December 4, 2015
This week, MOAA President, Vice Adm. Norb Ryan, USN (Ret.), testified before the House Armed Services Personnel Subcommittee on what's working vs not working in military healthcare delivery, and what should be done about it.
MOAA was invited to testify and provide its perspective on recent TRICARE and military health reform proposals, including the Military Compensation and Retirement Modernization Commission's (MCRMC) to replace all forms of TRICARE with a commercial insurance plan much like federal civilians'.
Subcommittee Chairman Rep. Joe Heck (R-Nev.), an Army Reserve physician, said he is determined that, “This process is not being driven by budgetary concerns,” but by “how we can best maintain readiness and provide the best health benefit to the military community.”
Ryan told the panel that the first goal should be to do no harm. Rather than tossing out the whole current system, Congress should focus on preserving what's working and fixing what isn't.
He laid out several key principles, including:
- Means-testing (e.g., setting premiums based on income) is inappropriate for service-earned military health benefits;
- Readiness-driven costs (such as when doctors deploy and patients get shifted to more costly civilian care) should not be passed to beneficiaries
- The military health benefit should be the “gold standard” rather than being made more like civilian plans through higher fees
Ryan debunked the oft-quoted myth that DoD's health care costs are “spiraling out of control”, noting that DoD projections of future rising costs have been consistently wrong. In fact, he said, “Military health costs have remained flat or have been declining for the past five years.” He showed Subcommittees a chart to demonstrate that fact.
Among things that are working well, he cited combat casualty care; the overall quality of health care, once it's delivered; TRICARE For Life; pharmacy programs, and TRICARE Standard, for the most part.
Key problem areas he cited included:
- TRICARE Prime's appointment and specialty care referral processes
- Inconsistent Guard and Reserve TRICARE coverage
- Provider capacity management in Military Treatment Facilities
- The inefficiencies of building DoD healthcare delivery around three separate military service programs,
- Inadequate case-management of the highest-cost or at-risk healthcare users, and
- Pediatric coverage.
MOAA's recent survey of more than 30,000 beneficiaries found that those who used TRICARE For Life are most satisfied. Among currently serving families and working-age retirees, TRICARE Standard had a higher satisfaction rate and significantly lower dissatisfaction than those who used TRICARE Prime.
In closing, Ryan stated that, “The primary purpose of the military health system is readiness.” But he insisted that also includes meeting the needs of and keeping commitments to families and retirees. When a service person goes over the horizon, they want to trust that their family is taken care of, he said, and also trust that when they complete a service career, the promises made about their future care will be kept.
MOAA's written statement for the subcommittee listed 12 specific recommendations, including:
- Testing a unified budget/oversight authority in major locations with multiple service facilities
- Setting provider payments to reward quality care, not just patient visits
- Revamping the Guard and Reserve health care system to make it a better, more consistent, and more flexible benefit
- Creating more appointment capacity in military hospitals and clinics
- Ensuring DoD appointment access and timeliness standards are met
- Adopting more child-centered provider payment for pediatric care, and
- Fee-setting should include an explicit acknowledgement of the very large, pre-paid premium inherent in decades of service and sacrifice.
MOAA appreciates the invitation to represent our members' in front of Congress. We will continue to work to make improvements to the military health system.
Read the Testimony
Read the oral testimony presented by MOAA President, Vice Admiral Norbert R. Ryan, Jr., USN (Ret) to the House Armed Services Subcommittee on Military Personnel.