The Military Retiree Grass Roots Group
WHITE PAPER Letter to Congress

17 June 2002

Dear Congressional Representative:

Reference the WHITE PAPER web site at:
http://mrgrg-ms.org/whitepaper.html

Last year, Congress passed the TRICARE for Life program, which is basically a Medicare supplemental insurance program designed to reduce costs of Medicare for over age-65 military retirees.

However, military personnel under age 65, both active duty and retired, are still the only federal employees whose families have no funded entitlement to health care and no health care insurance. Instead of an insurance program with choice, like that offered to other federal employees, they are forced into a new expensive, contractor-run, government managed care program called TRICARE.

TRICARE was designed in three parts: Prime, Extra, and Standard. Although TRICARE has only been in existence less than a decade, it has already been proven a failure in many ways. This is especially true of that portion called TRICARE Standard. TRICARE Standard is used by about half the 8.8 million people who are eligible for it. Since about 85 percent of active duty personnel use TRICARE Prime, most of those using TRICARE Standard are military retirees under age 65 and their families.

The problems with the TRICARE Standard program are too numerous to be able to list them all here, but they are detailed in a "White Paper" on the Internet at: http://mrgrg-ms.org/whitepaper.html. However, there are two major problems that can be discussed.

The first major problem is that overall funding for TRICARE is uncertain each year. This is because overall TRICARE funding is provided in the Operations and Maintenance portion of the budget. As a result, the level of care is not only subject to annual appropriations from Congress; it depends upon Defense Department operational decisions unrelated to the earned benefits of retirees. TRICARE funding, especially for TRICARE Standard, is of necessity low priority compared to immediate readiness needs of our deploying forces. Health care for military families simply does not compete well with the immediate needs of national defense, regardless of past promises made and service of at least twenty years on active duty. Regardless, overall funding for the proposals in the White Paper can be accomplished within existing Defense resources.

The second major problem is the steady decline in the number of doctors who will accept TRICARE Standard. Some areas of the country have no doctors who accept TRICARE Standard assignment. The end result is that those who rely on TRICARE Standard for medical care end up with little, or no, choice in their health care benefit.

Because of these two major flaws, as well as many other problems mentioned in the White Paper, we recommend the following actions by Congress to remedy problems in the TRICARE Standard system specifically, and the military health care system generally. Because of space limitations, solutions are mentioned only in general terms.

First, health care for all military retirees and their families should be funded in the entitlements portion of the federal budget.

Second, legislation to guarantee access and choice in health care should be enacted. This can be accomplished by allowing military retirees to participate in the Federal Employees Health Benefits Program, as provided for in HR179 and S278. Additional actions needed are the immediate elimination of the Non Availability Statement requirement for TRICARE Standard participants; requiring the Department of Veterans Affairs to accept TRICARE without fees or copayments for all military retired beneficiaries; establishing a comprehensive, defined health benefit to include dental, vision, chiropractic, physical exams and other accepted benefit services common to other civilian health plans as part of TRICARE; and requiring TRICARE reimbursement rates to be no less than FEHBP levels without additional copayments or charges.

Third, legislation to improve benefit administration should be enacted. Such legislation should replace TRICARE procedure codes with MEDICARE procedure codes; eliminate enrollment fees and cost-share for retirees who select or can access TRICARE Prime; eliminate TRICARE certification/authorization of providers through use of existing FEHBP providers; reduce TRICARE Standard in-patient cost sharing between the patient and DoD to reflect FEHBP cost-sharing arrangements of unlimited days, $100 maximum copayment per day per admission, and $500 cap per admission; and raise copay levels for TRICARE Standard from 75% to a minimum of 80% and eliminate deductibles.

Legislation to improve claims administration and operation should be enacted. Such legislation should direct that an automated claims administration system be developed; provide for a DoD claims ombudsman in each military service, and establish a fair claims appeal mechanism that is independent of the contractors; direct that current lists of network providers who are accepting new patients be kept on-line; eliminate pre-authorization for TRICARE Standard; reinstate "coordination of benefits" for TRICARE Standard; and establish a system that prevents balance billing at time of service for TRICARE Standard beneficiaries.

Also needed is legislation to improve communication and information flow. Such legislation should establish a real-time DoD-administered TRICARE problem identification system for TRICARE participants and health care provider input; establish essential practices across all TRICARE regions and worldwide; provide for publication of an Annual Heath Benefits Summary and Stakeholders Report for every military family/retiree in TRICARE Standard with the specific information, requirements and services offered by TRICARE for each Region in the U.S. and overseas; and establishment of a TRICARE Standard Working Group in each region composed of TRICARE Standard users.

Legislation is also needed to eliminate sole-source contracting for TRICARE.

Finally, Congress should direct that an immediate and comprehensive GAO audit of the military health care system be undertaken to determine why, if OPM can successfully operate FEHBP without a contractor and HHS can operate MEDICARE without a contractor, DoD needs a contractor to operate TRICARE.

This letter is only a brief summary of the problems affecting the current TRICARE health care system and the Congressional actions needed to remedy the situation. Active duty and retired military families earned low or no-cost health care as part of their basic compensation package. Their salaries in that package were expressly reduced based on the specific high cash values of their promised health care. However, they have received neither the cash their federal civilian counterparts are paid to buy health insurance, nor the funded legal entitlement their federal civilian counterparts have for health care. Neither do they have the excellent, affordable range of choices of health care programs of their federal civilian counterparts.

I ask for your immediate consideration of these urgently needed changes to the current TRICARE health care system.

The White Paper can be downloaded in either the MS-WORD (.doc) or Adobe (.pdf) format from: http://briefcase.yahoo.com/fhs1713

Thank you for your assistance.