 in medical costs per year, with the military bearing $13,778 of the expense while the family picks up $189, or about 1.4 percent.
Under the new plan, active-duty families would pay an average $30 more a year, or roughly 1.6 percent of their overall health costs.
A working-age retiree's family of three accrues $16,982 in medical costs per year, according to DoD, and pays $1,360, or 8 percent of the cost. Under the plan, they would pay an average of $1,768, or 10.5 percent, of their estimated annual costs.
DoD officials say that when Tricare was implemented in 1996, retirees paid 27 percent of their total health care expenses. With them now paying less than 9 percent of their costs, the DoD health budget is unsustainable, officials argue.
“The internal savings initiatives and modest congressional fee increases are helpful but are not enough to curb the projected increase in health care costs, for the department,” officials wrote in the budget documents.
In the past three years, DoD has proposed various iterations of Tricare consolidation and new fees designed change beneficiary behavior and trim costs. Congress has largely rejected the Pentagon's reform proposals and currently is reviewing the entire military health system to determine what changes should be made.
In early 2015, the Military Compensation and Retirement Modernization Commission proposed moving all beneficiaries who are not on active-duty to private health care plans.
Article from Military Times
Thursday, March 6, 2014
DoD Budget Plan Takes Aim at TRICARE and other Benefits
From Military Advantage........
The proposed 2015 DoD budget could kill TRICARE Prime and increase out-of-pocket medical expenses for dependents and retirees.
Much of the first reports on the proposed 2015 defense budget didn’t necessarily focus on the details or specific areas to be cut. Many of details won’t be available until March 4th. However, there are some details available on one of the most significant benefits areas to be hit – TRICARE.
TRICARE, originally named for its three levels of health care coverage (Prime, Extra, and Standard), has been providing affordable healthcare coverage for military dependents and retirees for nearly 20 years. But, according to columnist Ton Philpott’s recent Military Update, the DoD is proposing to merge the three options into a single fee-for-service insurance option, similar to the current Standard option.
The proposed changes to TRICARE would not affect active-duty service members access to free healthcare, but their dependents and working-age military retirees would face higher costs to include a share of medical expenses and perhaps a new annual enrollment fee, set initially at $285 for individuals and $569 for families.
Beneficiaries could see lower costs if they use military treatment facilities or “preferred” care providers who offer military discounts. However, the plans include charging retirees a new co-pays for using on-base treatment facilities. New co-pays also would be set for military families and retirees who use emergency rooms inappropriately for routine care.
Philpott reports that TRICARE Prime would likely end as defense health officials continue to argue that Prime is too costly to operate for the military.
According to Philpott, beneficiaries 65 and older would continue to have access to TRICARE for Life, but, they would face a new enrollment fee. It might be set at one percent of military retired pay but capped so as not to exceed $300 a year.
On the upside, many believe that most of the DoD’s proposed benefit cuts are not likely to get passed Congress. The question is, which ones will? Stay tuned as more details will be available March 4 when the budget is formally rolled-out.
Additionally, other cuts in compensation are planned:
COMMISSARY CUTS -- The prized commissary system, which offers deep discounts on groceries, would see taxpayer support slashed from $1.4 billion annually to $400 million. This would occur over three years and lower average shopper discounts from 30 percent down to 10 percent compared to commercial grocers. The military would continue to subsidize commissaries overseas and at remote U.S. bases.
The intent, said Hagel, is not to close any stores. But resale industry experts say closings are inevitable once stateside stores can't offer enough savings to keep patrons from using commercial discounters off base. "We are not closing commissaries," agreed one Defense official. "They will be forced to close on their own."
Exchanges, or base department stores, are self-sustaining. But they too could be jeopardized if they lose patrons because their top priority for shopping on base is discounted groceries. If exchanges profits fall, so too will funds for base morale, welfare and recreation programs, critics contend.
Populations hardest hit would be young military families and older retirees and survivors who prize store discounts as deferred compensation for years of service when pay and allowances were relatively low.
Defense Secretary Hagel should understand that the benefit of commissaries stateside is not just to have stores on base, said Joyce Wessel Raezer, executive director of the National Military Family Association. "The 30 percent savings is the benefit. If savings go down to 10 percent, that benefit is gone," Raezer said.
