Senate and House Versions of NDAA Reveal Tricare Changes

When it comes to Tricare fees, there is good news and not so good news for Tricare beneficiaries.  For the Pentagon, the news is not even that good, because the Department of Defense, again, did not get its way.

As of Friday, May 25, both the House and the Senate rejected the DoD’s proposals that would establish enrollment fees for Tricare Standard and Tricare for Life in the National Defense Authorization Act for Fiscal Year 2013.  Further, the two chambers did not accept increases to Tricare deductibles or the annual catastrophic cap.

Continuing in a pattern set by Congress since 2006, the Pentagon has had its proposal to increase enrollment fees rejected. Seeing that increases to enrollment fees and deductibles would generate discretionary money, the House and Senate were not pressured to accept the Pentagon’s proposal. However, higher enrollment fees were part of President Obama’s proposed budget. Thus, the Pentagon is at risk of having a hole in its funding.

Beneficiaries will see increases in the pharmacy co-payments after October 2013.   Both the House and Senate versions of the NDAA include increases.  Since there are differences between the two chambers, the final amounts will not be determined until the NDAA goes to conference. Below is a summary of the proposed changes from both chambers:

	2012	2013	2013
	Current	House	Senate
Retail Pharmacy
Generic	$5	$5	$5
Brand	$12	$17	$26
Non-Formulary	$25	$44	N/A*
Home Delivery
Generic	$0	$0	$0
Brand	$9	$13	$26
Non-Formulary	$25	$43	$51

* the Pentagon would eliminate non-formulary drugs from retail, requiring beneficiaries to pay for these specialty prescriptions.

 

In the House version of the bill, pharmacy co-payments would be increased in Fiscal Year 2014 and beyond by the same rate as the retirement COLA increase.  The Senate bill recognizes that the Pentagon continues to have authority to increase prescription co-payments independently unless Congress directs otherwise.

Last September, the Obama administration suggested that the pharmacy co-payments plan would shift retail co-pays from a dollar amount to a percentage co-pay.  The administration claims that this shift would provide savings of $15.1 billion in mandatory funds and $5.5 billion in discretionary funds over 10 years said the president in a speech at the White House rose garden.  If Congress takes no action to alter Pentagon authority, this option could be proposed in the next presidential budget.

In 2005, the NDAA established a health plan to give Reservists access to Tricare for a monthly fee. However, as the health care comes with a monthly fee, many still choose to go to Veterans Affairs facilities that provide free care from specialists. These facilities are geographically centralized and as a result are often invonveniently located for many reservists spread disparately across communities. Further these facilities often encumber the patient with long, many times tedious clerical steps before receiving initial treatment. With total troop withdrawal from Iraq and the increased troop withdrawal from Afghanistan, these facilities are often overcrowded and do not give veterans the necessary time and attention they need. It is because of the challenges today’s Reservists face in obtaining affordable and efficient health care that  many of our nation’s heroes go with undiagnosed injuries or inadequate care. . In a study conducted by the Urban Institute and the Robert Wood Johnson Foundation, an estimated that one in 10 of the nation’s 12.5 million nonelderly veterans report either not having health insurance or using Veterans Affairs (VA) health care.[1]

It is essential that government  work to establish a sustainable, affordable and efficient veteran health care system.

ROA continues to advocate and testify on behalf of all Reservists and Guardsmen in the halls of the Capitol and the Pentagon. By June 1, ROA will have a letter posted at www.roa.org/write2congress so that members can write their elected officials on the topic of Tricare pharmacy co-payments. Further, members can always write to their elected officials about the various concerns on health care for today’s Reserve forces. Let it be known that today’s health care is not acceptable for tomorrow’s Reservist.

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[1] For a summary of the report, visit: http://www.rwjf.org/files/research/74428.quickstrike.veterans.exsummary.052412.pdf

For the full report, visit:

http://www.rwjf.org/files/research/74428.quickstrike.veterans.052412.pdf

ROA Discusses Transitional Challenges for Today’s Reservists

Over the past week, ROA addressed government leaders as well as military and veteran support organizations on the challenges Reservists face when transitioning back to the home front.

On Thursday, May 17, ROA was invited to attend a roundtable which was hosted by House Democratic leader Nancy Pelosi, who was joined by 15 other Democrat members of Congress.  Continuing a series of talks that have been held over the last seven years, ROA joined other associations in discussing issues affecting veterans. CAPT Marshall Hanson, ROA’s legislative director spoke about Guard and Reserve unemployment and healthcare, especially during transition from deployment back to the home front.

In the discussion, Hanson focused on the challenging  problem that Reservists and Guardsmen face upon returning home: unemployment. Arguing that members of the Reserve Components face discrimination from employers, Hanson highlighted that the unemployment for the Reserve and Guard remains at about ten percent higher than nonaffiliated veterans. “This is a result of stealth discrimination when employers avoid individuals who could be recalled to active duty.” Hanson contended “While the passage of the Vow to Hire Heroes Act was a good first step, further incentives need to be put in place to encourage employers to hire Reserve Component members, who while veterans, also remain on call with the military.”

