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VAWATCHDOG
FOR HELP WITH PTSD CONTACT THE FOLLOWING OR
VETERANS FOR PEACE PHOENIX:
Dr. Beverly Dexter, Clinical Psychologist, retired NAVY
www.nomorenightmares.org
bdexter@nomorenightmares.org
Joseph Little, MSW, Vet Center
Joseph.Little2@va.gov
Betty Merritt, Merritt Center and Lodge (returning vets free)
www.merrittcenter.org
betty@merrittcenter.org
928-474-4268
Colleen Flanagan, EFT-ADV (returning vets free)
Colleen@EMORescue.com
www.EMORescue.com
602-942-0564
VETERANS FOR PEACE PHOENIX:
Dr. Beverly Dexter, Clinical Psychologist, retired NAVY
www.nomorenightmares.org
bdexter@nomorenightmares.org
Joseph Little, MSW, Vet Center
Joseph.Little2@va.gov
Betty Merritt, Merritt Center and Lodge (returning vets free)
www.merrittcenter.org
betty@merrittcenter.org
928-474-4268
Colleen Flanagan, EFT-ADV (returning vets free)
Colleen@EMORescue.com
www.EMORescue.com
602-942-0564
| Health Care Quality/Price Update 02: We all know that Americans spend too much money on healthcare – more than twice as much per patient as people in other industrialized countries, on average – but we don‘t necessarily know who to blame. A study published in 27 SEP edition of Archives of Internal Medicine offers up a surprising culprit: primary care doctors who admit that they give their patients too much care. That‘s right – 42% of the docs in a nationwide survey said the patients in their own practices ―were receiving too much medical care‖ and 28% said they personally were ordering more tests and making more referrals to specialists than they would ―ideally like to be.‖ Why do they do it? Three reasons: 1) 76% of doctors in the survey said fear of malpractice lawsuits prompted them to practice more aggressive medicine; 2) 52% blamed it on the use of clinical performance measures that are used to judge whether doctors are doing their jobs correctly; and 3) 40% said they didn‘t get to spend enough time with their patients to figure out what is really wrong with them, so they ordered tests and consultations to provide some of the answers. Defensive medicine was clearly a problem. In the survey, 83% said they felt that ―they could easily be sued for failing to order a test that was indicated,‖ but on the flip side only 21% worried that a patient might file a lawsuit against a doctor who ordered a test that wasn‘t medically necessary. Making money was another factor. Only 3% of the 627 internists and family practice doctors who participated in the survey acknowledged that they sometimes ordered extra tests to boost their own bottom line, but 39% said they thought that other primary care physicians ordered tests in part to boost their own revenue. If they were suspicious of their colleagues, they held even lower opinions about subspecialists – 62% said these doctors (think cardiologists, oncologists, etc.) ― would cut back on testing in the absence of a financial incentive,‖ according to the study. Overall, 61% of the primary care doctors judged subspecialists to be providing too much care. In addition, 47% felt that nurse practitioners and physician assistants – thought to be lower-cost substitutes for doctors – were practicing too aggressively. ―Many primary care physicians believe there is substantial unnecessary care that could be reduced, particularly by increasing time with patients, reforming the malpractice system, and reducing financial incentives to do more,‖ wrote the authors from the Veterans Administration Outcomes Group in White River Junction, Vt., and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H. That‘s easier said than done, of course. Changing the medical malpractice system would be no small task. There‘s also the matter of changing the way doctors are reimbursed so that they can get paid for talking and thinking as well as for doing. On the plus side, it should be possible to spend less on medical bills while actually improving the quality of medical care. [Source: Los Angeles Times Karen Kaplan article 27 Sep ++] Another reason for NATIONAL HEALTH CARE!!!!! |
| Tricare Flu Shots Update 01: Two forms of the flu vaccine are distributed in the U.S., and both are covered by TRICARE. These are an injectable, inactivated vaccine that contains a killed virus and can be used in all age groups 6 months and older and an intranasal spray, made with live, weakened influenza viruses; limited to use in people who are between the ages of 2 and 49 years, and who are not pregnant at the time they receive the vaccination. Flu vaccines may be received at no cost from any TRICARE- authorized provider or at one of the TRICARE retail network pharmacies that participates in the vaccination program. To find a participating pharmacy, search online at http://www.express- scripts.com/TRICARE/pharmacy or call 1-877-363-1303. If you get the vaccine from your provider, you may have to pay copayments or cost shares for the office visit or other services received during the office visit. Uniformed service members (Active duty, National Guard, and Reserves) are required to be immunized. Active duty service members (ADSM) have priority for getting the vaccine at military treatment facilities but may also receive the vaccine at a participating network pharmacy. When received at a network pharmacy, ADSMs are required to follow their Service policy guidance for recording the immunization in their shot record by the close of business the next duty day. Proper documentation should be obtained from the pharmacy which includes patient identification; the date the vaccine was given; the vaccine name or code, manufacturer, and lot number. Everyone six months and older should get a flu vaccine as soon as its available each fall. Some people are at a higher risk of serious flu-related complications and should get vaccinated each year. According to the Centers for Disease Control and Prevention (CDC), the following people should be vaccinated each year: • All children aged six months to 18 years • Adults aged 50 years and older • Persons with underlying chronic medical conditions • All women who are be pregnant during the influenza season • Health care workers involved in direct patient care • Child care and elderly care workers • Persons at high risk of severe complications from influenza Daily steps to take to Prevent the Spread of the Flu include: • Wash your hands with soap and warm/hot water • Use an alcohol-based sanitizer when hand-washing is not possible • Cover your mouth or nose when you cough or sneeze • Avoid contact with your nose, eyes or mouth • Avoid contact with people who are sick • Stay home if you have flu-like symptoms • Take anti-viral medications to treat your flu symptoms when prescribed by a doctor. [Source: http://www.tricare. mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Flu+Vaccine Sep 2011 ++] ********************************* |
| COLA 2012 Update 06: Although federal workers face at least one more year without a pay raise, government retirees are cautiously looking forward to a cost of living adjustment of around 3.3 percent in their January checks. That COLA, if it holds up, would be the first inflation-catchup federal, military and Social Security retirees have had since they got a 5.8 percent increase in 2009. The actual amount of the 2012 COLA won't be known until mid-September. The raise could be higher if inflation creeps up in September. It would be less if living costs drop between now and the end of September. By law, retirees are supposed to get COLAs to match the rise in inflation as measured by the Bureau of Labor Statics Consumer Price Index. But for the past few years, inflation has been flat and there were actually months when living costs dropped. Result: No retiree COLA in 2010 or 2011. That despite the fact that health insurance premiums for retirees (and workers) have been going up. And up. In recent months, there has been back-and-forth inflation. The January COLAs for retirees are based on the rise (if any) of the CPI from the third quarter of the previous year to its level for the current year. The third quarter measuring period is July, August and September. So that means there are still two months (August and September) left in the countdown. Many feds, fed up with the pay freeze, have indicated they may retire over the next few months if there is a retiree COLA in January. It's a great plan with one flaw: In order to get a COLA intended for retirees, you must be retired while the inflation is taking place. The COLAs are pro-rated. David Snell of the National Active and Retired Federal Employees says that individuals who retired in June will get one half (6/12ths) of the January COLA. If you retired last month you will get even less and if you retire this month, less than that. [Source: Veteran Issues by Colonel Dan 11 Sep 2011 ++] |
| VA Disputed Claims Update 01: Clifford Bare, a 76-year-old retired U.S. Navy veteran, has a monthly income, gathered from Social Security and a state pension, of $1,233. His wife Norma's monthly Social Security check is $893. They are not people of means. But, try telling that to the U.S. Department of Veterans Affairs. Bare is one of about 18,000 veterans in Montana who do not qualify for health care coverage in the VA system. He is, in government speak, a Priority 8 veteran, defined as men and women who make above a certain amount of money and have no service- connected disabilities and therefore are not allowed to enroll in the VA health care program. Under current restrictions, a veteran with no service-related injuries and with an annual income of $35,577 can be denied VA health benefits. The amount varies by state but it is about $35,000 in Montana. By all calculations, the Bares' $25,000 annual income falls well below the threshold. But his benefits may now be jeopardized because the cash-strapped couple tapped their savings for about $8,000 to help cover Norma's hospital costs after being treated for cancer and a heart attack. That single move nudged him