Spurred by Gates, Congress May Consider Overhauling Military Health Care
By Josh Rogin, CQ Staff
For the first time in years, Congress and the Defense Department may be ready to reach a compromise on how to overhaul the military health care system, the fastest-growing portion of the defense budget.
The negotiations will play out during the formation of the fiscal 2010 defense authorization and appropriations bills and could include an updated fee structure for the more than 9 million users of the military’s Tricare system, as well as continued congressional overhaul efforts.
The Pentagon has long advocated for increases in Tricare fees and co-payments. But Congress has repeatedly rebuffed those politically unpopular initiatives. With military health care costs spiraling upward and placing increased pressure on other parts of the Pentagon’s budget, Defense Secretary Robert M. Gates is hoping to persuade Congress to look again at raising fees.
“Health care is eating the department alive,” Gates told an audience at Alabama’s Maxwell Air Force Base on April 15, adding that the department will spend $47 billion on health care in fiscal 2010. “Part of the problem is, we cannot get any relief from the Congress in terms of increasing either co-pays or the premiums.”
During each of the last three years of the Bush administration, the Pentagon tried to raise those fees and co-payments. It assumed huge budget savings — $1.2 billion in fiscal 2009 — but Congress rejected the payment increases and added the difference back into the defense budget each time.
This year, Gates plans to fund Tricare fully in the fiscal 2010 budget request and over the course of the budget cycle try to convince Congress of the need to raise fees and co-payments.
“Hit us over the head with a two-by-four three times, and we’re beginning to get the message,” Gates told reporters April 7. “We figure maybe we’ll have a better chance of having a serious dialogue with the Hill if we go ahead and fund it and then begin the conversation.”
Leading lawmakers seemed open to such an exchange.
“In previous years, the main source of savings in the department’s proposals have been from forcing a large number of beneficiaries out of Tricare, which we believe is fundamentally wrong,” said Susan A. Davis , D-Calif., the chairwoman of the House Armed Services Personnel Subcommittee. “Based on Secretary Gates’ budget proposal, it appears that the [Pentagon] finally understands this.”
Political Momentum
In Congress, bipartisan resistance to increasing Tricare fees and co-payments is based on a fundamentally different view of how to overhaul the system, as well as on the perennial popularity of increasing military benefits and pay.
“In time of war, it’s very hard for Congress to make decisions that would look as though they are not completely supportive of the troops,” said Cindy Williams, a principal research scientist of the Security Studies Program of the Massachusetts Institute of Technology.
Growing Fast: Click here to view chart
“Meanwhile, the costs just go up and up,” she added.
The fact that Tricare fees haven’t been raised since 1995 is partially responsible for a growing military health care budget that could total $64 billion by fiscal 2015, according to the Congressional Research Service. The Congressional Budget Office reported in December that raising fees and co-payments could save the Pentagon about $25 billion over the next decade.
But, CRS noted, the fee increases are “vehemently opposed by organizations representing servicemembers and military retirees who argue that giving medical care to retirees on favorable terms is appropriate given the unique hardships of a military career.”
There is a growing acknowledgment among lawmakers that some fee increases might be necessary, however, particularly for former career servicemembers who haven’t reached age 65, when they become eligible for permanent benefits.
The concern is that these retirees are using Tricare at levels that exceed the original design of the program. They often forgo alternative insurance options, such as private, corporate or state-sponsored health care, because Tricare fees are significantly lower than market rates.
Ben Nelson , D-Neb., the chairman of the Senate Armed Services Personnel Subcommittee, has said he might consider Tricare fee increases for working-age retirees. Matters such as Tricare funding “need to be considered in the context of the present economic climate and circumstances,” Nelson said.
Still, resistance to any increases will persist.
“I do not believe that raising the cost of health care on our military families through fee and co-payment increases is the correct course of action,” said Joe Wilson of South Carolina, the House subcommittee’s ranking Republican. “This would simply place the burden of reform onto the men and women who protect this nation and their families.”
Congress included several overhaul measures in the fiscal 2009 defense authorization act (PL 110-417), such as provisions to give Tricare users incentives to use more preventive services, better monitor their health and quit smoking.
These measures could control health care costs without culling the rolls of Tricare users, staff members said. In fact, there will be an effort to increase the level of benefits provided to the National Guard and reserves in light of their increased service roles.
Lawmakers hope a better working relationship with the Obama administration will allow more comprehensive changes to accompany any fee increases.
“You can’t play a health care cost shell game,” said one House Democratic aide. “You have to actually fix the system.”
First posted April 17, 2009 4:19 p.m.
Correction
Corrects 12th paragraph to say that the military health care budget could total $64 billion by fiscal 2015.
Question
allan
Subject: [VeteranIssues] Congress May Consider Overhauling Military Health Care
Date: May 27, 2009 3:20 PM
The fight isn’t over, tell DOD & congress..NO Fee Increases for TRICARE..
