August 07, 2009
Visit Your Legislators in August During the month of August, most U.S. Senators and Representatives return to their home states and meet with constituents. This is a great opportunity for our members to visit their legislators’ local offices and urge their support for several key MOAA initiatives that will be up for consideration when Congress reconvenes in September.
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| President Vows to Protect TRICARE, VA. President Obama met with a group of military-oriented reporters this week to foot-stomp his intent that national health reform will protect military and VA beneficiaries’ health benefits. |
| What About Medicare and Tricare For Life? MOAA takes a look at how the various health reform bills might affect older beneficiaries. |
| New GI Bill Launched The VA mailed out the first checks this week for student veterans and active duty service members under the new Post-9/11 GI Bill. Active duty dependent spouses and children are eligible for college-cost reimbursement if their military sponsor transfers benefits to them in exchange for an extended service commitment. |
Visit Your Legislators in August
During the month of August, most U.S. Senators and Representatives return to their home states and meet with constituents. This is a great opportunity for our members to visit their legislators’ local offices and urge their support for several key MOAA initiatives that will be up for consideration when Congress reconvenes in September.
We have prepared
fact sheets and talking points on six key issues – four on provisions in the FY2010 Defense Authorization Bill, one on national health reform and the military, and one on MOAA’s need for a federal charter – to assist you in meetings with your legislators or their staffers.
President Vows to Protect TRICARE, VA.
We’ve reported in previous columns and blogs about assurances we’ve received from legislators and staffers of both parties that there’s no intent to affect TRICARE or VA beneficiaries’ benefits or taxes under ongoing national health reform initiatives.
President Obama called a small group of military-oriented reporters in for a White House interview this week to emphasize this point. Syndicated columnist Tom Philpott and the Stars and Stripes ran articles quoting the president as saying this effort will not diminish TRICARE or VA health benefits for service families or retirees.
“While his universal health care plan is still in flux, Obama is promising that none of the changes will affect Tricare or VA health services,” according to Stars and Stripes.
We’ve also said you can never say “never.” That’s why MOAA and The Military Coalition have sent letters to every member of Congress and why MOAA has generated more than 35,000 member messages to Congress through our Web site, urging legislators to ensure military and VA health coverage isn’t curtailed or taxed under any reform bill.
On the Hill, Reps. Joe Wilson (R-SC) and Steve Buyer (R-IN) secured amendments to bills in the House aimed at ensuring those protections.
To date, we haven’t found anyone on the Hill who isn’t supportive of protecting VA and TRICARE.
What About Medicare and Tricare For Life?
Now let’s take a look at how national health reform legislation would affect Medicare. That’s a big issue for military retirees and survivors age 65 and over, for whom TRICARE For Life is a Medicare supplement. It also has the potential to affect beneficiaries under age 65, since TRICARE payment rates are tied to Medicare’s.
First things first: Nobody can be certain what the effects will be at this point, because there are already four 1,000-page bills on the table and at least three more still to come.
Three House committees have passed separate versions, and House leaders are now negotiating behind closed doors how to combine those into one. One Senate committee has approved its own bill, and another is working behind closed doors to develop an alternative that could win some bipartisan votes. If and when that happens, Senate leaders will have to find some ground between the two that can win Senate approval.
And then House and Senate leaders will have to work out a further compromise that both the House and Senate can pass and that the President will be willing to sign.
So everything we may think we know now is subject to change tomorrow.
It’s also essential to keep in mind that Medicare is nearing an extremely serious fiscal sustainability problem. The coming wave of retiring baby boomers, plus the escalating cost of care, will dictate dramatic benefit cuts and/or tax increases in the not-too-distant future unless something else is done to ease the growing mismatch between benefits and funding. Since the population projection isn’t going to change, Congress must find ways to restrain spending growth in the least objectionable way, and that’s what every legislator is trying to do, in his or her own way.
Further, the statutory formula for setting Medicare (and TRICARE) payments to doctors is broken. Unless Congress passes some kind of fix, Medicare and TRICARE rates will be cut 21% this coming January – which would be a disaster, as many doctors would stop seeing elderly and military patients.
So what do we know – or think we know (that’s a lot of stuff to read and a lot of room for misunderstanding) – about the health reform bills?
They all would at least fix the doctor payment issue for 2010, and some would go beyond that – and that can only be good.
All would invest in primary care and wellness initiatives, raising payments up to 10% for primary care providers and eliminating copays for preventive care. The idea is to reduce long-term costs by encouraging preventive care and healthier lifestyles. Another good thing.
Let’s not forget the obvious: constraining cost growth also means constraining future growth in Part B premiums – another good thing, assuming the benefit cost constraints are appropriate.
They all would reduce or eliminate the extra 14% federal subsidy now provided for Medicare Advantage (HMO) programs. (You may recall that managed care programs originally were supposed to cost less, but the opposite proved true. Hill leaders believe alternative plans shouldn’t cost the government more per person than regular Medicare does.)