above the threshold and apparently disqualified him from receiving health care benefits. "It's a damn crying shame," said Bare, who served in the Pacific during both the Korean and Vietnam wars. Citing privacy, the VA declined to comment on Bare's case. Bare said he has been dealt a double whammy, penalized for tapping into his savings account, and further punished for not being wounded. "We put in our time," Bare said. "We dodged bullets. Does that make us less than the men who lost a leg?" Bare relies on five daily life-saving medications and a pacemaker, his third, in his chest to help control abnormal heart rhythms. The VA has helped pay for none of it. "I gave the Navy the best years of my life," Bare said. "I was faithful to my country. Now, I'm living on borrowed time and I'm being screwed and nobody seems to care -- until now." Bare, whose state pension comes from serving 12 years as a Stillwater County Commissioner, is referring to U.S. Sen. Jon Tester, (D- MT) who has called on the U.S. Department of Veterans Affairs to expand health care coverage to include all veterans regardless of income or whether they are wounded. Tester, a member of the Senate Veterans Affairs Committee, has implored VA Secretary Eric Shinseki to immediately return Priority 8 veterans to the health care system. In 2003, then-VA Secretary Anthony Principi, who worked under President George W. Bush, stopped Priority 8 enrollments. He argued their numbers strained the system and crowded out higher-priority veterans, including those who were wounded and returning from Afghanistan and Iraq. During the first six months of this year, nearly 47,000 veterans applied for VA enrollment but were denied health care due to income. Bare contacted The Billings Gazette after reading that Tester was working to restore Priority 8 veterans' health care benefits. While Bare said he admires Tester's effort, he fears the senator is "shoveling against the wind." Tester isn't convinced. Thousands have already been let back in. In 2009, as President Barack Obama took office, Congress provided the VA with enough money to begin enrolling some Priority 8 veterans, and the expansion began. The VA announced that up to 266,000 veterans with no service-connected health conditions would be allowed to enroll in VA health care. Those who enrolled earned less than $35,000 annually. Nearly 12,000 of the 30,000 eligible Priority 8 veterans in Montana were enrolled at that time. Moreover, Tester has amassed a successful resume in securing benefits for veterans, which bodes well for Bare and others. During Tester's tenure in the Senate, Montana has received six new VA clinics in Lewistown, Havre, Hamilton, Libby, Cut Bank and Plentywood. Two VA Vet Centers in Great Falls and Kalispell also opened this year. In February, the U.S. Department of Veteran Affairs approved doubling the size of the Billings VA Clinic. Montana has also received additional resources, including transportation vans and housing vouchers, for veterans. At Tester's invitation, Shinseki made his first visit to Montana in July."That didn't happen on its own and it sure wasn't happening before I came to Congress," Tester said. "That happened because I listened to veterans in Montana and we worked together to get it done."Tester stopped short of saying he's optimistic about enrolling more Priority 8 veterans, saying he's not a betting man. He said there are difficult decisions to make as Congress reduces debt and cuts spending in the months and years ahead."But I make my decisions and pick my battles based on the priorities that are right for Montana," Tester said. "And I just don't believe in backpedaling on our commitment to veterans. Federal budgets should reflect our priorities, which is why I sent my letter to Secretary Shinseki asking him to prioritize Priority 8s in his budget." [Source: Billings Gazette Cindy Uken article 27 Sep 2011 ++] Clifford Bare |
| Mobilized Reserve 20 SEP 2011: The Department of Defense announced the current number of reservists on active duty as of 20 SEP 2011. The net collective result is1739 more reservists mobilized than last reported in the 1 SEP 2011 RAO Bulletin. At any given time, services may activate some units and individuals while deactivating others, making it possible for these figures to either increase or decrease. The total number currently on active duty from the Army National Guard and Army Reserve is 71,771; Navy Reserve 4,704; Air National Guard and Air Force Reserve, 10,782; Marine Corps Reserve, 5,697; and the Coast Guard Reserve, 653. This brings the total National Guard and Reserve personnel who have been activated to 93,607 including both units and individual augmentees. A cumulative roster of all National Guard and Reserve personnel who are currently activated may be found at http://www.defense.gov/news/d20110920ngr.pdf. [Source: DoD News Release No. 823-11 dtd 26 Sep 2011 ++] |