HOUSING ALLOWANCES -- Service members living off base stateside would see Basic Allowance for Housing (BAH) level off for a few years. The plan is not to cut payments but to cap yearly adjustments until members must pay five percent of monthly rent and utility costs using other income.
In the late 1990s, BAH rates covered only 82 percent of average rental costs off base. When war broke out, Congress gradually closed that allowance gap. Today BAH fully covers average rent, utilities and renter's insurance. Defense officials now call that coverage "unsustainable."
Hagel and military chiefs want to cap the allowance until average BAH covers 95 percent of rent and utilities. BAH also no longer would be set to cover renter's insurance, saving perhaps $200 a year per recipient.
The proposed 2015 DoD budget could kill TRICARE Prime and increase out-of-pocket medical expenses for dependents and retirees.
Much of the first reports on the proposed 2015 defense budget didn’t necessarily focus on the details or specific areas to be cut. Many of details won’t be available until March 4th. However, there are some details available on one of the most significant benefits areas to be hit – TRICARE.
TRICARE, originally named for its three levels of health care coverage (Prime, Extra, and Standard), has been providing affordable healthcare coverage for military dependents and retirees for nearly 20 years. But, according to columnist Ton Philpott’s recent Military Update, the DoD is proposing to merge the three options into a single fee-for-service insurance option, similar to the current Standard option.
The proposed changes to TRICARE would not affect active-duty service members access to free healthcare, but their dependents and working-age military retirees would face higher costs to include a share of medical expenses and perhaps a new annual enrollment fee, set initially at $285 for individuals and $569 for families.
Beneficiaries could see lower costs if they use military treatment facilities or “preferred” care providers who offer military discounts. However, the plans include charging retirees a new co-pays for using on-base treatment facilities. New co-pays also would be set for military families and retirees who use emergency rooms inappropriately for routine care.
Philpott reports that TRICARE Prime would likely end as defense health officials continue to argue that Prime is too costly to operate for the military.
According to Philpott, beneficiaries 65 and older would continue to have access to TRICARE for Life, but, they would face a new enrollment fee. It might be set at one percent of military retired pay but capped so as not to exceed $300 a year.
On the upside, many believe that most of the DoD’s proposed benefit cuts are not likely to get passed Congress. The question is, which ones will? Stay tuned as more details will be available March 4 when the budget is formally rolled-out.
Additionally, other cuts in compensation are planned:
COMMISSARY CUTS -- The prized commissary system, which offers deep discounts on groceries, would see taxpayer support slashed from $1.4 billion annually to $400 million. This would occur over three years and lower average shopper discounts from 30 percent down to 10 percent compared to commercial grocers. The military would continue to subsidize commissaries overseas and at remote U.S. bases.
The intent, said Hagel, is not to close any stores. But resale industry experts say closings are inevitable once stateside stores can't offer enough savings to keep patrons from using commercial discounters off base. "We are not closing commissaries," agreed one Defense official. "They will be forced to close on their own."
Exchanges, or base department stores, are self-sustaining. But they too could be jeopardized if they lose patrons because their top priority for shopping on base is discounted groceries. If exchanges profits fall, so too will funds for base morale, welfare and recreation programs, critics contend.
Populations hardest hit would be young military families and older retirees and survivors who prize store discounts as deferred compensation for years of service when pay and allowances were relatively low.
Defense Secretary Hagel should understand that the benefit of commissaries stateside is not just to have stores on base, said Joyce Wessel Raezer, executive director of the National Military Family Association. "The 30 percent savings is the benefit. If savings go down to 10 percent, that benefit is gone," Raezer said.
HOUSING ALLOWANCES -- Service members living off base stateside would see Basic Allowance for Housing (BAH) level off for a few years. The plan is not to cut payments but to cap yearly adjustments until members must pay five percent of monthly rent and utility costs using other income.
In the late 1990s, BAH rates covered only 82 percent of average rental costs off base. When war broke out, Congress gradually closed that allowance gap. Today BAH fully covers average rent, utilities and renter's insurance. Defense officials now call that coverage "unsustainable."
