February 15, 2008
| Military Widows Win Right to Pursue Damages. Survivors suing the federal government to end the VA benefits deduction from their Survivor Benefit Plan annuities got good news this week when a federal judge denied the government's motion to dismiss their suit. |
| Civilian Rx Plans Would Beat TRICARE's. According to a respected survey of private benefit plans, the proposed TRICARE pharmacy plan would charge military beneficiaries more than most civilians pay. |
| Budget Hits Medicare Beneficiaries' Wallets. The FY2009 budget for Medicare proposes significantly higher Part B premiums for many beneficiaries and lower payments for physicians. |
| Life after Walter Reed. One year after The Washington Post reported the debacle at Walter Reed Army Medical Center, the Senate Armed Services Committee held a hearing on progress made in caring for our nation's wounded. |
| Berkeley Council Retreats Under Fire. The city council of Berkeley, California, which earlier this month told Marine recruiters they were "unwelcome intruders" in their town, changed their tune this week rescinding a letter that admonished recruiting efforts there. |
Military Widows Win Right to Pursue Damages
The US Court of Federal Claims has ruled in favor of three Survivor Benefit Plan (SBP) annuitants who are suing the federal government (Sharp v. The United States) to restore their full SBP annuities and avoid any deduction of the VA's Dependency and Indemnity Compensation (DIC). On February 11, Judge George W. Miller denied the Pentagon's motion to dismiss the suit and decided to let the case proceed. As a practical matter, he went a big step further, systematically refuting every argument in the Pentagon's motion.
At issue is a 2004 law (PL 108-183) that restored DIC payments to veterans' surviving spouses who remarry after their 57th birthday. Before the law change, survivors lost DIC regardless of the age they remarried. The plaintiffs in the case contend that a provision of the law should be interpreted as prohibiting the deduction of DIC from their SBP annuities. A DoD legal review of that provision at the time determined that it did not repeal the SBP offset provision. The judge's ruling on the motion made it pretty clear that he leans toward agreeing with the widows.
But the battle is far from over. DoD has until February 26 to appeal the judge's ruling or proceed with the case. And no matter the final outcome, it will likely be appealed. We should note that this case addresses only the three survivors pursuing the suit. It's not a class action case, and it's not certain whether a favorable decision would affect any other survivors.
MOAA commends and strongly supports these determined survivors for their tenacity in seeking equitable relief. We'll be following this case closely and will keep you posted on any further updates.
Civilian Rx Plans Would Beat TRICARE's
Raising military pharmacy copays by 100% to 400%, as recommended in the FY2009 Defense budget proposal would put military pharmacy benefits among the lower half of civilian plans, according to the HayGroup 2007 Benefits Prevalence Report.
For generic drugs purchased in retail pharmacies, the defense budget proposes raising the beneficiary copay from $3 to $15. According to HayGroup, 83% of civilian employer plans charge less than that for generic drugs, with almost 20% charging $5 or less.
For brand-name drugs in retail stores, the Pentagon proposes raising the TRICARE copay from $9 to $25. The HayGroup survey indicates that almost half of civilian employers (45%) charge less than that.
For brand-name, non-formulary medications, the TRICARE copay would rise from $22 to $45 -- more than 68% of civilian plans charge. This chart shows the percentage of civilian retail pharmacy plans that offer lower copays for medications. It distinguishes between the current copay structure and the DoD proposal for FY09.
In fact, many civilian plans are reducing or eliminating copays for generic drugs and medications used to treat chronic diseases like diabetes, because studies have found that higher copays actually deter many patients from taking medications that reduce the need for much higher-cost procedures later in life.
For one data point, MOAA's own employee plan (BlueCross BlueShield) offers our employees retail medications for copays of $10 (generic), $20 (brand) and $35 (non-formulary brand) -- lower across the board than proposed for military beneficiaries. The TRICARE copays also would exceed those offered under many plans available to legislators and federal civilians.
Most telling of all, Wal-Mart offers over 360 medications at a copayment of only $4 to anyone who walks in the door.
Perhaps the purpose of the Pentagon-proposed fee hikes is to push more beneficiaries to use Wal-Mart rather than their TRICARE benefit.