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| PTSD Update 78: How About One Website for Combat Stress Info? That's the take of the Senate Appropriations Committee in its report on the 2012 Defense budget bill, which found the Pentagon and military services have set up a confusing mess of websites that purport to provide support for service members and their families struggling to deal with combat stress. For example, the report said, the Navy published one pamphlet explaining how to combat operational stress that listed 16 different websites and phone numbers for outreach. Yet another Navy pamphlet listed eight additional websites, while an Air Force pamphlet listed 13 sites and points of contact and an Army information sheet on combat stress and mental health assistance listed 19 sites. But, as the report pointed out, the website descriptions contains little information as to what services the sites will provide, thus requiring users to read through them to find one that meets his or her needs. Rather than consolidating these efforts and streamlining this information for service members, the Department continues to approve new programs, resulting in a maze of information that poses a significant challenge to navigate, the report added. The committee believes the Army, Navy and Air Force, as well as the Office of the Under Secretary for Personnel and Readiness, the Office of the Assistant Secretary of Defense for Health Affairs, and the Department of Veterans Affairs need to work together with the private sector to consolidate these efforts and develop a single portal. Getting all these folks into the same room let alone reaching an agreement sounds like a task that could take years. [Source: NextGov.com Bob Brewin article 22 Sep 2011 ++] |
| Medicare Reimbursement Rates 2012 Update 02: Congress has less than 90 days to stop the 29.4% Cuts in Medicare/Tricare Physician Reimbursements coming in January 2012. The 112th US Congress has totally failed to do anything about the cuts in Medicare/Tricare payments to physicians mandated by the Sustained Growth Rate (SGR) formula to be imposed in 2012. Since the Sustained Growth Rate (SGR) formula used to determine Medicare and Tricare physician reimbursements became an issue in 2002, rather than fixing the problem, the US Congress has chosen to "band aid" the problem with annual suspensions of the SGR implementation and providing patches to at least maintain reimbursements at prior year levels. The 111th Congress made the process a joke with short term extensions that caused much confusion and wasted taxpayer dollars. The 112th Congress has simply done NOTHING! Unless the Congress acts with either a band-aid fix or with a permanent fix, the SGR now mandates a 29.4% cut in physician reimbursements effective 1 JAN. Access to quality care is the #1 healthcare problem faced by members of the military community whether active duty or retired. Deployed troops shouldn't have to worry whether their doctor will refuse to see their sick spouse or child because of these large payment cuts. To urge your elected officials to sponsor legislation to replace the SGR with a more realistic computation that will at least match the Consumer Price Index or some other workable index you can use USDR's preformatted editable message at http://capwiz.com/usdr/issues/?style=D&. [Source: USDR Action Alert 20 Sep 2011 ++] ********************************* |
| Medicare Update 07: A small but notably bipartisan group of lawmakers has introduced antifraud legislation that would create smartcards for Medicare enrollees and providers, a move that sponsors say could save $30 billion a year. The proposed Medicare Common Access Card Act of 2011, introduced in the Senate (S.1551) 13 SEP by Sens. Mark Kirk (R-IL), Ron Wyden (D-OR), and Marco Rubio (R-FL) and in the House (H.R.2925) 14 SEP by Reps. Jim Gerlach (R-PA), Earl Blumenauer (D-OR), and John Shimkus (R-IL), would create a series of pilot programs to embed secure chips on Medicare identification cards. If the pilots were to prove successful after a year, the legislation would authorize distribution of smartcards to all beneficiaries of Medicare, currently about 48 million people and counting. The program is modeled on the 20 million Common Access Cards that now identify U.S. Department of Defense personnel and other Military Health System enrollees. Current Medicare ID cards display the holder's social security number. The new cards would hide this prime target of identity thieves and give the beneficiary a PIN to verify his or her identity. Providers would receive smartcards, too, theirs containing a biometric security element. Both patient and provider would insert their cards into a reader to confirm that a transaction actually took place. "Building on the smartcards already issued to all Americans in uniform, we can offer seniors more protection for their identities while reducing fraud and waste in the strained Medicare system," Sen. Kirk said in a joint press release. "By removing a senior's social security number from the front of