Hagel and military chiefs want to cap the allowance until average BAH covers 95 percent of rent and utilities. BAH also no longer would be set to cover renter's insurance, saving perhaps $200 a year per recipient.
Wednesday, February 29, 2012
Possible Big Changes to TRICARE
From the article Trashing Tricare
The Obama administration’s proposed defense budget calls for military families and retirees to pay sharply more for their healthcare, while leaving unionized civilian defense workers’ benefits untouched. The proposal is causing a major rift within the Pentagon, according to U.S. officials. Several congressional aides suggested the move is designed to increase the enrollment in Obamacare’s state-run insurance exchanges.
The disparity in treatment between civilian and uniformed personnel is causing a backlash within the military that could undermine recruitment and retention.
The proposed increases in health care payments by service members, which must be approved by Congress, are part of the Pentagon’s $487 billion cut in spending. It seeks to save $1.8 billion from the Tricare medical system in the fiscal 2013 budget, and $12.9 billion by 2017.
Many in Congress are opposing the proposed changes, which would require the passage of new legislation before being put in place.
“We shouldn’t ask our military to pay our bills when we aren’t willing to impose a similar hardship on the rest of the population,” Rep. Howard “Buck” McKeon, chairman of the House Armed Services Committee and a Republican from California, said in a statement to the Washington Free Beacon. “We can’t keep asking those who have given so much to give that much more.”
Administration officials told Congress that one goal of the increased fees is to force military retirees to reduce their involvement in Tricare and eventually opt out of the program in favor of alternatives established by the 2010 Patient Protection and Affordable Care Act, aka Obamacare.
“When they talked to us, they did mention the option of healthcare exchanges under Obamacare. So it’s in their mind,” said a congressional aide involved in the issue.
Military personnel from several of the armed services voiced their opposition to a means-tested tier system for Tricare, prompting Chairman of the Joint Chiefs of Staff Gen. Martin Dempsey to issue a statement Feb. 21.
Dempsey said the military is making tough choices in cutting defense spending. In addition to the $487 billion over 10 years, the Pentagon is facing automatic cuts that could push the total reductions to $1 trillion.
“I want those of you who serve and who have served to know that we’ve heard your concerns, in particular your concern about the tiered enrollment fee structure for Tricare in retirement,” Dempsey said. “You have our commitment that we will continue to review our health care system to make it as responsive, as affordable, and as equitable as possible.”
Under the new plan, the Pentagon would get the bulk of its savings by targeting under-65 and Medicare-eligible military retirees through a tiered increase in annual Tricare premiums that will be based on yearly retirement pay.
Significantly, the plan calls for increases between 30 percent to 78 percent in Tricare annual premiums for the first year. After that, the plan will impose five-year increases ranging from 94 percent to 345 percent—more than 3 times current levels.
According to congressional assessments, a retired Army colonel with a family currently paying $460 a year for health care will pay $2,048.
The new plan hits active duty personnel by increasing co-payments for pharmaceuticals and eliminating incentives for using generic drugs.
The changes are worrying some in the Pentagon who fear it will severely impact efforts to recruit and maintain a high-quality all-volunteer military force. Such benefits have been a key tool for recruiting qualified people and keeping them in uniform.
“Would you stay with a car insurance company that raised your premiums by 345 percent in five years? Probably not,” said the congressional aide. “Would anybody accept their taxes being raised 345 percent in five years? Probably not.”
A second congressional aide said the administration’s approach to the cuts shows a double standard that hurts the military.
“We all recognize that we are in a time of austerity,” this aide said. “But defense has made up to this point 50 percent of deficit reduction cuts that we agreed to, but is only 20 percent of the budget.”
The administration is asking troops to get by without the equipment and force levels needed for global missions. “And now they are going to them again and asking them to pay more for their health care when you’ve held the civilian workforce at DoD and across the federal government virtually harmless in all of these cuts. And it just doesn’t seem fair,” the second aide said.
Spokesmen for the Defense Department and the Joint Chiefs of Staff did not respond to requests for comment on the Tricare increases.
The massive increases beginning next year appear timed to avoid upsetting military voters in a presidential election year, critics of the plan say.
