If you think Medicare laws and changes affect only people who are older than 65 or disabled, you couldn’t be more wrong. Check out how one Medicare law poses a significant risk for you and your family.

There’s at least one Medicare issue — the process of setting Medicare payments to doctors — that could have a bigger impact on many active duty, Guard, Reserve, and younger retired military beneficiaries than it does on older Americans. That’s because TRICARE doctor payment rates are tied to Medicare’s (capped at Medicare’s, actually). And unless Congress acts to change the law, Medicare (and TRICARE) payment rates are scheduled to be cut by 4.4 percent in January 2006. The statutory rate-setting formula for doctors cuts payments when the economy founders. That’s crazy.

Payments to other providers — hospitals, nursing homes, HMOs, and home health care providers — all are tied to the cost of providing those services. Doctor payments should be, too, and Congress knows it. But it’s expensive to change the permanent law, so Congress ends up playing year-to-year fiscal “chicken” with the country’s doctors — and their elderly and military patients, too.

Medicare and TRICARE already are among the lowest-paying insurance programs in the country. If the 4.4-percent cut goes through, these programs would pay doctors less in 2006 than they did in 2001. A recent American Medical Association survey showed one-third of providers would cut back on seeing Medicare patients if that happened.

Provider participation is an even greater problem for TRICARE than for Medicare, because low payment rates are compounded by TRICARE-unique administrative requirements and lower patient volume.

The No. 1 health care problem for thousands of military beneficiaries is finding doctors who will accept them. That’s particularly true for Guard, Reserve, and retired families and survivors who live in areas where there isn’t a large military population.

When our servicemembers are sent in harm’s way, the last thing they should have to worry about is whether their families will be able to find a TRICARE doctor or whether their current doctor will stop seeing them.

As this column was being written, the Senate had proposed to reverse the cut and substitute a 1 percent payment increase, but no similar fix had been proposed in the House.

Congress simply must fix the Medicare payment-setting law.

It’s not just a matter of fairness to providers and our country’s senior population. It’s a real national security issue if TRICARE can’t provide access to quality care — one that will have long-term retention and readiness consequences.
 

Col. Steve Strobridge, USAF-Ret., director of MOAA government relations