All would extend Medicare therapy cap protections for speech and physical therapy.
All would reduce payments to most hospitals (except rural hospitals), and the associations representing hospitals have agreed to accept the cuts – meaning it shouldn’t affect their willingness to accept military/Medicare patients.
All would establish “carrot and stick” incentives to encourage hospitals to use best practices and reduce preventable readmissions.
All contain language explicitly barring benefits for illegal aliens.
H.R.3200, the core bill in the House, also would:
- Move vaccines (e.g., shingles) from Part D to Part B, a big plus for TFL-eligibles
- Raise payments 5% for providers of psychiatric services to encourage them to see Medicare (and TRICARE) patients
- Allow a 12-month Part B enrollment period and waive late enrollment penalties for disabled military retirees under 65 – a major plus for wounded warriors
- Provide $100 million per year to combat claims fraud and abuse
- Constrain growth in durable medical equipment, home health and certain other ancillary care through “market basket updates,” “productivity adjustments” and other adjustments to payment formulas
The most fiscally austere bill is likely to come from the Senate Finance Committee, where Chairman Max Baucus (D-MT) is striving behind closed doors to reach a bipartisan agreement with fiscally conservative Republicans and Democrats.
Finance staffers have acknowledged that winning that agreement may end up entailing such things as higher copays on lab tests and further means-testing options (e.g., restricting annual inflation adjustments to Part B income thresholds so that more people end up in the higher Part B premium categories).
The Finance plan also calls for a commission to review Medicare spending in 2015-16, and, to the extent that it exceeds some inflation-adjusted baseline, propose a set of payment reductions to restore the funding balance. Under that concept, Congress would have a year to pass alternative legislation to achieve the same savings or let the commission-recommended cuts would go into effect.
Here’s MOAA’s bottom line:
- Congress is not going to “kill Medicare” or “kill TFL”
- Seniors are the most powerful voting bloc in America, and legislators aren’t going to flagrantly disregard their interests
- Many things in the health care reform legislation are positive for Medicare/TRICARE beneficiaries and seek reasonable cost constraints that minimize impact on beneficiaries
- There also are some things that cause justifiable concern, such as (a) the risk of putting significant power in the hands of a commission or set of administrators who would be empowered to take action that might or might not be draconian at some point in the future, (b) the potential for extending means-tested premiums ever-further down the income scale, and (c) using some Medicare savings to fund universal health care, but applying cost-constraint “hammers” (e.g., a future commission) only to Medicare
- There’s no denying that something has to be done to constrain Medicare cost growth, as the alternative (much higher taxes) won’t fly, and that will almost certainly necessitate some “lesser of the evils” choices
- There’s no free lunch, especially coming into a new decade in which the country faces massive economic challenges and rising deficits. If something isn’t done now, the task will only get tougher later
- Part of the challenge to understanding is that some in both parties and their supporters use rhetoric aimed more at scoring political points than providing factual perspectives
- MOAA will keep vigilant to protect members’ legitimate interests, and MOAA members need to respond with grassroots action when those interests come under attack
New GI Bill Launched
On August 3, MOAA President VADM Norb Ryan, Jr. (USN-Ret) joined President Obama, VA Secretary Shinseki, and a host of other officials to recognize and celebrate the first day payments were issued under the newly implemented Post-9/11 GI Bill.
An enormous amount of effort went into launching the Post-9/11 GI Bill in just over 12 months, and we commend the VA and DoD for going above and beyond to get the job done.
Currently serving active duty, Guard and Reserve members with at least 90 days of continuous active duty since Sept. 10, 2001 are eligible for the new program. Details and an application are available on the
VA website’s GI Bill homepage.
Currently serving active duty or Selected Reserve troops with at least 6 years’ service may transfer their benefits to family members in exchange for a 4-year reenlistment or service extension (there are some exceptions for retirement-eligible members). Servicemembers wishing to transfer benefits can use
DoD’s Transfer Education Benefits (TEB) portal.
Over 28,600 active duty sponsors already have applied to transfer benefits, and the VA has approved nearly 18,000 so far, with priority going to dependents enrolling in college this fall.
The VA has fixed one problem for California veterans attending private colleges. Students pay no tuition at California public colleges and universities. All costs are bundled under the state's "fee" structure. For veterans attending a public undergraduate college in California that's not a problem, since the VA covers the "fee" cost up to the highest-cost state public college. But veterans attending private colleges or graduate programs in public universities receive no reimbursement for their tuition under the state's "no-tuition" rule.
But a new California state budget item referring to "tuition/fees" has given the VA leeway to establish a more appropriate payment level for veterans in those situations. Other states like Massachusetts and Florida, where fees are extremely high and tuition is low, were not affected by the decision.
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