MOAA Legislative Update: Clock Ticks on Medicare Fix

May 9, 2008

House Panel: No Health Fee Increases

Last week we reported that the Senate Armed Services Committee reported its version of the FY2009 Defense Authorization Bill. On May 7, the House Armed Services Military Personnel Subcommittee approved its own version. Full details were embargoed until the full Committee completes action next week, but MOAA learned the Subcommittee plan includes:

• Rejecting the large TRICARE fee increases recommended by the Pentagon
• A 3.9% military pay raise for 2009, vs. the 3.4% in the President’s budget
• Increase Navy and Air Force end strength by a combined 1,473 to prevent military to civilian conversions of medical positions
• A tuition assistance program to help active duty spouses develop portable careers
• A pilot program for a “career intermission” (sabbatical) for servicemembers to temporarily pursue other life achievements (e.g., to have a baby) before returning to service
• Army National Guard and Reserve manpower increases of 30,450 and 16,320, respectively
• Initiatives under TRICARE Prime and Standard to remove financial disincentives for beneficiaries to seek prevent care

Since the House and Senate Armed Services Committees have both rejected the Pentagon’s proposed health fee increases, beneficiaries hopefully will not see their health and pharmacy fees increase in the coming year.

However, MOAA thinks it’s imperative to put statutory guidelines in law on what military beneficiaries have earned and why with respect to health care, without which, health fees will continue to be subject to the annual threat of increases.

One concern is that the subcommittee indicated the preventive health care initiatives don’t include Medicare-eligibles, because the subcommittee could not identify budget offsets that congressional rules require when increasing benefits for that group. Subcommittee chair Susan Davis (D-CA) said House leaders hope to address that problem and include all beneficiaries in the final provision. MOAA pledges cooperation with that effort to ensure older beneficiaries aren’t disadvantaged. We’ll have to wait until next week to determine exactly what those disadvantages might be, since most Medicare-eligibles don’t incur any copays under TFL other than for medications.

We’ll provide details on this and more next week after the full Armed Services Committee approves and releases the specifics of the House bill.

Clock Ticks on Medicare Fix

Everyone in Congress wants to stop a 10.6% cut in Medicare and TRICARE payments to doctors that's scheduled to take place on July 1.

Medicare administrators don't want the cut to happen either, but they're worried about how to administer the program if Congress waits until the end of June -- or worse yet, until sometime in July or later -- to change the law.

This week, they told Congress that the law needs to be changed by June 16 in order to allow Medicare computers to be reprogrammed by July 1. If they don't get updated guidance by that date, Medicare will have to implement the cut on July 1 and undo all the erroneous payments later if and when Congress changes the law.

Is that doable? Yes, because the same thing happened a couple of years ago, when Congress had to make a retroactive payment fix. But it's a nightmare for Medicare (and TRICARE) administrators, and even more so for the doctors who have to suffer the income and book-keeping consequences. MOAA worries that such frustration may cause some doctors to stop seeing elderly and military beneficiaries.

Congressional leaders would love nothing better than to meet the June 16 deadline, but they're struggling to find ways to pay for the $15-$18 billion cost of the fix that a majority of legislators are willing to accept. Like it or not, that's turned into a political football, with Republicans and Democrats preferring different options. And many on the Hill seem in no mood to compromise in this election year.

To MOAA, it's unacceptable to hold TRICARE and Medicare-eligibles' access to care hostage to these kinds of political considerations. Congressional leaders need to work out a compromise -- and fast -- to stop that from happening.

You can help by visiting MOAA’s Web site to send a suggested message to urge your legislators to act fast.

War Funding 101 and the GI Bill

The details of congressional appropriations bills are enough to roll your eyes under the best of circumstances, but that goes double for the FY2008 emergency supplemental appropriations bill.

Let’s sort this out.

