With passage of the FY 2004 Defense Authorization Act, Congress opened TRICARE for the first time to 170,000 drilling reservists who are unemployed or have no employer-sponsored health plan.

But there is disagreement between defense policy-makers and reserve advocates over whether such an expansion of TRICARE benefits is long overdue or goes too far.

The change means Reserve and National Guard members will be able to buy into TRICARE with annual premiums that cover 28 percent of program costs. Early estimates are that the members’ cost share will be $420 for individuals or $1,440 for family coverage.

Dr. William Winkenwerder, assistant secretary of defense for Health Affairs, has a task force developing plans to open TRICARE to these nonmobilized reservists and to implement other reserve health care enhancements passed in the defense bill.

But Winkenwerder questions whether Congress is being too lax with defense dollars. He cites differences “in duty and in sacrifice’’ between nonmobilized reservists who attend weekend drills and active duty members. When mobilized, he says, reserve component members deserve active duty benefits. “That’s the way our program works now,’’ he says. But what Congress has approved is a benefit “comparable to an active duty person’s for someone who is not activated. It’s a concern.’’ 

Congress only had money to allow this and other reserve health care enhancements for one year but presumably will vote next year to make the changes permanent. In addition to TRICARE for uninsured drilling reservists, the law authorizes DoD to screen reservists upon call-up notification and provide immediate dental and medical care. Also, TRICARE coverage will kick in for all reservists and families up to 90 days before they mobilize, which means they no longer have to wait until they enter active duty.

Finally, transitional military health benefits will be available for 180 days after separation from active duty. The current limit is 60 to 120 days, depending on a member’s years of service.

Reserve force advocates in The Military Coalition, including Col. Bob Norton, USA-Ret., MOAA’s deputy director for Government Relations, disagree that this year’s bill goes too far. Not only should drilling forces be allowed to buy into TRICARE, he says, but for reservists who elect to maintain their civilian health insurance, the military should reimburse a portion of their health insurance costs when they are mobilized.

Winkenwerder says the enhancements will add hundreds of millions of dollars—perhaps even billions—to defense budgets. The actual cost will depend on how many drilling reservists, out of the 20 percent made eligible, will elect to enroll in TRICARE. Another cost factor will be the number of reservists mobilized year after year.

By opening TRICARE to uninsured reservists, Winkenwerder suggests, Congress takes a piecemeal approach to the nationwide issue of affordable health care. “It is certainly not an issue that DoD alone should seek to try to solve,’’ says Winkenwerder, “or that others should have DoD seek to try to solve. It’s a broader issue, I would argue.’’

Managing current TRICARE costs is challenging enough without adding new “sets of benefits,” says Winkenwerder.

DoD will look “very carefully’’ at whether the benefit for nonmobilized reservists is superior to what is provided to other beneficiary groups, says Winkenwerder. For example, drilling reservists will have the equivalent of TRICARE Prime Remote, except with premiums. Retirees under age 65 who live away from a base now must rely on TRICARE Standard with an annual deductible plus copayments of 25 percent of costs. “One has to be cognizant of those kind of comparative issues,’’ Winkenwerder says.

Norton says reserve health care enhancements are needed given the expanding role of reserve forces in America’s defense. Also, better medical benefits will ensure that more reservists are ready when mobilized.

Asked if his staff can set up TRICARE for the uninsured before it is set to expire as a demonstration, Winkenwerder says, “Only time will tell. Our goal is to expeditiously implement the benefit that has been outlined into law. That’s our obligation, and that’s our goal.”

Tom Philpott is a freelance writer and syndicated news columnist. His column, "Military Update," appears in 48 daily newspapers throughout the United States and overseas.