the card and including the security upgrades used on the cards of our troops, this secure Medicare Common Access Card will also help end Medicare's current 'pay then chase' policy that allows so much fraud and waste." Today, the Centers for Medicare and Medicaid Services generally pays all claims submitted by registered providers, and then attempts to recoup any fraudulent reimbursements after the fact. A video released by the Secure ID Coalition, a group of four companies that produce smartcards and other identity-protection technologies--and posted on Kirk's official Senate website--said modernization of the Medicare card could trim fraud by half. The coalition said there would be a one-time cost of $19 per person to issue the cards and distribute readers nationwide, but that small investment would save taxpayers $675 per Medicare enrollee per year in reduced waste. "We feel like this is a real step forward," Secure ID Coalition executive director Kelli Emerick told InformationWeek Healthcare. "Smartcards were invented to prevent fraud." Emerick said that similar programs in Germany, France, and Taiwan have been successful in dramatically curtailing fraud and waste in those countries' healthcare systems. The legislation also has the support of the AARP, the nation's largest advocacy group for older Americans. Emerick said that the newly introduced House and Senate bills are under consideration for referral to the so-called "super committee," the 12-member congressional panel tasked with finding specific ways to reduce federal debt. [Source: InformationWeek Healthcare Neil Versel article 20 Sep |
| Tricare Uniform Formulary Update 37: The Beneficiary Advisory Panel (BAP) met 23 JUN to provide comments to the Department of Defense (DoD) Pharmacy and Therapeutics (P&T) Committee‘s recommendations on formulary status, prior authorizations, and the effective date for a drug‘s change from formulary to non-formulary status. Moving a drug to non-formulary status means it will still be available to beneficiaries, but usually at a higher price. It may also require medication authorization. The BAP Committee members reviewed Atypical Antipsychotics (AAP), Nasal Allergy Drugs (NADs), and newly approved drugs for their placement on the Uniform Formulary, requirement for a prior authorization, and the time for implementation of any changes made to the formulary status. The BAP recommended for all drugs requiring a change in formulary status and/or prior authorizations to be done after a 60-day implementation period. The P&T committee recommended a prior authorization and step therapy criteria for certain drugs. This was done to provide guidance to health care providers on which medications beneficiaries should be given first. They cited U.S. Food and Drug Administration (FDA) guidelines, safety concerns, along with the drug‘s cost as reasons for including or modifying an existing prior authorization and step therapy requirement. All medications reviewed by the BAP were recommended to be placed or kept on formulary status with the following exceptions: 1. The BAP recommended the following drugs remain on Uniform Formulary and require a prior authorization with step therapy (use of another drug first) for recently approved drugs: • Dipeptidyl peptidase-4 inhibitor (DDP-4)/Biguanide fixed dose combination: saxagliptin/metformin ER (Kombiglyze XR). • Alphar blockers for benign prostatic hyperplasia: tamsulosin/dutasteride (Jalyn). 2. The BAP recommended the following drugs move to non- formulary status: • AAPs: iloperidone (Fanapt), asenapine (Saphris), and lurasidone (Latuda) • NADs: azelastine 0.15% (Astepro), beclomethasone (Beconase AQ), budesonide (Rhinocort Aqua), ciclesonide (Omnaris), fluticasone furoate (Veramyst), and triamcinolone (Nasacort AQ). Other items which were discussed during the 23 JUN meeting of beneficiary interest were:. • Dabigatran (Pradaxa) was recommended that a prior authorization was NOT required at this time, but will be reviewed again by the P&T Committee when other anticoagulants are reviewed at a future meeting. • The P&T committee recommended an adjustment to the per medication co-payment that was proposed in President Barack Obama‘s Fiscal Year 2012 budget. Recommendations included changes to medications purchased using the TRICARE Pharmacy Home Delivery and TRICARE network retail pharmacies. a.) Recommendations for medications purchased using the TRICARE Pharmacy Home Delivery were: generic (Tier 1) $0, formulary (Tier 2) $9, and non-formulary (Tier 3) $25 for a 90-day supply. b.) Recommendations for medications purchased using a TRICARE network retail pharmacy were: generic (Tier 1) $5, formulary (Tier 2) $12, and non-formulary (Tier 3) $25 for a 30-day supply. The current purchased cost for medications using either option is $3, $9, and $22. The recommended pharmacy co-payment changes will go into effect October 1, 2011. Go to http://www.tricareformularysearch. org/dod/medicationcenter/default.aspx for a complete list of formulary medications, For additional information on this or other BAP meetings, refer to www.tricare.mil/pharmacy/bap/. [Source: http: //www.tricare.mil/pharmacy/bap23 Jun 2011 |