That would certainly save the Defense Department money. But it wouldn't make military people feel very good about their military health coverage.
MOAA believes military beneficiaries' extraordinary service and sacrifice have earned them the best health coverage in America, and that it's an insult to propose shifting them to second-tier pharmacy coverage.
Budget Hits Medicare Beneficiaries' Wallets
The Administration's FY2009 budget would deal heavy blows to Medicare and many older beneficiaries.
Physician reimbursement cuts of almost 10% originally planned for January will go into effect in July unless Congress acts to reverse them, and the budget envisions further cuts in January 2009.
The new budget would repeal annual inflation adjustments to the income levels used to means-test Part B premiums. If enacted, that would push more and more people each year into paying significantly higher Part B premiums. This year, the higher premiums apply to single seniors with incomes over $82,000 ($164,000 for a married couple) as opposed to $80,000/$160,000 last year.
Additionally the budget proposes freezing payment levels through FY2011 for inpatient care, skilled nursing facilities, hospice care, and ambulance services, and a freeze through FY2013 for home health agencies.
Once again, we'll need your help in convincing Congress to overturn these cuts. Go to MOAA's Web Site to send your legislators a MOAA-suggested message and urge them to avoid the July 2008 cut in Medicare/TRICARE payments to physicians.
Life after Walter Reed
At a Feb. 12 hearing, the Senate Armed Services Committee heard testimony from Defense and VA officials on improvements made for wounded warriors and their families.
"I think the term 'seamless' transition is more an oxymoron and we may just be better off calling the process 'nearly seamless' as a more achievable goal," said Sen. Ben Nelson (D-NE). His comments pretty much summed up the state of affairs between the two departments in transforming their systems.
The Defense, Army, and VA witnesses reported significant progress on seamless transition and strengthening relationships and lines of communication between DoD and the VA. But on a more basic and pressing issue, a transferable electronic medical record, an interoperable system solution is still many years away.
MOAA agrees that DoD/VA leaders have dramatically improved their working relationship, with significant improvements in leadership involvement, case management, and commitment of resources. But MOAA remains concerned about sustaining that momentum into the next administration as leaders change and competition heats up for funding.
Chairman Carl Levin's (D-MI) asked DoD and VA officials to provide a legislative proposal for the establishment of a joint transition office. MOAA strongly agrees that a joint, permanent office is necessary to ensure continued progress between the two agencies. We need an institutional, jointly manned structure to provide stability and continuity for the longer-term, rather than relying on the part-time involvement of the DoD-VA Joint Executive Council (JEC) whose department leaders will come and go and relative focus will wax and wane.
All attendees agreed on the need for further clarification of disability evaluation guidelines, as well as more traumatic brain injury and Post Traumatic Stress Disorder care, treatment and research, and family support. Defense witnesses also were troubled over higher suicides rates over the last five years in the Army, including accidental deaths in wounded warrior transition units.
Berkeley Council Retreats Under Fire
The Berkeley, Calif. city council, newly informed that the rest of the country has grown beyond the 1960s, has canceled its planned attack on the U.S. Marine Corps. But they're not signing any peace agreement.
The council made headlines across America two weeks ago by voting (6 to 3) to direct the city clerk to send the Marines a letter calling them "uninvited and unwelcome intruders" for establishing a recruiting office in the city. They also approved a parking permit to let a group called "Code Pink" park in front of the Marines' office one day a week to disrupt recruiting efforts with marches and noise.
That touched off multiple rounds of incoming fire from outraged citizens, editorial writers, business leaders, and members of Congress -- who threatened legislation withdrawing appropriations earmarked for companies and public projects in the Berkeley area. That prompted a worried University of California, Berkeley chancellor to write the area's congressional delegation, indicating the university's disagreement with the city council and strong support for its ROTC program and military people in general.
The furor culminated this week in marches and countermarches of pro- and anti-Marine protestors, before the city council voted (7 to 2) to withdraw the letter.
"We embarrassed our city," said one council member.
But a separate motion to apologize to the Marines was defeated.
The Marines remain optimistic that they can find a few good men and women, even in Berkeley.
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