Each month, a MOAA lobbyist will take an hour to answer live and previously e-mailed questions from members about our legislative issues. Please keep in mind that we may not be able to answer all the emails, but we will attempt to get through as many as possible. Our intent is to provide an additional avenue for a member to talk directly with MOAA's Government Relations lobbyists.
We will advertise this in our e-newsletters, but please feel free to pass this information along to fellow servicemembers. Our February chat featured our Health Care lobbyist, Cmdr. John Class, USN-Ret. The chat was held on February 15th below is the full transcript.
Don't forget to join us in March when our compensation expert Col. Mike Hayden, USAF-Ret., will answer more member questions. Please check back with us in early March for more information.
View January Chat
View March Chat
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Commander John Class joined MOAA in November 2004 as Deputy Director for Health Affairs. He is Co-Chair of the Military Coalition Healthcare Committee, Chairman of the TRICARE Pharmacy Beneficiary Advisory Panel, a member of the BRAC Working Group on Military Health Care and a member of various other committees of the Military Coalition.
Before joining MOAA his assignments included various Medical Administrative positions at Naval Medical Centers, Naval Hospitals and Clinics. John served as an Executive Assistant in the Healthcare Operations Division at the Bureau of Medicine and Surgery. After retiring in 2002, John served as a Senior Healthcare Analyst at the TRICARE Management Activity.
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Disclaimer: MOAA moderators retain editorial control over live online discussions and choose the most relevant questions to answer for members.
John Class: Thanks for joining me for the chat today. As you know the President released his budget last week which has cut the TRICARE budget by $1.8 Billion. Click here for a quick recap of the TRICARE portion and what it means to you.
Make sure to refresh your screen to see the most recent questions. Lets get started!
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(2:00pm) John E.: My firm pays me $500 per year since I opt out of their health insurance plan. I heard Congress wants to make the company payments to me illegal. Can you update us on where this plan stands in the current legislature?
John C.: John, last years Defense Authorization Act had a provision that gives the Defense Department authority to prohibit coverage when employers provide cash incentives to employees to use TRICARE, but it delayed the effective date until January 2008. the Armed Services Committees are aware of and concerned about potential fairness problems where the employer has a general policy that isn't just aimed at TRICARE-eligibles, so they tasked DoD for a report on how they would handle that situation. The report is due 1 April 07. But MOAA is leery about just relying on some defense policy that could be changed at any time. We want Congress to change the law this year to exempt situations like cafeteria plans or plans where the cash payment isn't just aimed at TRICARE folks.
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(2:04pm) Ed C.: Nothing fails to pass the common sense test more then asking retired officers to pay double or triple what the retired enlisted ranks must pay. What if anything is MOAA doing to address this terrible situation?
John C.: Ed, we think the fees DoD proposes charging the lowest grades is too high for any retiree. From our perspective, all retirees already prepaid very high premiums for their lifetime health care, and paid up-front through 20 or 30 years of service and sacrifice. Congressmen and the Secretary of Defense and the President don't pay higher premiums for their federal health insurance than any of their staff members.
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(2:08pm) Retsae M.: What are the new proposed changes in the TRICARE for Life Health Insurance for those officers over 65? I am 70 years old. Will the tripled proposed increase fees affect me as mentioned in the President's Defense Budget sent to Congress this week?
John C.: Retsae, under the current proposal, the only change that would affect beneficiaries over age 65 would be retail pharmacy copays, which DoD proposes to raise from $3 (generic) and $9 (brand name) to $5 and $15. We're concerned about the future, though, and think it's only a matter of time before someone starts proposing some kind of fee for TRICARE For Life coverage.
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(2:10pm) Joe W.: It is extremely difficult to find good doctors who will take Medicare/TRICARE patients. I think the same problem exists in other similar cities. When is DOD and H&HS going to face up to the problem and provide an increase to medical professionals?
John C.: Joe, TRICARE physician payment rates are based on Medicare rates, which are about 25% below what commercial insurance pays doctors. Everybody in government recognizes there's a flaw in the law that sets Medicare/TRICARE payments. For each of the last several years, MOAA has worked with the American Medical Association and others to stave off this formula's annual cuts to TRICARE/Medicare payment rates. We'll be pushing Congress hard this year to fix the law once and for all.
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(2:13pm) Lee A.: I am getting increasingly upset that we are going in an opposite directions from the "free medical care for life" that most retirees thought we had been promised. We need to remember that the courts didn't deny that we had been promised free medical care for life, just that the people making those promises didn't have the authority to do so.
John C.: You're right, Lee. We've fought for years to waive Medicare premiums for pre-1956 entrants -- and gotten nowhere fast, mainly because it would cost over 1 billion a year. Congress is really worried about about Medicare funding (it's in worse financial shape than Social Security). Both the Administration and Congress are way more focused on raising Part B premiums than cutting them. Since TRICARE For Life, Congress sees military retirees having the best health care deal of any seniors, and retirees love TFL. So Congress pretty much sees that problem as solved -- no matter what we think.