| Tricare User Fees Update 71: On 19 SEP, the Obama Administration unveiled its plan to cut the deficit by $3 trillion over the next 10 years. The proposal includes $27 billion in cuts to the military health care package and a proposal that could be expected to cut even more from the military retirement system. First, the Administration proposes establishing a $200-per-person annual enrollment fee for TRICARE For Life beginning FY2013. The proposal would tie this to some unspecified health cost index so that it would increase every year after that. Second, it proposes changing TRICARE pharmacy copays to bring them more in line with federal civilian coverage: • Retail Generic: Change copay from a flat $5 to 10% of DoD Rx cost in FY13 and raise that to 20% of Rx cost in outyears • Retail Brand Name: Change copay from $12 to 15% of DoD Rx cost in FY13 and subsequently to 30% of Rx cost • Mail-order Brand Name: Raise copay from current $12 to $20 in FY13 and subsequently to $40 • Mail-order Non-formulary: Raise copay from current $25 to $35 in FY13 and subsequently to $40 Finally, the Administration calls for a DoD BRAC-style commission to recommend "modernizing" the military retirement system. The commission proposal would have to get an up-or-down vote by Congress, without any amendment options. The language in the Administration plan makes it clear that the intent of these initiatives is to generate large savings by making the military healthcare and retirement system more like civilian plans. This shows a shocking insensitivity to the radical difference between military and civilian careers and the reasons why these military programs were built. The whole purpose of the unique military retirement and healthcare package is to offset the extraordinary demands and sacrifices inherent in a service career. They were built to provide a powerful incentive for top-quality people to serve 20-30 years in uniform, despite the kind of hardships imposed on troops and families over the last 10 years of war. Why endure that if the reward is a benefit package similar to that provided civilians who don't bear any such burden of arduous and extended sacrifice? If the Administration and Defense Department won't make the case to protect current and future military members, families, retirees, and survivors in these tough budget times, Military Officers Association of America certainly intends to. Now is the time for all military retirees to mobilize. This isn't just about equity. It's about an attack on the core elements that sustain the quality career force that protects our national security. Any who continue to sit on the sidelines jeopardize their own interests, the military community's, and the nation's future capability to sustain a strong national defense. Retirees can start voicing their concerns by sending a MOAA- suggested message which can be accessed at http://capwiz. com/moaa/issues/alert/?alertid=53748506 to their elected officials. [Source: MOAA Weekly Update 23 Sep 2011 ++] ********************************* Tricare User Fees Update 72: Military retirees would pay an annual fee for TRICARE-for-Life health insurance and TRICARE pharmacy co-payments would be restructured under the deficit reduction plan President Barack Obama released 19 SEP. "If we're going to meet our responsibilities, we have to do it together," Obama said during a Rose Garden speech to announce the President's Plan for Economic Growth and Deficit Reduction. The plan reduces $4.4 trillion from the $14.7 trillion federal deficit over 10 years through a combination of spending cuts and increased tax revenue. For the military portion, Obama said the government will save $1.1 trillion from the drawdown of forces in Iraq and Afghanistan, which are to be complete at the end of this year and in 2014, respectively. The plan includes savings of $6.7 billion over 10 years by establishing "modest annual fees" for members of TRICARE-for-Life, which becomes a second-payer insurance to military retirees who transition to the federal Medicare program upon turning age 65. The change would begin with a $200 annual fee in fiscal 2013. The plan also includes savings of $15.1 billion in mandatory funds and $5.5 billion in discretionary funds over 10 years by restructuring co-payments for TRICARE pharmacy benefits. To bring the TRICARE plan more in line with private and other federal plans, the president's proposed plan would eliminate co-pays for generic mail-order drugs, while shifting retail co- pays from a dollar amount to a percentage co-pay. The change would apply to military families and retirees, but not active- duty service members. These changes will ensure fiscal responsibility without compromising quality care for service members and their families, Pentagon Press Secretary George Little