[HEALTH.MIL] Time To End Tricare's Bloated-But-Untouchable Status

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  • Date: Wed, 27 Mar 2013 21:44:43 -0500


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Time To End Tricare's Bloated-But-Untouchable Status


By Charles Lane

The Washington Post

Published: March 26, 2013



The U.S. government's fiscal predicament has many causes. But if you had to
reduce them to one sentence, it might go like this: "Congress responds to the
short-term demands of particular groups, not the long-term needs of the nation
as a whole."


Case in point: the seemingly unstoppable growth of medical benefits for former
military personnel under Tricare, the Defense Department's health program. This
mushrooming expense is a major reason that Pentagon health care spending rose
from $19 billion in fiscal 2001 to $52.8 billion in fiscal 2012.


The latter figure represented nearly 10 percent of that year's defense budget.


President Barack Obama has tried repeatedly to rein in this category of
spending, on the very sound theory that resources are finite and that dollars
spent on retiree health care cannot be spent equipping and training the
active-duty armed forces for war - the Pentagon's primary mission.


Military health care's traditional role was to serve active-duty troops and
their families, at no out-of-pocket cost. Tricare still does that, except for
small prescription co-payments. That makes sense as an incentive to sign up for
service and its attendant sacrifices.


Since 2000, however, Congress has repeatedly expanded the access of former
military personnel to Tricare. By 2010, the eligible population had increased
from 6.8 million a decade earlier to 9.7 million - nearly 85 percent of whom
were not active-duty service personnel, according to an excellent May 2012 Armed
Forces Journal article by Brittany Gregerson, of the Institute for Defense


Obama's reforms have been rebuffed every time, by Democrats and by supposedly
fiscally conservative, pro-defense Republicans.


The expansion of Tricare dates to the post-Cold War base closings in the 1990s.
Some military hospitals were shut in the process, and retirees who had been
allowed to use them on a space-available basis protested that Congress owed them
a substitute.


Some even claimed that recruiters had offered them free health care for life
when they enlisted and that Congress was welshing on this purported contract.


The courts correctly rejected this legally, and factually, spurious claim - but
it fared better in the political sphere.


In 1996, Congress allowed military retirees ages 37 to 64 and their family
members to join Tricare for an annual contribution that averaged 27 percent of
total health care costs for a family of three.


That contribution, however, did not increase with inflation. As a result,
Tricare's real cost to working-age beneficiaries dropped 41 percent between 1997
and 2010, Gregerson found. Not surprisingly, working-age retirees and their
families began leaving employer-paid plans and signing up for Tricare.


Congress did allow a modest increase in costs for working-age retirees to take
effect last year and indexed that cost increase to inflation. But those costs
are still far less than what an average civilian would pay for comparable
employer-provided health insurance.


Once former military personnel turn 65, they are eligible for Medicare, like
everyone else. But in 2002, Congress gave them "Tricare for Life" - essentially,
a free Medigap plan. Roughly 2 million people take advantage of this perk, at a
projected cost to taxpayers of $9.7 billion in the current fiscal year,
according to the Congressional Budget Office.


On a per capita basis, Tricare for Life is the most expensive Tricare program of
the Defense Department, Gregerson writes. Beneficiaries' utilization rate far
exceeds that of the other Tricare programs' participants - no surprise, since
Tricare for Life beneficiaries have zero incentive to conserve.


Obama's 2013 budget plan would have saved $12.8 billion over five years by
gradually increasing the annual enrollment fees of Tricare's working-age
retirees, with discounts for lower-income participants, and then indexing the
fees to the rate of national growth in health spending.


The maximum fee would have quadrupled to $2,000 - still far cheaper than most
civilian plans. The president also proposed adding an enrollment charge to
Tricare for Life.


Congress would have none of it - then or, apparently, now. Neither the recently
adopted Senate budget plan for fiscal 2014, drafted by Democrats, nor the
supposedly "austere" Ryan budget passed by the Republican House, touched
Tricare. Hell hath no fury like a veterans' lobby scorned, as senators and
representatives of both parties know.


So do I! In anticipation of a lot of hate mail, I would note that I respect and
honor America's veterans. They should be well provided for, including reasonable
health benefits. But no one - not even a veteran - is entitled to taxpayer
support regardless of competing public needs.


In the case of Tricare, this is what the veterans' lobbies have demanded of
Congress, and what Congress has given them.


(Charles Lane is a member of The Washington Post's editorial board.)



SOURCE:  Stars and Stripes article at



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