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(2:15pm) Brian I.: I am retired military with TRICARE Prime and have chronic lower back pain and sciatica caused by a service connected injury. Neither TRICARE nor the VA provides for chiropractic care. As a result, I tried a chiropractor on my own and have had significant success. However, the bi-weekly and weekly adjustments cost me $150-$250 a month out of my pocket.
John C.: Brian, thanks for bringing this matter up. We support making Chiropractic care a covered benefit under TRICARE. Thus far, no bills have been introduced this year to cover Chiropractic care under TRICARE. We think there will be, but it's still early.
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(2:18pm) Robert H.: It seems the military medical facilities (i.e. Malcolm Grow MC at Andrews AFB) are trying to discourage retirees under TRICARE from using their facilities by providing minimal service, not being forthcoming with information/answers to questions, and making it harder and harder to get appointments. If I ever really get sick, my only option nowadays is to go to the emergency room, unless I can wait a month or more. I am considering going back to the VA (which is probably also overwhelmed) or paying more for civilian health insurance as a federal employee.
John C.: Robert, one of our main goals has been and will continue to be maximizing the use of military treatment facilities (MTF). DoD needs to recapture the more expensive workload that is being pushed out into town. It doesn't make sense for MTFs to be turning away retirees when they have the infrastructure available. We have advised Congress of the negative consequences of this and we'll continue to push on that front so that retirees can continue to use MTFs.
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(2:20pm) Charlie F.: Why won't MOAA take more aggressive action to promote [Medicare] subvention?
John C.: We pushed very hard for subvention for years on end and had some steam when Medicare-eligible retirees had no military health coverage at all. We actually got Congress to approve a three-year test program. But all momentum disappeared when TFL was enacted. One big problem is that Medicare leaders and the congressional committees that oversee Medicare see subvention as raiding Medicare funds to pay for programs the Pentagon should be funding. We never give up hope, but it's been years since we've seen anyone on the Hill or in DoD display even a slight interest in subvention. As far as they're concerned, TFL solved the problem for military medicare-eligibles, and Medicare has other big problems that they have to focus on. They're trying to cut Medicare spending, not increase it.
Don't forget to refresh your screen!!
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(2:23pm) Scott R.: Will we ever get to a point that we will have Tri-Care Prime Remote for retirees? While on Active Duty here in Sioux Falls I am Tri-Care Prime Remote. What would be the difference from active duty to retiree?
John C.: Scott, TRICARE Prime Remote was established for Active Duty folks who were sent to locations where no military medical facility was available. For retirees, I believe the issue boils down to having TRICARE Prime available everywhere throughout the entire country. We have stressed that the healthcare benefit should be consistent throughout all the TRICARE regions. Currently, Prime is offered everywhere in the South Region. We believe this should be something considered in the next set of TRICARE contracts.
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(2:25pm) Charles C.: When I was commissioned and when I retired 27 years later, there was no mention of an enrollment fee for TRICARE Standard. I don't think DoD or Congress should impose TRICARE Standard fees on those already retired. If they want to do so on future retirees, then at least they will be forewarned and therefore able to prepare.
John C.: Charles, I couldn't agree with you more except I don't believe there should be any fee for TRICARE Standard. For those enrolled in TRICARE Prime they receive guaranteed timely access to providers in return for their fee. No guaranteed access - No fee. And by the way let's not change the rules on service members after DoD has extracted their service.
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(2:28pm) Mike P.: Based on current age demographics and an ever-increasing demand on a taxed healthcare system, what steps can Congress take now to ensure that those of us who are retired and not yet 60 years of age will have adequate healthcare through the VA in the future when we are entitled to it?
John C.: I'm assuming you are referring to authorizing non-disabled 'gray area' retirees to have access to the VA health care system. MOAA is not opposed to that objective, but the reality is that most 'gray area' retirees would be ineligible for VA health care anyway because of a 'means test' set in the law and, for a few gray area retirees, insufficient qualifying active duty service.
I think the first order of business would be to work towards a law-change to allow reservists who will draw reserve retired pay at age 60 to be allowed to enroll in TRICARE Reserve Select (TRS) before their 60th birthday. The thought process here is that drilling reservists can enroll in TRS now and in retirement at age 60 become entitled to TRICARE. That closes a potential gap in coverage when they are in the gray area.
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(2:30pm) Anitabud H.: Travis AFB no longer provides eye glasses and exams for Retirees over 65 years of age. (or perhaps 70) How can they draw the line with age???
Why is Dental care not an issue when Medical care is discussed? Was it not considered an earned right just as was medical care for life after 20 or more years?
