Congress has taken to heart — and looks to address — almost every argument DoD has made in recent months for sharply increasing TRICARE fees for under-age-65 military retirees and their families. What Congress isn’t persuaded to do this year, despite those arguments, is to increase TRICARE fees. That judgment, to the deep frustration of Defense officials, will be under review for at least another year.

For a time, the stars were aligned and the skids seemed plenty greased for TRICARE enrollment fees, deductibles, and copayments to double for enlisted retirees under age 65 — and to triple for officers — over the next two years. A Republican president was proposing the idea to fellow Republicans who controlled both the House and the Senate.

Key lawmakers, including Sen. Lindsey Graham (R-S.C.), the persuasive chairman of the Senate Armed Services Committee, told Defense officials publicly that they could count on their support.

Every member of the Joint Chiefs was on board, describing the planned increases as an overdue and necessary “re-norming” of beneficiary cost shares mistakenly ignored since they were set in 1995.

Then Capitol Hill began to hear from affected retirees — tens of thousands of them — through an avalanche of letters, telegrams, and e-mails. Members of Congress began to scrutinize Pentagon cost-saving claims tied to their initiatives. Progress in Iraq and Afghanistan seemed to stall, retired generals criticized how the Iraq war was planned and executed, and the president’s poll numbers fell far and stayed there.

With elections scheduled in November for every House seat and a third of the Senate, even the most loyal Republicans became worried that administration ideas such as higher TRICARE fees put their own survival at risk. Within the House and Senate Armed Services committees, attention shifted from increasing TRICARE fees to addressing the arguments made by Pentagon health officials for needing to increase those fees.

For example, rather than accept the contention that fees and deductibles are so low they endanger a robust benefit, the Armed Services committees have directed that their own auditors, at the Government Accountability Office (GAO) and the Congressional Budget Office (CBO), study the reasonableness of current and proposed TRICARE fees and confirm the cost savings projected by DoD.

For the Senate, a GAO study is enough. House members, however, want a task force. And who can blame them if, as Defense officials contend, the military health care system is sliding toward a fiscal crisis: Conduct a thorough review of the challenges, with no less than 14 task force members appointed by the secretary of defense, and develop the kind of detailed and thorough recommendations needed to sustain the military health system for the long term. Now that’s taking an issue seriously.

In an interview, Dr. William Winkenwerder, assistant secretary of Defense for Health Affairs, said these studies can be conducted quickly, certainly in time for House-Senate conferees to consider when working on a final compromise Defense Authorization Bill later this summer.

Not likely, say House and Senate staff members, and their auditors agree. A GAO official said their work won’t be completed this year. A CBO official said his agency can’t begin a TRICARE study until a final defense bill is passed. The House-ordered task force, if that’s the vehicle finally adopted for conducting a full review of health care costs, would need time to set up and months to deliberate and write a report. DoD then would be given six months to study the findings before sending it on to Congress with a revised plan of action to save TRICARE.

More plans address other arguments for increasing TRICARE fees. Defense officials, for instance, said current fees are so low, relative to the cost of alternative health insurance, that state governments and private-sector employers are offering incentives for military retirees on the payroll to use TRICARE rather than employer-provided health benefits. This is driving up the number of TRICARE users and therefore military costs.

To address this concern, the House and Senate bills would bar state governments and private-sector employers from treating TRICARE-eligible workers differently than other employees. There is a precedent. Medicare law prohibits employers from enticing their Medicare-eligible workers into using those benefits instead of employer-provided health insurance.

Congress accepts the DoD argument that TRICARE retail pharmacy costs need to be brought under control. The House and Senate were taking slightly different paths toward rebalancing pharmacy copayments to encourage greater use of the TRICARE mail-order plan.

The House would end copayments for most mail-order drugs. The Senate bill would end copayments for mail-order generic drugs, but only for brand name medicines if physicians said they were needed. The Senate plan also would require that all maintenance drugs be ordered by mail.

Regarding the retail network, the House would increase copayments from $3 to $6 for generic drugs and from $9 to $16 for brand-name drugs on the military formulary. Copayments for non-formulary drugs would stay at $22.

The Senate bill, as sent to the floor, would not interfere with DoD plans to increase retail drug copayments to $15 for brand-name and to $5 for generic drugs.

MOAA and other members of The Military Coalition were urging passage of a floor amendment to delay any retail pharmacy increases for at least a year. If Congress agrees, DoD’s first attempt to increase TRICARE user fees will go into the 2006 legislative record book as an embarrassing rout.

Defense leaders failed to consult with beneficiary associations and congressional staff last year while developing their plan for higher TRICARE fees. They are signaling a willingness to consult and compromise in 2007.

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.