Answers to Your Letters

Editor's note: Many thousands of MOAA members used the tear-out letters included with the February 2003 issue to urge the secretary of defense and the chairmen of the House and Senate Armed Services committees to make improvements to TRICARE. Responses from the House Armed Services Committee and the Department of Defense appear below.

More than 38,000 of you wrote us to express concerns about the TRICARE program and to recommend improvements. Here's what we are doing:

As you requested, Congress increased Medicare rates for providers. We will watch closely the impact of the increase on TRICARE provider participation, especially as the Department of Defense (DoD) begins implementing the next generation of TRICARE contracts.

Last year, testimony to the committee about the decreasing availability of providers and the reluctance of some to join or continue in TRICARE led us to direct the General Accounting Office (GAO) to examine the trends and issues in provider participation. We await the final report but have urged MOAA and other organizations to share results from their own surveys with GAO to assist the evaluation effort. With definitive data on provider participation trends, we'll be better able to prescribe broad remedies. However, we will continue to press DoD to address specific problem areas with provider adequacies.

Your letters focused on TRICARE Standard. As a result, we asked witnesses from MOAA and other organizations to testify on that and other TRICARE issues at a Total Force Subcommittee hearing March 27. Using that input and other information, we will work to make TRICARE Standard more effective.

With regard to your desire to enroll in the Federal Employees Health Benefit Program, we remain committed to making TRICARE work effectively for all DoD beneficiaries but will keep an open mind to alternative solutions should there be significant indicators that TRICARE is not meeting your needs.

We thank you for the effort to bring your concerns to us. As the letters we received demonstrate, MOAA is effective in conveying those concerns and helping to make important changes for all military personnel, active and retired, and their families.

Rep. Duncan Hunter (R-Calif.)
Chairman, Committee on Armed Services
Rep. John M. McHugh (R-N.Y.)
Chairman, Subcommittee on Total Force

Thank you for your recent letter to Secretary Donald Rumsfeld concerning TRICARE reimbursement rates, provider participation, and assistance to beneficiaries.

We agree that TRICARE reimbursement rates and the acceptance of those rates by civilian providers are central to the ongoing success of the TRICARE program. Payment levels have significant effects on the military health system's ability to implement the TRICARE health care benefit, ensure beneficiary access to the full spectrum of health care services, and perform in a cost-effective manner.

By law, since the early 1990s, TRICARE reimbursement rates have been linked to Medicare payment rates. Despite reductions in payment rates since that time, provider acceptance of TRICARE payment rates has increased nationwide from 86 percent in 1994 to 98 percent in 2002. The participation rate reflects the percentage of claims on which providers accept TRICARE maximum allowable charge as payment in full. Even though this high participation rate is reassuring, we realize that it does the individual beneficiar[ies] no good if their health care provider of choice refuses to see them. To maintain adequate numbers of health care providers, we must provide appropriate reimbursement and eliminate administrative hassles for providers.

Congress has recognized the need to address Medicare payment rates. In the FY 2003 Omnibus Appropriations Act, Congress agreed not only to maintain current payment levels but also to provide a 1.6 percent increase. This will avoid the scheduled March 2003 Medicare payment cut of 4.4 percent. TRICARE rates will similarly be adjusted upward 1.6 percent. In addition, when the linkage of TRICARE and Medicare rates was codified, Congress included authority for [the Department of Defense] to increase rates if necessary to protect access. [TRICARE Management Authority] has applied that authority in Alaska and recently approved a 15 percent increase in reimbursement rates for nine specialties in the Boise, Idaho, area. We will use this authority where necessary to assure adequate access to health care for our beneficiaries.

TRICARE Managed Care Support Contractors (MCSCS) must provide certain administrative services, including toll-free numbers for beneficiaries, whether they be TRICARE Prime or Standard, to call for information or assistance. Not only is a toll-free number established for those beneficiaries with questions about TRICARE Prime, but contractors also are required to provide toll-free access for TRICARE Standard beneficiaries needing assistance in locating a TRICARE participating provider in their area. If a provider cannot be found, the mcsc must contact local providers on behalf of the beneficiary to locate a provider willing to participate in TRICARE.

We view the degree of beneficiary satisfaction with TRICARE health services seriously and will continue our efforts to improve the TRICARE program to better meet the expectations of both beneficiaries and providers.

Rear Adm. Thomas F. Carrato, USPHS
Chief Operating Officer
TRICARE Management Activity

Weigh the Pros and Cons

Thank you for including ["Should the U.S. military increase its end strength to meet present and future operations and contingencies?"] in the March issue of Military Officer. ... As witnessed in Afghanistan and already in the opening week in Iraq, obviously high-precision bombing can't do the job alone, given unconventional use of civilians, dust storms, and terrain factors. So it won't be long before the answer to the question posed to [Frank J. Gaffney Jr] and [Loren] Thompson will be answered in real life rather than in theoretical debate.

While I thought Thompson was the more realistic given our national budget challenges, there was truth in both positions. Neither, however, seemed to fully address a critical factor in the end strength question -continued use of Reserve and National Guard forces. This is something that I anticipate will be a much greater challenge in the years ahead after the current lengthy deployment has its impact on recruitment and retention in those ranks. ...

I think it would be good [for MOAA] to begin to move toward developing an annual "military assessment" document - a posture statement spanning all the services. ... It should not merely echo speeches by the service chiefs or advocate more [of] this or that but provide a real service to the nation by handling the tough issues of competing demands as seen from the Office of the President.

That's what I appreciated most about Thompson's approach, though I felt Gaffney better appreciated what it really takes to win a war. Without this kind of analysis, we're left with no help in making the trades between, say, health care for the elderly (including old soldiers) and the strength needed for military operations to meet our global commitments.

Col. J. Randall Johnson, USAF-Ret.
via e-mail

It is obvious from [the Pro/Con] that Thompson does not have any idea about wear and tear on men and equipment. At the rate we are deploying our troops and equipment, nothing will last very long. Airplanes are flying much more than they were designed to do. Eventually this will show up in needed repairs and overhauls. After a while, even this won't work. The people flying and maintaining these aircraft start wearing out also. ... Without more men and equipment to replace what we are using now, our armed forces soon will be running on air. It is essential that Congress and this administration start looking at the long haul regarding this problem.

Lt. Col. David Napoli, USAF-Ret.
Kansas City, Mo.

Taking Action on SBP

We just received our March issue of Military Officer and want to thank you for making it so easy for us to contact our representatives! [The Survivor Benefit Plan] is very important to us. Thank you for continuing to be a great voice for our military members, active and retired!

Tina Fellin
via e-mail