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Tension on the Hill as military health care reform comes to a head

By John Grady, ScoutComms special correspondent

The biggest military personnel question coming in 2016 on Capitol Hill will be the future of the military healthcare system — from the proper role of its clinics and hospitals to TRICARE itself. The debate over possible changes promises to be every bit as contentious as those over this year’s overhaul of the retirement system.

As Sen. John McCain, R-Ariz., Chairman of the Senate Armed Services Committee, said Wednesday at the opening of a hearing on overhauling the military personnel system said, “The primary focus [in the coming year] must be to provide a better health care system” for all beneficiaries. “We may need to eliminate some organizations,” including the services’ distinctions in delivering care.

He was setting the same tone that Rep. “Mac” Thornberry, R-Texas, Chairman of the House Armed Services Committee, did in early October when he said a “lot more work needs to be done” on military healthcare. That day, flanked by Sen. Jack Reed, D-R.I., Ranking Member of the Senate Armed Services Committee, Rep. Adam Smith, D-Wash., Ranking Member of the House panel, and McCain, he added they were looking for ways that “saves money and provide better service.”

That’s “a goal the four of us have agreed” upon, Thornberry said in explaining the current authorization bill’s reform of the retirement system, often called the “third rail” of military personnel policy.

And the starting point for the debate lays in the recommendations of the Military Compensation and Retirement Modernization Commission on healthcare, just as it did with the retirement system. While not all of the panel’s recommendations on compensation were included in this year’s defense authorization act, many big ones were. As commission members have noted repeatedly, the reasons for their success were commission unanimity and no minority footnotes on recommendations.

Stephen Buyer, a member of the commission and a former Chairman of the House Veterans Affairs Committee, made it clear to an audience at the conservative Heritage Foundation earlier this month he saw “the gargoyles who will defend” the present system gathering.

The “gargoyles” will have their supporters on Capitol Hill, including Rep. Joe Heck, R- Nev., Chairman of the personnel subcommittee. In a June hearing on the impact of the commission’s recommendations on the military system, Heck said the shift of emphasis to training for combat casualty care in the military facilities was “one of the places where the commission missed the mark.” He is a physician and has served more than 30 years in the Army Reserve.

“The vast majority of people we treat are not combat casualty care,” Heck added.

That’s precisely the point Dov Zakheim, the Pentagon comptroller in the George W. Bush administration and a member of the commission, said at Heritage. There “are twice as many OB-GYNS at Fort Bragg [North Carolina] that orthopedic surgeons…If you broke your hand playing tennis would you go to an OB-GYN?”

The most common procedures in military care facilities are child birth and pregnancy.

In a sharp exchange in February before the personnel subcommittee, Buyer told Heck: “Do not get sucked into the status quo” when it comes to a military healthcare system that can be fixed with “little tweaks here and there.”

There is “a fundamental disconnect … between peacetime healthcare and military [healthcare] readiness,” Michael Higgins, a member of the commission and a longtime specialist in personnel issues of the House Armed Services Committee staff, added at the Heritage event.

“We made the recommendation that TRICARE should be replaced,” Buyer said at Heritage.

Not so fast on any big changes, senior military health officials told Congress this summer.

Dr. Jonathan Woodson, assistant secretary of defense for health affairs, testified in June the department already was offering choice to its beneficiaries — similar to health maintenance organizations, fee-for-service that includes a preferred provider option and with “a single point of accountability.” He predicted if the insurance plan offerings became law beneficiaries would use “private insurance for health care and back to us for other services,” meaning there would be “a lot of touch points for a highly mobile population” to navigate.

Lt. Gen. Patricia Horoho, Army surgeon general, added during the subcommittee hearing the shift to the private plans likely would have a major impact on military hospitals and clinics because the services could no longer accurately estimate patient load and case mix.

The ripple effect would touch on readiness, she added. “We look at our hospitals as being our medical training platforms because that’s where we house our Graduate Medical Education,” she said.

Commission recommendations that directly affects service members, their families, retirees who are not under Medicare and those who are Medicare-eligible:

*Active-duty families, guardsmen and reservists and retirees would pick private-sector insurance from a menu of plans, similar to the way the Federal Employees Health Benefit Program works. Instead of having the Pentagon oversee these plans, the Office of Personnel Management would, as it does with FEHBP. To help active-duty pay for the private sector plans, there would be a new Basic Allowance for Health Care to cover premiums and out-of-pocket costs.

*Active-duty service members would continue to receive care from military hospitals and clinics.

*Military retirees who are not eligible for Medicare “would continue to have access to the military health benefit program, at premiums below the civilian levels in recognition of their sacrifices for the Nation.”

*Military retirees who qualify for Medicare would keep TRICARE-For-Life which picks up costs that Medicare does not cover.

So how many of these recommendations will pass muster in Congress?

Hard to estimate at this stage.

Both Thornberry and McCain dedicated this year to looking at “reform” across the board and hearings into numerous aspects of how to make the Pentagon more efficient and effective have been held long after the committees passed their versions of the authorization bill. McCain may have more drive to push “reform” bills through in the coming year for several reasons. The Republicans could lose the Senate, and under party rules, his time as chairman would be running out even if the GOP holds the upper house. Thornberry does not feel the pressure of time as much since the Republicans are unlikely to lose the House and he has served only one-year as chairman.

Before and as TRICARE was being created in the 1990s, Congress ordered a pilot study of adopting FEHBP for the armed services but that was discarded as an option for a number of reasons including cost.

Some things will be changing, including who might be using military clinics and hosptials.

During the July hearing the point was made that DoD will be “trying to attract more beneficiaries,” including federal civilian employees to improve the patient mix and increase use. “The bottom line there is capacity” in military hospitals and clinics to take on new patients, Woodson said.


For more information:

Commission report

GAO Report on FEHBP for the armed services

House subcommittee hearings on healthcare recommendations



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