said in a statement released 19 SEP. Defense Secretary Leon E. Panetta "has consistently emphasized the need to keep faith with our troops and their families," Little said. "That includes maintaining the highest quality health care for them," he continued. "We will continue to maintain the highest possible health care, but during this period of fiscal belt tightening, we may see modest cost increases in TRICARE enrollment fees and co-pays to sustain the health system." The changes are necessary to help reduce the deficit and ensure the long-term strengths of the programs, a White House news release issued after Obama's speech said. The changes also would help to level "a measurable disparity" between military retirees and private sector workers, it says. The statement notes that the administration has expanded GI Bill benefits, job training and veterans' homeless prevention programs, and proposed tax credits for employers to hire veterans. "Still, as the cost of health care rises and benefit programs across the public and private sectors are being restructured to remain solvent," the release says, "it's important that programs that serve military retirees and veterans are modernized to be able to meet the needs of the future." The plan also would create a commission to "modernize" military benefits through a process based on that of the 2005 Base Realignment and Closure Commission, the White House release said. Under the proposal, the Defense Department would make a proposal to the commission, which can alter the proposal before sending it to the president. The president may not alter the proposals, but would decide whether or not to send it to Congress. The Congress would have to approve or disapprove without modifications. "The administration believes that any major military retirement reforms should include grandfathering provisions that ensure that the country does not break faith with military personnel now serving," the statement said. Obama said the proposal to save $4 trillion "finishes what we started last summer" when he and the Congress agreed to $1 trillion in cost savings. Under the plan, the deficit -- the difference between revenue and spending -- would level out in 2017 where spending is no longer adding to the nation's debt. While "we are scouring budget for every dime of waste and inefficiency," Obama said, the proposed plan also closes corporate tax loopholes, raises taxes on millionaires and makes changes to Medicaid and Medicare in an effort to help small businesses and middle class Americans, and protects spending on education, science and infrastructure such as roads and bridges. "We're asking everybody to do their part so no one has to shoulder too much burden," Obama said. The President's Plan for Economic Growth and Deficit Reduction titled ―Living Within Our Means and Investing in the Future can be read at http://www.whitehouse. gov/sites/default/files/omb/budget/fy2012/assets/jointcommitte ereport.pdf . To send a preformatted editable message to you elected officials noting your displeasure with the plan go to http://capwiz.com/moaa/issues/alert/? alertid=53748506&PROCESS=Take+Action. [Source: Tricare Press Release No. 09-10-11 20 Sep 2011++] |
| Tricare User Fees Update 73: Tricare users would see out-of-pocket costs rise by $27 billion over the next decade, through higher pharmacy co-payments at retail drug outlets and a first-ever Tricare for Life annual , under President Obama's $3 trillion plan to address the nation's massive and growing debt. The same plan would protect current members from retirement changes but would form a powerful commission to modernize military retirement for future generations. Like base closing commissions, final recommendations would have to be wholly rejected or accepted. The president and the Congress could not make select changes. The White House debt cutting plan, delivered to the Joint Select Committee on Deficit Reduction, confirms what advocates for Tricare beneficiaries had feared: that they are expected to share in the fiscal sacrifices to be asked of millions of Americans drawing federal entitlements. Military associations sound equally alarmed by the rhetoric in the White House recommendations suggesting that key military benefits are just too generous and must be brought nearer to what civilians receive. "We were shocked at the tone of it," said Steve Strobridge, director of government relations for Military Officers Association of America. "It talks about, basically, civilianizing the military benefits package. I mean it expresses that as a goal, which to us is absolutely anathema (i.e. intolerable). The whole point of the benefit package is to provide an offset for unique conditions of military service. You can't civilianize the package without civilianizing service conditions. If the last 10 years show us anything it's that military conditions are getting worse than when these programs were designed." Two Tricare features are targeted. • Users of Tricare