In his statement, Hanson thanked ranking member Susan Davis (CA-D) formerly of the House Armed Services Military Personnel Subcommittee, commending her and the committee for including transitional health care for individual Selected Reservists who have to leave drilling status in the National Defense Authorization Act for FY 2013. If passed, the new coverage would provide six months of access to TRICARE Reserve Select for those who are eligible. However, the proposed new coverage would make a small victory in the grand scheme of seamless transitions for service members. “Unfortunately, the transition for injured and wounded Reserve and Guard members coming off of active duty is not going as smoothly,” Hanson said. “Many are being discharged before finishing their military health treatment.   This shifts the medical treatment cost burden from the Department of Defense to the Veterans Administration or TRICARE.  Savings in military pay and allowances are offset by higher health care costs and the potential disability compensation costs from a diminished quality of life as a result of deferred medical treatment.”

Further focusing on healthcare, especially in rural areas, ROA attended a roundtable discussion hosted by the White House on Veteran mental health treatment on Tuesday, May 22. Addressing the Chiefs of Staff from the White House, the First Lady’s office, and the Domestic Policy Council, CAPT Hanson joined other military and veteran support organizations in analyzing the problems veterans have in accessing mental health treatment. Hanson highlighted that only Tricare beneficiaries have access to telehealth and mental health counseling. Through working with Health Net and the Department of Veterans Affairs on Rural Mental Health Program, these beneficiaries can receive the aid they need. However, as discussed in previous posts (see Healthcare: A Catch-22 for Reservists), Tricare may not be the best solution for Reservists and Guardsmen.

As the total force structure will rely more on an operational Reserve force as the United States withdraws from Afghanistan, ROA believes that more efficient policies need to be established for Reservists in order to create an enduring Reserve force. Having to balance both military and civilian lives, these men and women make more sacrifices; it is only fitting that their nation gives back to them.

Healthcare: A Catch-22 for Reservists

In the early hours of Thursday morning, May 16, 2012, the House Armed Services Committee approved a $643 billion defense budget for FY 2013. Notable among the HASC approved amendments to the FY13 National Defense Authorization Act (NDAA), is broad rejection of changes to the current TRICARE fee schedule With deference to TRICARE’s 9.3 million beneficiaries, including 5.5 million military retirees, Chairman Howard P. “Buck” McKeon offered a different approach in amending the bill; one that ensures fiscal responsibility while protecting the benefits earned by those who risk their lives to defend the nation. While rejecting the majority of the President’s proposal concerning TRICARE, McKeon’s mark does include an increase to pharmacy copays in 2013, and a cap on pharmacy copays beginning in 2014. More importantly, for the Reserve service members, McKeon’s mark extends Tricare Reserve Select for 180 days for members of the Selected Reserves who are involuntarily separated from service.

The decision to avoid a substantial fee hike along with the 180 day extension for Tricare Reserve Select should be applauded as an appropriate step towards meeting the health care needs of today’s 21^st century Reservists. However, it is not the ultimate solution. Unlike previous conflicts, veterans of Iraq and Afghanistan represent less than one percent of the total U.S. population. More than 840,000 National Guard and Reserve troops have served in Afghanistan and Iraq during the past decade, many having been deployed multiple times. Upon returning home, these men and women represent a battle hardened force of combat veterans. Yet despite progress as a total force, the individual toll for each service member is undeniable.  Reservists have been hastily channeled through a post-deployment process that does not adequately identify or address the personal challenges these veterans face, including signature wounds like post-traumatic stress and traumatic brain injury. While their active-duty counter parts return to military bases with free, comprehensive medical care and support networks, Reservists return to their civilian homes, often far and away from their fellow veterans and the networks of support at the military base. Ultimately identification, diagnosis, and action fall into the hands of the Reservist and his or her family.

In 2005, the NDAA established a health plan to give Reservists access to Tricare for a monthly fee. However, as it comes with a monthly fee, many still choose to go to Veterans Affairs facilities that provide free care from specialists. These facilities, like their fellow veterans, are often far and away. Further, these facilities often encumber the patient with long, many times tedious clerical steps before receiving initial treatment. Finally, with the total troop withdrawal from Iraq and the increased troop withdrawal from Afghanistan, these facilities are often overcrowded and do not give veterans the necessary time and attention they need.  Between the Tricare fees and the VA facilities, Reservists face a Catch-22 when it comes to healthcare. Coming off deployments, often carrying untold burdens, these veteran Reservists many times opt to avoid seeking help and put their healthcare on the back burner.

This Catch-22 scenario has historically been passed to successive generations without a comprehensive solution. With over ten years of conflict and the vast number of Reserve and Guard troops slated to return from deployment in the coming years, now is the time for serious consideration and review from all levels of the government to ensure that these men and women receive the services they deserve after sacrificing so much for their country.