Additionally, the critics said leaving civilian workers’ benefits unchanged while hitting the military reflect the administration’s effort to court labor unions, as government unions are the only segment of organized labor that has increased in recent years.
As part of the increased healthcare costs, the Pentagon also will impose an annual fee for a program called Tricare for Life, a new program that all military retirees automatically must join at age 65. Currently, to enroll in Tricare for Life, retirees pay the equivalent of a monthly Medicare premium.
Under the proposed Pentagon plan, retirees will be hit with an additional annual enrollment fee on top of the monthly premium.
Congressional aides said that despite unanimous support among the military chiefs for the current healthcare changes, some senior officials in the Pentagon are opposing the reforms, in particular the tiered system of healthcare.
“It doesn’t matter what the benefit is, whether it’s commissary, PX, or healthcare, or whatever … under the rationale that if you raise your hand and sign up to serve, you earn a base set of benefits, and it should have nothing to do with your rank when you served, and how much you’re making when you retire,” the first aide said.
Military service organizations are opposing the healthcare changes and say the Pentagon is “means-testing” benefits for service personnel as if they were a social program, and not something earned with 20 or more years of military service.
Retired Navy Capt. Kathryn M. Beasley, of the Military Officers Association of America, said the Military Coalition, 32 military service and veterans groups with an estimated 5 million members, is fighting the proposed healthcare increases, specifically the use of mean-testing for cost increases.
“We think it’s absolutely wrong,” Beasley told the Free Beacon. “This is a breach of faith” for both the active duty and retiree communities.
Congressional hearings are set for next month.
The Veterans of Foreign Wars on Feb. 23 called on all military personnel and the veterans’ community to block the healthcare increases.
“There is no military personnel issue more sacrosanct than pay and benefits,” said Richard L. DeNoyer, head of the 2 million-member VFW. “Any proposal that negatively impacts any quality of life program must be defeated, and that’s why the VFW is asking everyone to join the fight and send a united voice to Congress.”
Senior Air Force leaders are expected to be asked about the health care cost increases during a House Armed Services Committee hearing scheduled for Tuesday.
Congress must pass all the proposed changes into law, as last year’s defense authorization bill preemptively limited how much the Pentagon could increase some Tricare fees, while other fees already were limited in law.
Tricare for Life, Tricare Prime, and Tricare Standard increases must be approved, as well as some of the pharmacy fee increases, congressional aides said.
Current law limits Tricare fee increases to cost of living increases in retirement pay.
The Obama administration’s proposed defense budget calls for military families and retirees to pay sharply more for their healthcare, while leaving unionized civilian defense workers’ benefits untouched. The proposal is causing a major rift within the Pentagon, according to U.S. officials. Several congressional aides suggested the move is designed to increase the enrollment in Obamacare’s state-run insurance exchanges.
The disparity in treatment between civilian and uniformed personnel is causing a backlash within the military that could undermine recruitment and retention.
The proposed increases in health care payments by service members, which must be approved by Congress, are part of the Pentagon’s $487 billion cut in spending. It seeks to save $1.8 billion from the Tricare medical system in the fiscal 2013 budget, and $12.9 billion by 2017.
Many in Congress are opposing the proposed changes, which would require the passage of new legislation before being put in place.
“We shouldn’t ask our military to pay our bills when we aren’t willing to impose a similar hardship on the rest of the population,” Rep. Howard “Buck” McKeon, chairman of the House Armed Services Committee and a Republican from California, said in a statement to the Washington Free Beacon. “We can’t keep asking those who have given so much to give that much more.”
Administration officials told Congress that one goal of the increased fees is to force military retirees to reduce their involvement in Tricare and eventually opt out of the program in favor of alternatives established by the 2010 Patient Protection and Affordable Care Act, aka Obamacare.
“When they talked to us, they did mention the option of healthcare exchanges under Obamacare. So it’s in their mind,” said a congressional aide involved in the issue.
Military personnel from several of the armed services voiced their opposition to a means-tested tier system for Tricare, prompting Chairman of the Joint Chiefs of Staff Gen. Martin Dempsey to issue a statement Feb. 21.