John C.: Anita, the age is drawn at 65 because at that point retirees become eligible for TRICARE for Life. TFL works as a second payer to Medicare which is another benefit retirees have paid for. Our website has some great information on this at http://www.moaa.org/serv/serv_healthcare/index.htm . In regards to Dental coverage, there is a TRICARE Retiree Dental Plan that is run by Delta Dental. More information can be found on our website at http://www.moaa.org/serv/serv_healthcare/serv_healthcare_tricare/index.htm .
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Halfway don't forget to continue to email me your questions!
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(2:34pm) Bill M.: studies have shown that Medicare - for all its inherent shortcomings - operates more efficiently that any corporate HMO or managed care organization and I have often read that for all intents and purposes what Medicare covers, TRICARE covers. With this in mind, is there any agency or advocacy group giving consideration to merging TRICARE into Medicare and thus allowing Medicare to run TRICARE?
John C.: Bill, when TRICARE For Life was enacted, we actually talked about the possibility of having Medicare administer TFL. They weren't interested in taking on a military-unique system. In the end, I'm not sure turning military coverage over to Medicare would be a good idea because of all the inherently unique differences in the programs for military beneficiaries under the age of 65. I believe it's more advantageous to have one organization that is focused on military beneficiaries care.
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(2:37pm) Charles L.: recently turned 65 and my TRICARE went from prime to "for life". Why can't our benefits coordinate with VA for those who are retired. It seems like they are in different worlds. Can we work to get a seamless system? What about Meds and diagnostic procedures?
John C.: Charles, you are correct in saying they are two different worlds. The VA is a closed "brick and mortar" medical system while TRICARE is more of a health insurance program that relies heavily on civilian providers. However, there are many VA medical facilities that have agreed to be part of the TRICARE provider network.
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(2:39pm) Joe M.: TRICARE payments to health providers (doctors, hospitals, etc.) should be declared 'tax-exempted' by Congress. This could provide an incentive to all providers to keep costs down, while making them feel 'proud' for caring for our soldiers, retired servicemen/women and their families. Also, it may encourage DOD NOT to raise rates as they are now trying to do. What do you think? Has this been tried before?
John C.: Joe, this is a new one on me and it's never been attempted as far as I know. There are lots of people pushing tax breaks in Congress, but I'm not sure there are many interested in pushing to make doctors' income tax-free, if that's what you mean.
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(2:41pm) Scott H.: I am concerned with Congress's latest funding efforts which fall well short of funding San Antonio Military Medical Center (SAMMC). What can we do, and have we got a plan to lobby Congress to fund the critical upgrades for SAMMC?
John C.: Scott, we are very concerned about this also. Full funding of DoD Healthcare is one of our highest priorities. The president's Defense health budget for next year cut that budget almost $2 billion below documented needs, assuming beneficiary fees will be increased or other savings of that size will be found somewhere. We think it's not appropriate or responsible to underfund the budget that way. We will continue to work with Congress to get DoD the healthcare dollars they need in spite of a low balled budget request.
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(2:44pm) Bryan R.: I am going to see Congressman Frank A. Lobiondo (R) 2nd District New Jersey at his District office with a group of other veterans from other organizations in February. I am asking you "Do you have any questions that I should be asking him"?
John C.: Bryan, do you have a couple days with him? All kidding aside we have a couple issues that MOAA will be bringing to Congress that we could use some help with. The big things are to ask for his support in protecting military retirees from big TRICARE fee increases and improving the Survivor Benefit Plan (see our SBP brochure at http://www.nxtbook.com/nxtbooks/moaa/unduesacrifice/ .
Please ask the Congressman to cosponsor HR579 introduced by Rep. Chet Edwards and Rep Walter Jones, which would reserve to Congress (rather than the Secretary of Defense) the right to increase military health care fees.
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(2:46pm) Carl B.: Is there any chance we retirees may get dental coverage in the near future?
John C.: Carl, retirees are eligible for the TRICARE Retiree Dental Plan that is run by Delta Dental. Unfortunately, that program isn't subsidized by the defense department like coverage is for active duty families. We have tried to get DoD to pick up part of the cost but haven't gotten much Congressional interest so far. With all the other health budget woes, the chances for action on this don't seem bright, at least for the short term.
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(2:48pm) Joyce T.: Am I correct in saying that those using TRICARE Standard are not eligible for a Health Savings Account? If that is true, WHY?
John C.: Joyce, you're correct. HSA's are based on high deductible insurance plans. TRICARE Standard doesn't qualify as a high deductible plan because it only has a $150 or $300 yearly deductible for self and family coverage, respectively.
