Research - Rehabilitation - Re-Employment

Sgt. Shaft 07/26/99

Dear Sgt. Shaft:
A lot has happened since I last wrote to you about the status of health care for uniformed service retirees.

The good news is that the test which allows Medicare-eligible uniformed service retirees to enroll in DoD's health care program called, Tricare Senior Prime, is progressing well. This "Medicare subvention" initiative is being tested at 10 sites around the country to determine who might enroll, the costs to DoD, the savings for Medicare, etc. Instead of a three year test, ending December 31, 2002, we hope to have the program up and running nationwide by October 1, 2000. The rationale is compelling - Tricare Senior Prime, as a permanent program, will be a win-win-win situation for the retirees, Medicare and the Department of Defense.

Congressman Joel Hefley (R-CO), who championed the test in 1997, introduced a bill expanding TRICARE Senior Prime to 10 additional sites by January 2001 and across the country where feasible by October 2002. Senator Phil Grammm (R-TX) introduced a similar bill on April 29th.

Another demonstration program important to older retirees is the FEHBP-65 test allowing Medicare-eligible uniformed service retirees to enroll in the Federal Employee Health Benefits Program. The three-year test commences January 2000 and will be tested at eight sites around the country. Despite some temporary procedural roadblocks, the implementation seems to be on track. Again, we hope to have accurate cost and participation data to enable expansion of the program worldwide within three years.

For those not yet Medicare-eligible, we're working to ensure that the military's Tricare program operates efficiently and effectively. Claims processing needs revamping so payments to providers are timely and accurate. Although DoD has begun the process, we have pressed Congress to include provisions in the FY 2000 National Defense Authorization Act to require more TRICARE claims be electronically-processed (presently only 15 percent of the health care claims are processed electronically) insuring greater claims accuracy and faster payments. Efficient and timely payments will encourage civilian providers to participate in TRICARE, making access to care better for beneficiaries.

The bad news is that the pharmacy benefit is not progressing the way we had hoped. Congress directed DoD to redesign the TRICARE Pharmacy Benefit using "best commercial practices" to make it uniform and equitable for all beneficiaries and submit their plan by March 31, 1999. Congress believed that potential efficiencies would result in savings that would allow both retail and mail order pharmacy benefits to be extended to all Medicare-eligible retirees. However, when the report was submitted on April 30th, the Defense Department concluded that the savings would not be sufficient to allow expansion of the benefit. A solution is critical to older retirees because many who live near a military treatment facility (MTF) are finding that many of the drugs they need are not carried on the pharmacy's formulary and have to buy them paying the full cost themselves. Retirees who live outside the catchment area of an MTF have it worse being forced to buy all their drugs out-of pocket. Costs ranging from $300 to $1,000 a month are not uncommon and frequently result in some retirees having to choose food and housing over their medications.

Extending the TRICARE pharmacy benefit (retail and mail order) is the most reasonable solution but according to DoD it would cost $267 million per year to provide the National Mail Order Pharmacy (NMOP) program and another $133 million per year to provide the TRICARE retail pharmacy benefit. DoD has told Congress they do not have the $400 million to provide the benefit and is looking to Congress to find the money. We're concerned that the Department of Defense has no plan to fix this problem, so we are pressing Congress and DoD to find a solution that is equitable for all retirees regardless of where they live.

Michael A. Nelson
President
The Retired Officers Association
Alexandria, VA

Dear General Nelson:
Thank you for updating me and my readers on the issue of improving health care coverage for military retirees.

Recently, I received a frantic call from a military enlisted retiree. He stated that he had spent over 20 years in the service with three tours in Vietnam. He said he was suffering from terminal pancreatic cancer and the only health facility near his home was the Indianapolis VA Medical Center (VAMC).

Money woes made his plight more traumatic as he was being inundated with co-payment charges from the VAMC in Indianapolis. Although he was exposed to Agent Orange in Vietnam, pancreatic cancer, as yet, is not one of the presumptive service connected Agent Orange exposure diseases. And his 20 years of military service gave him limited access to VA medical care.

I contacted Hershel Gober, Veterans Affairs Under Secretary, and he used his good offices to have past and future co-payments waived for this terminally ill veteran.

When I told the retiree that he soon would soon be receiving a letter waiving his past and future co-payments, he broke down and cried with gratitude.

Military retirees should not have to jump through bureaucratic hoops, reach into their own pockets, and shed tears for access to VA health care. Cost sharing agreements must be entered into between the Department of Veterans Affairs and the Department of Defense so military retirees have free and easy access to VA medical care in addition to other health care programs you mention in your letter.

General, I also found your website www.troa.org very informative regarding retiree health care and legislative issues.

Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax to 301-622-3330; call 202-462-4430 or email sgtshaft@bavf.org.

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