Dempsey said the military is making tough choices in cutting defense spending. In addition to the $487 billion over 10 years, the Pentagon is facing automatic cuts that could push the total reductions to $1 trillion.
“I want those of you who serve and who have served to know that we’ve heard your concerns, in particular your concern about the tiered enrollment fee structure for Tricare in retirement,” Dempsey said. “You have our commitment that we will continue to review our health care system to make it as responsive, as affordable, and as equitable as possible.”
Under the new plan, the Pentagon would get the bulk of its savings by targeting under-65 and Medicare-eligible military retirees through a tiered increase in annual Tricare premiums that will be based on yearly retirement pay.
Significantly, the plan calls for increases between 30 percent to 78 percent in Tricare annual premiums for the first year. After that, the plan will impose five-year increases ranging from 94 percent to 345 percent—more than 3 times current levels.
According to congressional assessments, a retired Army colonel with a family currently paying $460 a year for health care will pay $2,048.
The new plan hits active duty personnel by increasing co-payments for pharmaceuticals and eliminating incentives for using generic drugs.
The changes are worrying some in the Pentagon who fear it will severely impact efforts to recruit and maintain a high-quality all-volunteer military force. Such benefits have been a key tool for recruiting qualified people and keeping them in uniform.
“Would you stay with a car insurance company that raised your premiums by 345 percent in five years? Probably not,” said the congressional aide. “Would anybody accept their taxes being raised 345 percent in five years? Probably not.”
A second congressional aide said the administration’s approach to the cuts shows a double standard that hurts the military.
“We all recognize that we are in a time of austerity,” this aide said. “But defense has made up to this point 50 percent of deficit reduction cuts that we agreed to, but is only 20 percent of the budget.”
The administration is asking troops to get by without the equipment and force levels needed for global missions. “And now they are going to them again and asking them to pay more for their health care when you’ve held the civilian workforce at DoD and across the federal government virtually harmless in all of these cuts. And it just doesn’t seem fair,” the second aide said.
Spokesmen for the Defense Department and the Joint Chiefs of Staff did not respond to requests for comment on the Tricare increases.
The massive increases beginning next year appear timed to avoid upsetting military voters in a presidential election year, critics of the plan say.
Additionally, the critics said leaving civilian workers’ benefits unchanged while hitting the military reflect the administration’s effort to court labor unions, as government unions are the only segment of organized labor that has increased in recent years.
As part of the increased healthcare costs, the Pentagon also will impose an annual fee for a program called Tricare for Life, a new program that all military retirees automatically must join at age 65. Currently, to enroll in Tricare for Life, retirees pay the equivalent of a monthly Medicare premium.
Under the proposed Pentagon plan, retirees will be hit with an additional annual enrollment fee on top of the monthly premium.
Congressional aides said that despite unanimous support among the military chiefs for the current healthcare changes, some senior officials in the Pentagon are opposing the reforms, in particular the tiered system of healthcare.
“It doesn’t matter what the benefit is, whether it’s commissary, PX, or healthcare, or whatever … under the rationale that if you raise your hand and sign up to serve, you earn a base set of benefits, and it should have nothing to do with your rank when you served, and how much you’re making when you retire,” the first aide said.
Military service organizations are opposing the healthcare changes and say the Pentagon is “means-testing” benefits for service personnel as if they were a social program, and not something earned with 20 or more years of military service.
Retired Navy Capt. Kathryn M. Beasley, of the Military Officers Association of America, said the Military Coalition, 32 military service and veterans groups with an estimated 5 million members, is fighting the proposed healthcare increases, specifically the use of mean-testing for cost increases.
“We think it’s absolutely wrong,” Beasley told the Free Beacon. “This is a breach of faith” for both the active duty and retiree communities.
Congressional hearings are set for next month.
The Veterans of Foreign Wars on Feb. 23 called on all military personnel and the veterans’ community to block the healthcare increases.
“There is no military personnel issue more sacrosanct than pay and benefits,” said Richard L. DeNoyer, head of the 2 million-member VFW. “Any proposal that negatively impacts any quality of life program must be defeated, and that’s why the VFW is asking everyone to join the fight and send a united voice to Congress.”