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(2:50pm) Michael S.: A medication that one of my physicians prescribes for me, that is administered once/4 weeks, is not available through the mail order pharmacy. If Congress approves that part of the budget proposed by the President which proposes to raise the cost share on Rx not available through the TRICARE mail-order pharmacy, that means my cost share for that med will rise from $9 to 25% of the cost of the med, correct? If so, the med becomes prohibitively expensive to me
John C.: Michael, I am assuming that you particular medication is a tier two or brand name drug since you indicate it costs you $9. The DoD proposal would raise your copay to $15. The 25% refers to third tier or non formulary drugs.
To find out what drugs are on the formulary you can go to the TRICARE page below.
http://www.tricareformularysearch.org/dod/medicationcenter/default.aspx
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(2:52pm) Ken T.: Is something being done to let those of us with OHI (other health insurance) have access to the TRICARE mail order pharmacy?
John C.: Ken, the short answer is not at this time. By law, TRICARE is second payer to any other health insurance a beneficiary has. That means TRICARE won't cover anything that your other health insurance would cover - including medications. If your other health insurance doesn't have pharmacy coverage, or doesn't cover the drug your doctor says you need, or if you have exhausted the pharmacy benefit under your other coverage, then you can use the TRICARE mail-order system for that drug. You'll have to provide documentation about your other insurance's lack of coverage.
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(2:54pm) Ken T.: Is something being done to let those of us with OHI (other health insurance) have access to the TRICARE mail order pharmacy?
John C.: Ken, the short answer is not at this time. By law, TRICARE is second payer to any other health insurance a beneficiary has. That means TRICARE won't cover anything that your other health insurance would cover - including medications. If your other health insurance doesn't have pharmacy coverage, or doesn't cover the drug your doctor says you need, or if you have exhausted the pharmacy benefit under your other coverage, then you can use the TRICARE mail-order system for that drug. You'll have to provide documentation about your other insurance's lack of coverage.
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(2:55pm) Ken N.: I am getting ready to retire and start drawing and will be using TRICARE. I was wanting some clarification of what fees you are referring to that DOD wants to triple for those of us under 65.
John C.: Ken, I am assuming you are a gray area reservist getting ready to turn 60. Once you turn 60 you become eligible for TRICARE, which includes TRICARE Standard and TRICARE Prime, until you turn 65 when you then become eligible for TRICARE for Life. The fees that DoD wants to triple are the enrollment fees for those who enroll in TRICARE Prime (the military HMO-style managed care plan). For an officer with a family, they would raise the annual fee from $460 to $1,400. For those in TRICARE Standard (a fee-for-service, insurance-style plan, DoD would raise the family deductible from $300 to $560 and establish a new $560 enrollment fee that doesn't exist now. Retail pharmacy copays would be increased by two-thirds.
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(2:57pm) Gerald: Why are the private insurance (sector) companies have so much control now, with the supplementary prices of medicine (formulas) drugs? Please let me know how much burden can be put on the tax payers! Thanks.
John C.: Gerald, I am assuming you are talking about the co payments you pay when you pickup your medicines. We have worked very hard to keep the TRICARE co payments low for prescription drugs while pushing DoD to maintain a broad range of drugs on the formulary. There are a few bills in Congress that will help protect against large increases in co pays. As a matter of fact, MOAA President spoke at a press conference this morning in support of a bill by Sen Lautenberg and Sen Hagel that would restrict copay increases. Check for the bill number in tomorrow's MOAA legislative update. In the House, Rep. Edwards and Rep Jones have introduced HR 579 that would freeze TRICARE pharmacy copays.
http://capwiz.com/moaa/issues/bills/?bill=9275676
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(2:59pm) Jon G.: I understand that the current $150/$300 deductibles for TRICARE Standard were established in 1995. Does MOAA have a position on what would be a "fair" adjustment in those deductibles, given that there has been some overall inflation since 1995.
John C.: We're not so naive as to think the deductible should never be increased. going forward, we think it's fair to say that retirees fees shouldn't be adjusted in any year by a percentage that's greater than the percentage increase in their retired pay. does that mean we'd be comfortable going back and doing a big "catch-up" hike for all COLAs since 1995? No. Too many people forget that there's more going on here than TRICARE fee increases. For most of the last 25 years, military people's pay raises were capped well below private sector pay growth. And that means that today's retirees under age 65 retired at pay rates that the government had chosen to depress by an average of 10%. An O-5 who retired with 20 years of service that same year in 1995 has been forced to give up 12.5% of his retired pay every year for the rest of his life. That amounts to more than $4,000 a year penalty for that O-5. So nobody's going to convince us that somehow he's beating the system because he hasn't had his $300 deductible raised another $100.
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(3:00pm) John C.: Thanks for joining me, please make sure to spread the word about the chat. Don't forget next month Col Mike Hayden will discuss compensation issues. Stay tuned to our Friday updates for more information.
John