A Great Country Takes Care of Its Own

On Tuesday, May 8, Volunteers of America hosted After the Uniform: Serving the Veterans Who Served Us, a panel discussion which focused on the critical challenges facing today’s returning veterans. The event, was the latest program in part of a three-year conversation focused on highlighting the obstacles facing veterans, identifying solutions, and issuing concrete policy recommendations.  The panel focused on the transition process and the need for community involvement. Moderated by David Gregory of NBC’s Meet the Press,  panelists included Barbara Banaszynski , Volunteers of America Senior Vice President, Program Operations; Betty Moseley Brown, Associate Director, U.S. Department of Veteran’s Affairs Center for Women Veterans; General Barry McCaffrey, USA (Ret.), former Director of the White House Office of National Drug Control Policy, and current NBC News Analyst; and, Lee Woodruff, cofounder of The Bob Woodruff Foundation and wife of ABC News journalist and anchor, Bob Woodruff.

The panel discussed key differences between today’s service members compared to previous generations of veterans whose service experiences were driving forces behind the institutional framework of current veteran support services.  Unlike previous conflicts, veterans of Iraq and Afghanistan represent less than one percent of the total U.S. population. A smaller all volunteer force means today’s war-fighters face multiple deployments. While the strategic benefit is a battle hardened force of combat veterans, the personal toll on the service member is undeniable and ultimately unacceptable.  Transition back to the home front, especially for Reservists and Guardsmen,  has been chief among these untenable issues. Perhaps more than any preceding generation, Iraq and Afghanistan veterans are returning home to an uncertain future: an unstable economy, murky employment prospects, wavering public support and an imperfect science to diagnosing and treating signature combat wounds all await our heroes here at home. Emphasizing that these men and women make up less than one percent of the nation’s population, it is easy for them, as Lee Woodruff put it, “slip into the sunset.”

Absent a comprehensive nation-wide initiative to address these lingering inequities, many veterans must take matters into their own hands. However, after coming home from several deployments, many veterans do not want to deal with going through the process. They do not want to dial and wait for a voice on the other end of the 800 number. They do not want to do the tedious and lengthy paperwork. And, most importantly they cannot wait for the delay in getting assistance. The matters then fall into the family’s hands to go through the necessary steps to receive the attention and support. Even by following the prescribed motions, many family members face obstacles and closed doors, compounded by the logistics of third party support. 

Clearly, there is a need as Brown stated for a “seamless transition,” in which veterans receive the fastest, most thorough care. With deference to the scale and complexity of these challenges, panelists conceded: the VA cannot do it alone. Banaszynki urged corporations, non-profits, and individuals to step in and take the initiative to aid veterans. This aid can be as small as taking a military spouse out to lunch, to taking a few names of veterans who need assistance to veteran support organizations. It’s when there is a lack of assistance to veterans that they and the whole country fail. Best stated by Lee Woodruff: “What a great country does is take care if its own.”

How will you make this country great and take care of its own? What should ROA do to achieve a seamless transition for those who have sacrificed so much?

Senator Chambliss: Do Your Part to Best Shape the Reserves

On April 26, the Reserve Officers Association co-hosted the annual Senate Reserve Caucus Breakfast at its headquarters in Washington, DC. In attendance were distinguished officers from the Reserve Components, congressional staff, and executives from the military, veteran, and civilian support communities.

Senator Saxby Chambliss (R-GA) delivered remarks highlighting the integral and challenging role the Reserve Components have in our nation’s security. Offering figures from each branch, Senator Chambliss summarized that since 9/11, Reservists from all branches have conducted over 840,000 activations. Within a decade alone, over 55,000 reservists from all services have been mobilized, becoming more operational rather than a strategic force. [1] “With the increase in the mission and the operational tempo of the Reserve Components, there has also been an increase in physical, psychological, and financial impact on out citizen-soldiers, sailors, and airmen, and their families and an often overlooked financial toll on their respective employers back home.” 

Seeing that the Reserve Components will continue to be an integral part of national security and the nation’s response to key global hotspots, such as Afghanistan, Senator Chambliss insisted that “We owe it to [them] to fully train and equip them for their service to the nation.” Further, Chambliss addressed the unique challenge that Reservists face: balancing their civilian and military lives.  Identifying that unlike their active duty counterparts, Reservists and Guardsmen must maintain civilian careers in addition to reporting for duty and training. This balance is difficult for some, and while ideally it should be a smooth process, some service members face discrimination from employers as they are reluctant to hire Reservists with this pre-condition and the uncertainty of when their Reservist employee will be called for duty. To circumvent this and reach the ideal smooth process, Chambliss insisted “we present our citizen-soldiers with predictable routine deployments so that they, their employers, and their families are able to plan and coordinate for their absence from home.”  

Senator Chambliss looked to the future and the individual’s role in supporting the Reserve Components. “As we look ahead, we must ask ourselves: how should the Reserve Components be best shaped to meet the increasingly complex security and stability challenges presented to our country, and in response to our constrained fiscal resources?” Leaving this question open and for the individual, not just the Reserve Components, to ponder, Chambliss concluded “I challenge you to do your part to continue to transform the Reserve Components to best meet the increasingly complex threats of the 21^st Century.”

What do you think of Senator Chambliss remarks? Do you agree with his idea to present predictable deployments? What will you do to best shape the Reserve Components to meet the challenges of today and beyond?

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[1] There were approximately 16,000 reservists deployed in April 2002. In comparison, at the beginning of April 2012, there were 71,662 mobilized reservists across all branches of service.