CQ TODAY PRINT EDITION – DEFENSE
Corrected May 5, 2009 – 5:34 p.m.
http://www.cqpolitics.com/wmspage.cfm?parm...ws-000003098130
Spurred by Gates, Congress May Consider Overhauling Military Health Care
By Josh Rogin, CQ Staff
For the first time in years, Congress and the Defense Department may be ready to reach a compromise on how to overhaul the military health care system, the fastest-growing portion of the defense budget.
The negotiations will play out during the formation of the fiscal 2010 defense authorization and appropriations bills and could include an updated fee structure for the more than 9 million users of the military’s Tricare system, as well as continued congressional overhaul efforts.
The Pentagon has long advocated for increases in Tricare fees and co-payments. But Congress has repeatedly rebuffed those politically unpopular initiatives. With military health care costs spiraling upward and placing increased pressure on other parts of the Pentagon’s budget, Defense Secretary Robert M. Gates is hoping to persuade Congress to look again at raising fees.
“Health care is eating the department alive,” Gates told an audience at Alabama’s Maxwell Air Force Base on April 15, adding that the department will spend $47 billion on health care in fiscal 2010. “Part of the problem is, we cannot get any relief from the Congress in terms of increasing either co-pays or the premiums.”
During each of the last three years of the Bush administration, the Pentagon tried to raise those fees and co-payments. It assumed huge budget savings — $1.2 billion in fiscal 2009 — but Congress rejected the payment increases and added the difference back into the defense budget each time.
This year, Gates plans to fund Tricare fully in the fiscal 2010 budget request and over the course of the budget cycle try to convince Congress of the need to raise fees and co-payments.
“Hit us over the head with a two-by-four three times, and we’re beginning to get the message,” Gates told reporters April 7. “We figure maybe we’ll have a better chance of having a serious dialogue with the Hill if we go ahead and fund it and then begin the conversation.”
Leading lawmakers seemed open to such an exchange.
“In previous years, the main source of savings in the department’s proposals have been from forcing a large number of beneficiaries out of Tricare, which we believe is fundamentally wrong,” said Susan A. Davis , D-Calif., the chairwoman of the House Armed Services Personnel Subcommittee. “Based on Secretary Gates’ budget proposal, it appears that the [Pentagon] finally understands this.”
Political Momentum
In Congress, bipartisan resistance to increasing Tricare fees and co-payments is based on a fundamentally different view of how to overhaul the system, as well as on the perennial popularity of increasing military benefits and pay.
“In time of war, it’s very hard for Congress to make decisions that would look as though they are not completely supportive of the troops,” said Cindy Williams, a principal research scientist of the Security Studies Program of the Massachusetts Institute of Technology.
Growing Fast: Click here to view chart
“Meanwhile, the costs just go up and up,” she added.
The fact that Tricare fees haven’t been raised since 1995 is partially responsible for a growing military health care budget that could total $64 billion by fiscal 2015, according to the Congressional Research Service. The Congressional Budget Office reported in December that raising fees and co-payments could save the Pentagon about $25 billion over the next decade.
But, CRS noted, the fee increases are “vehemently opposed by organizations representing servicemembers and military retirees who argue that giving medical care to retirees on favorable terms is appropriate given the unique hardships of a military career.”
There is a growing acknowledgment among lawmakers that some fee increases might be necessary, however, particularly for former career servicemembers who haven’t reached age 65, when they become eligible for permanent benefits.
The concern is that these retirees are using Tricare at levels that exceed the original design of the program. They often forgo alternative insurance options, such as private, corporate or state-sponsored health care, because Tricare fees are significantly lower than market rates.
Ben Nelson , D-Neb., the chairman of the Senate Armed Services Personnel Subcommittee, has said he might consider Tricare fee increases for working-age retirees. Matters such as Tricare funding “need to be considered in the context of the present economic climate and circumstances,” Nelson said.
Still, resistance to any increases will persist.
“I do not believe that raising the cost of health care on our military families through fee and co-payment increases is the correct course of action,” said Joe Wilson of South Carolina, the House subcommittee’s ranking Republican. “This would simply place the burden of reform onto the men and women who protect this nation and their families.”
Congress included several overhaul measures in the fiscal 2009 defense authorization act (PL 110-417), such as provisions to give Tricare users incentives to use more preventive services, better monitor their health and quit smoking.
These measures could control health care costs without culling the rolls of Tricare users, staff members said. In fact, there will be an effort to increase the level of benefits provided to the National Guard and reserves in light of their increased service roles.
Lawmakers hope a better working relationship with the Obama administration will allow more comprehensive changes to accompany any fee increases.
“You can’t play a health care cost shell game,” said one House Democratic aide. “You have to actually fix the system.”
First posted April 17, 2009 4:19 p.m.
Correction
Corrects 12th paragraph to say that the military health care budget could total $64 billion by fiscal 2015.
"Keep on, Keepin' on"
Dan Cedusky, Champaign IL "Colonel Dan"
See my web site at:
http://www.angelfire.com/il2/VeteranIssues/
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