Senior Air Force leaders are expected to be asked about the health care cost increases during a House Armed Services Committee hearing scheduled for Tuesday.
Congress must pass all the proposed changes into law, as last year’s defense authorization bill preemptively limited how much the Pentagon could increase some Tricare fees, while other fees already were limited in law.
Tricare for Life, Tricare Prime, and Tricare Standard increases must be approved, as well as some of the pharmacy fee increases, congressional aides said.
Current law limits Tricare fee increases to cost of living increases in retirement pay.
Saturday, December 18, 2010
Association of the U.S. Army (AUSA) Legislative Update
MEDICARE/TRICARE CUT AVERTED
For one year, AUSA has been fighting to get Congress to pass a long-term fix to the scheduled cut to rates paid to physicians who treat seniors and the military. We scored a partial victory when Congress cleared a measure that will provide a one-year extension of Medicare/TRICARE physician rates. The legislation freezes current payment rates until Dec. 31, 2011, averting a 25 percent cut that was scheduled to take effect on Jan. 1.
The bill would be fully paid for by a change in the health care reform law. A provision in the law provides tax credits to help individuals and families afford insurance on state-run insurance exchanges when they take effect in 2014. If a tax credit recipient misstates income, or if it changes over the course of the year, he or she has to pay back part of the subsidy — up to $250 for an individual or $400 for families. The “doc fix” bill passed week replaces that flat repayment with a sliding-scale structure, requiring smaller repayments at lower incomes and dramatically increasing the maximum amount for high earners.
AUSA and its partners in The Military Coalition will work closely with the 112th Congress to develop a long-term solution to this perennial Medicare/TRICARE problem that affects seniors and the military population.
"DON ' T ASK, DON ' T TELL" SINKS DEFENSE BILL
The controversial “Don’t Ask, Don’t Tell” provision included in the fiscal 2011 defense authorization bill caused the bill to go down in flames in the Senate last week.
The Senate voted 57-40 in favor of cloture, three votes short of the 60 votes needed to advance the bill.
After the vote, Armed Services Committee Chairman Sen. Carl Levin, D-Mich., expressed hope that the defense bill could be passed and become law. He and House Armed Services Committee Chairman Rep. Ike Skelton, D-Mo., are expected to meet soon to discuss the next move.
Levin also said he believes it is "vitally important to our national security to pass a defense authorization act. I will continue to explore paths that could lead to that goal, though given the limited amount of time left in this Congress, that may be too high a mountain to climb."
While the long-term continuing resolution passed by the House last week guards against some of the worst effects of having no authorization bill, Congress must still find a way to get the bill passed. There is no way a continuing resolution could contain all of the critical authorities needed for our military and their families.
We are still holding out hope that some form of the defense bill will be passed. It is expected that the 111th Congress will adjourn at the end this week. Therefore, it is critical that you add your voice to ours. Go to the AUSA website, www.ausa.org, click on “Legislative Agenda’” then click on “Contact Congress”, and type in your zip code beside “Elected Officials”. Send your members the AUSA-suggested letter “Pass the FY 2011 Defense Authorization Bill Now!”
HOUSE PLAYS WAITING GAME
Last week, the House passed a $1.09 trillion fiscal 2011 spending bill that would keep the federal government’s fiscal 2011 discretionary funding at the same level that was provided for fiscal 2010, but would shift billions of dollars in funds.
House appropriators used the stalled fiscal 2010 Military Construction-VA spending bill which had previously passed in the Senate, as the vehicle for the long-term continuing resolution, a move that could save time in moving the measure through parliamentary steps in both chambers.
The measure would provide $513 billion for the Department of Defense and $75.2 billion for military construction and veterans. It also includes $159 billion for war operations in Afghanistan and Iraq . The measure carries no earmarks and would freeze federal pay, except for that of military personnel, for two years.
The bill includes provisions that would fund a 1.4 percent military pay raise. It also includes additional funding for basic allowance for housing and subsistence; additional funds for the defense health program to address cost increases; and funding to upgrade schools on DoD bases that are owned and operated by local education authorities.