Every year, Congress approves a supplemental appropriations bill that provides “make-up money” for unforeseen needs or programs that cost more than Congress expected. In recent years, the Administration has chosen to fund the war through these supplemental appropriations bills, which Congress doesn’t like.

In addition, the supplemental appropriations bills have become a way to get around the “pay-as-you-go” (or PAYGO) rules that require Congress to pay for any increases in so-called “mandatory spending programs” (such as Medicare, Social Security, military and federal retired pay and survivor benefits, TFL, and the GI Bill) with offsetting reductions in other mandatory spending programs. The problem is that it’s hard to find such offsets because nobody wants to cut any of those programs or raise taxes (the other alternative).

But a loophole in the PAYGO rules exempts initiatives designated as “emergency” supplemental appropriations from the offset requirement. So that has generated new annual fights over what’s considered an “emergency”.

House leaders had hoped to take up this year’s emergency war supplemental bill this week, but that plan got derailed for a couple of reasons. First, the supplemental bill includes a package of restrictions on war policies that many object to.

Then, a group of conservative democrats objected to the House plan to designate a package of GI Bill improvements as emergency funding. The problem is that, as Congress has been reaching a political consensus on the need for a significant GI Bill upgrade (which MOAA strongly supports), the multi-billion-dollar cost of the plan makes it very difficult to come up with palatable offsets.

Consideration of the bill has been kicked to next week while congressional leaders try to work out a way ahead.

The reality is that the restrictions on the war policy almost certainly won’t win enough votes to stay in the bill.

But MOAA is very concerned about the badly-needed and long-overdue GI Bill improvements. We might have more sympathy for the PAYGO argument if Congress hadn’t already passed many hundreds of billions in other PAYGO-exempt “emergency” appropriations without blinking an eye - including the recent economic stimulus payments and loads of other spending in previous years.

If America can afford all those other waivers, year after year, America can afford to provide fair education benefits to the troops who have laid their lives on the line for their country, year after very long year.

VA Suicides – Not Just a Number

The House Veterans’ Affairs Committee held a lengthy hearing this week to grill VA leaders on alarming suicide rates among VA patients and get answers on what the VA is doing about them.

VA Secretary LTG James Peake (USA-Ret) and his top mental health official answered a barrage of questions about emails written by VA’s senior mental health doctor that brought into question the reliability of VA’s public statements on suicides among its veteran population.

Peake told the Committee that no single agency has accurate statistics on veteran suicides, but he is implementing ways to improve data collection and reduce suicide rates, including hiring suicide coordinators in VA facilities, establishing a suicide prevention call center, and pushing outreach and prevention efforts for veterans and their families.

A Government Accountability Office offered additional recommendations, including:

• ensuring more timely referral to care
• developing a comprehensive substance abuse program
• enhancing access to mental health care
• coordinating efforts between VA and non-VA health care providers
• fostering increased communication with veterans and their families

Peake assured the committee that his agency would be more forthcoming with information in the future and would work toward more transparency in the VA system.

AAFES Plans Community Malls

On April 30, MOAA deputy director of government relations, CDR Rene Campos (USN-Ret) attended a Retiree Advisory Council Meeting hosted by the Army and Air Force Exchange Service (AAFES) in Dallas.

AAFES plans to build Life Style Centers (outdoor community malls) at six locations: Fort Bliss and Fort Sam Houston, TX; Fort Lewis/McCord, WA; Fort Carson, CO; and Eglin AFB, FL. These malls will include theaters that will show new releases, well-known restaurants, play areas for children and families, shopping outlets, banking and medical services, and a variety of other features to enhance customers’ shopping experience.

Last year AAFES provided $269 million dollars to support facilities like golf courses, pools, auto shops, craft stores, child care centers, and many other military community services. AAFES was also named one of the top ten employers of military spouses in 2007, with over 24 percent of its workforce made up of military family members.

MOAA pledged to work with AAFES to sustain a strong exchange program that meets the needs of all beneficiaries.

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