for Life (TFL), the prized supplement to Medicare for beneficiaries 65 and older, would pay an annual fee, starting at $200 in 2013, with adjustments for inflation. The White House notes that TFL users now pay only the Medicare Part B premium, $110 a month for most, and pharmacy co-pays. Otherwise they face no out of pocket health costs. By contrast, private sector elderly, in 2009, paid on average $2100 a year for their "Medigap" policy. The annual TFL fee would save a $6.7 billion over 10 years. • Obama's (plan) would save another $20 billion across a decade by raising pharmacy co-pays in the Tricare retail network, sparing only active duty members. Current co-pays "have lagged" behind other plans, it says. Family and retiree drug costs at retail outlets would move "closer to parity with the most popular federal employee health plan, BlueCross BlueShield Standard, and closer to the health plans that most Americans have from their employers," the White House report explains. Federal civilians now pay about $45 to get a brand name drug at retail. Military beneficiaries pay $9 and it rises next month to $12. Obama also wants military drug co-pays to rise automatically with costs to the government, thus shifting from a set dollar co-pay to a percentage formula. So co-pays for generic drugs at retail would be set at 10 percent of the Defense Department's cost for the medicine. Sometime after 2013 this would climb to 20 percent. Co-pays for brand names would start at 15 percent of cost and be raised to 30 percent over some yet unspecified period. Even as associations like MOAA and FRA alerted members to details of Obama's plan, and urged that e-mails and letters of protest flood Congress, the outcome of this fight to protect benefits appeared more uncertain than in battles past, with the real chance changes could become law by year's end. [NOTE: Elected officials may be contacted via http://www.usa. gov/Contact/Elected.shtml]. The unusual structure adopted in August to reach a final debt deal -- with the president and Congress conceding to the joint or "super" committee of 12 lawmakers responsibility to shape a take-it-or-leave-it legislative package by 23 NOV -- almost certainly handcuffs the influence of lobbyists to derail whatever package of cost curbs the committee's majority embraces. "It changes the dynamic considerably," said a key congressional staff member. "The changes get rolled into a package and all of a sudden it looks like just your fair share. And we shouldn't take our fair share?" The super committee's power to cut a final deal leaves Tricare advocates automatically at a disadvantage that they didn't face defeating the Bush administration's call for hefty Tricare fee hikes starting in 2006. Those ideas had to clear familiar ground, the armed services committees. "They can influence those committees very dramatically," the staffer said. Only two super committee members also serve on armed services, though all standing committees are invited to share views on cuts they favor and oppose. Sen. Jim Webb (D-Va.), who chairs the Senate military personnel panel, said he views lifetime health care as "part of a moral contract between our government and those who have stepped forward to serve. For this reason, I oppose the president's proposals to impose new Tricare fees on military retirees and other beneficiaries." But Arnold Punaro, a retired Marine major general, strongly supports initiatives to slow Tricare cost growth as well as retirement reforms for new entrants. He applauds the planned retirement commission, urging that a prominent military leader, like retired Gen. Colin Powell, serve as chairman. Punaro is an influential member on the Defense Business Board, which has recommended to the defense secretary broad changes in retirement and new initiatives to curb "out-of-control" health costs. "The path advocated by the Praise-the-Lord-and-Pass-the- Benefits outfits are pushing this nation either to a hollow military or to a military way too small to deal with the threats we face," Punaro said. To comment, e-mail milupdate@aol.com, write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111 or visit: http://www.militaryupdate.com. [Source: Stars & Stripes Tom Philpott article 22 Sep 2011 ++] ********************************* Tricare User Fees Update 74: Following is a compilation of Tricare Copay changes for FY2010 through FY2012: Fee/copay Changes Coming Program FY2010 FY2011 FY2012 effective Oct. 1, 2011 TRICARE Prime Enrollment - Retirees $230/single $230/single $260/single $460/family $460/family $520/family TRICARE Standard Inpatient Non-network Copay – Retirees $535/day $535/day $700/day TRICARE Retiree Dental Program Premium Based on coverage level and # covered Vary by residence zip code Vary by residence zip code; increases approx. $5/month for families and $1/month singles Continued Health Care $933/single $988/single $1,065/single I THINK THESE ARE FAIR AS LONG AS THE WEALTHY GIVE UP THEIR TAX BREAKS. |