The bill now moves to the Senate. Appropriations Committee Chairman Sen. Daniel Inouye, D-Hawaii, wants to replace it with a fiscal 2011 omnibus package that would include the text of all 12 annual spending bills.
It is far from certain that the Senate can pass an omnibus and it is unlikely that they will pass the House’s continuing resolution without making any changes.
Note to Congress: The 11th hour is almost up!
For one year, AUSA has been fighting to get Congress to pass a long-term fix to the scheduled cut to rates paid to physicians who treat seniors and the military. We scored a partial victory when Congress cleared a measure that will provide a one-year extension of Medicare/TRICARE physician rates. The legislation freezes current payment rates until Dec. 31, 2011, averting a 25 percent cut that was scheduled to take effect on Jan. 1.
The bill would be fully paid for by a change in the health care reform law. A provision in the law provides tax credits to help individuals and families afford insurance on state-run insurance exchanges when they take effect in 2014. If a tax credit recipient misstates income, or if it changes over the course of the year, he or she has to pay back part of the subsidy — up to $250 for an individual or $400 for families. The “doc fix” bill passed week replaces that flat repayment with a sliding-scale structure, requiring smaller repayments at lower incomes and dramatically increasing the maximum amount for high earners.
AUSA and its partners in The Military Coalition will work closely with the 112th Congress to develop a long-term solution to this perennial Medicare/TRICARE problem that affects seniors and the military population.
"DON ' T ASK, DON ' T TELL" SINKS DEFENSE BILL
The controversial “Don’t Ask, Don’t Tell” provision included in the fiscal 2011 defense authorization bill caused the bill to go down in flames in the Senate last week.
The Senate voted 57-40 in favor of cloture, three votes short of the 60 votes needed to advance the bill.
After the vote, Armed Services Committee Chairman Sen. Carl Levin, D-Mich., expressed hope that the defense bill could be passed and become law. He and House Armed Services Committee Chairman Rep. Ike Skelton, D-Mo., are expected to meet soon to discuss the next move.
Levin also said he believes it is "vitally important to our national security to pass a defense authorization act. I will continue to explore paths that could lead to that goal, though given the limited amount of time left in this Congress, that may be too high a mountain to climb."
While the long-term continuing resolution passed by the House last week guards against some of the worst effects of having no authorization bill, Congress must still find a way to get the bill passed. There is no way a continuing resolution could contain all of the critical authorities needed for our military and their families.
We are still holding out hope that some form of the defense bill will be passed. It is expected that the 111th Congress will adjourn at the end this week. Therefore, it is critical that you add your voice to ours. Go to the AUSA website, www.ausa.org, click on “Legislative Agenda’” then click on “Contact Congress”, and type in your zip code beside “Elected Officials”. Send your members the AUSA-suggested letter “Pass the FY 2011 Defense Authorization Bill Now!”
HOUSE PLAYS WAITING GAME
Last week, the House passed a $1.09 trillion fiscal 2011 spending bill that would keep the federal government’s fiscal 2011 discretionary funding at the same level that was provided for fiscal 2010, but would shift billions of dollars in funds.
House appropriators used the stalled fiscal 2010 Military Construction-VA spending bill which had previously passed in the Senate, as the vehicle for the long-term continuing resolution, a move that could save time in moving the measure through parliamentary steps in both chambers.
The measure would provide $513 billion for the Department of Defense and $75.2 billion for military construction and veterans. It also includes $159 billion for war operations in Afghanistan and Iraq . The measure carries no earmarks and would freeze federal pay, except for that of military personnel, for two years.
The bill includes provisions that would fund a 1.4 percent military pay raise. It also includes additional funding for basic allowance for housing and subsistence; additional funds for the defense health program to address cost increases; and funding to upgrade schools on DoD bases that are owned and operated by local education authorities.
The bill now moves to the Senate. Appropriations Committee Chairman Sen. Daniel Inouye, D-Hawaii, wants to replace it with a fiscal 2011 omnibus package that would include the text of all 12 annual spending bills.
It is far from certain that the Senate can pass an omnibus and it is unlikely that they will pass the House’s continuing resolution without making any changes.
Note to Congress: The 11th hour is almost up!
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