CITIZEN JOURNALISM: Tricare benefits

CITIZEN JOURNALISM:

President Obama and his party have endorsed legislation that would drastically cut the Tricare for Life benefits of retired and veteran service members. If it is approved by Congress in a vote next month, retired and veteran service members will be obliged to pay high deductibles and co-pays. Military treatment facilities currently do not charge eligible persons co-pays for medical services or pharmaceuticals.

The concept of providing medical care for families of active-duty members of the uniformed services dates back to the late 1700s. In 1884, Congress declared that “medical officers of the Army and contract surgeons shall whenever possible attend the families of the officers and soldiers free of charge.” There was very little change until World War II, when family members could not be treated. Most draftees in that war were young men who had wives of childbearing age; the extremely large number of babies being born caused a burden on the system. The Korean War again strained the capabilities of the military health care system, and it was not possible to provide free medical care for military families.

On Jan. 1, 1967, Congress passed legislation giving military retirees, their family members and qualified surviving family members of deceased military members free medical care. That promise was broken in the 1980s, when Congress revoked the legislation in order to cut the budget.

Tricare for Life was instituted by Congress in 2002 to reinstate the broken promise that military retirees would receive free health care coverage for life. It was introduced as a supplement to Medicare for military retirees and their family members who are eligible for Medicare. The program pays nearly all medical costs not covered by Medicare.

Now, however, the benefits of retired service members and veterans are in danger again. Tricare comprises three options: one similar to a health maintenance organization, called Tricare Prime; an option with a preferred-provider network, called Tricare Extra; and a traditional fee-for-service plan, called Tricare Standard. Military retirees who are not yet eligible for Medicare may enroll in Tricare Prime by paying an annual enrollment fee of $230 for individual coverage or $460 for family coverage.

In addition, those enrollees in Tricare Prime make a $12 co-payment for each outpatient visit to a civilian physician or other civilian health care provider; visits to military providers are free. Those who do not enroll in Tricare Prime may receive benefits under Tricare Extra or Standard. Beneficiaries who use either of those two plans must pay an annual deductible of $150 for individual coverage or $300 for family coverage. The Tricare enrollment fees, co-pays and deductibles have remained unchanged since 1995.

A Congressional Budge Office study states that “… if the savings that would accrue from reduced spending for Medicare were included, the introduction of cost sharing under this option would reduce the federal spending devoted to Tricare for Life beneficiaries by about $14 billion through 2014 and by about $40 billion through 2019. Approximately 22 percent of those savings would come from a reduced demand for medical services rather than from a transfer of spending from the government to military retirees and their families.

“An advantage of this option is that greater cost sharing would increase Tricare for Life beneficiaries’ awareness of the cost of health care and promote a corresponding restraint in their use of medical services. Research has generally shown that introducing modest cost sharing can substantially reduce medical expenditures without causing measurable increases in adverse health outcomes. Among its disadvantages, this option could discourage some patients, particularly low-income patients, from seeking preventive medical care or from managing their chronic conditions under close medical supervision, which might negatively affect their health.”

If this change is approved by Congress in September, the first curtailment of benefits would occur in 2011. Cost sharing would require retirees to pay the first $525 of medical costs and 50 percent of the next $4,725 for a first-year cost of at least $2,888 per person. The new charges would be indexed to increase with inflation.

The CBO report (which can be found at http://www.cbo.gov/doc.cfm?index= 99255) recommends eventually eliminating the Tricare for Life program because it is “too expensive.”

“People who are professionals always look for the channel of least resistance when it comes to cutting money out of the federal and DoD budget,” retired Air Force Brig. Gen. Bob Clements said in an interview. “I can tell you this straight on: Military retirees are one of those channels of least resistance noted for sitting around, doing nothing, and waiting for ole Joe to do it for them. You had better wake up. Your medical benefits are the prime target. If you lose them, you have nobody to blame but yourself.

“Let me repeat that … you have nobody to blame but yourself,” Gen. Clements said. “The way to secure your benefits is to write to your members of Congress and to keep writing and writing and writing. Once is not enough! Keep repeating the above statement until you are blue in the face.

“Health care will eventually become the dominating factor in your life. Remember that it will impact you big time with the utmost in cruelty unless you are fortunate enough to die from a heart attack or get run over by a truck. The service organizations will put up a fight, but they will need your help and can’t do it by themselves. I hope this makes it clear as to what you can expect if you do nothing,” Gen. Clements said regarding younger people who are not yet eligible for Tricare for Life and may be oblivious to the impact of the proposed legislation.

Mr. Obama’s plan also has strong advocates who tout its overall beneficial impact.

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