Wednesday, February 25, 2009

Today's Soap Box...

My 2 cents are added below the quote.

Chapter# 9/Page# 173 & 174
The Department of Defense (DoD) provides health care
benefits to family members of active-duty personnel
through a collection of health plans known as TRICARE.
There are currently three TRICARE plans from which
such beneficiaries may choose—Prime, Standard, or
Extra—and those beneficiaries pay no premiums or
enrollment fees for their coverage. TRICARE Prime is
operated much like a civilian health maintenance organi-
zation (HMO), with a military or civilian primary care
manager providing referrals to network providers. Family
members of active-duty personnel enrolled in TRICARE
Prime generally face no copayments at the point of ser-
vice, whether they receive care from a military or civilian
provider.1 In part because of the low out-of-pocket costs,
those beneficiaries have rates of utilization of services that
are substantially higher than those of a comparison group
in a civilian HMO.2 Family members who choose not to
enroll in Prime are covered by TRICARE Standard (the
program’s fee-for-service plan) or Extra (the program’s
preferred provider plan). Beneficiaries in those two
planshave a greater choice of providers but face deduct-
ibles and coinsurance rates that vary depending on the
type of service and whether the provider participates in a
TRICARE network.
Under this option, DoD would provide active-duty per-
sonnel who have dependents with a special $500 cash
allowance for health expenses while at the same time
increasing out-of-pocket costs for care received through
TRICARE Prime. The allowance would be nontaxable
(like the current housing allowance) and could be used in
one of two ways. Under the first alternative, family mem-
bers could use the allowance to help offset the out-of-
pocket costs of any of the current TRICARE plans
(Prime, Standard, or Extra). However, cost sharing under
TRICARE Prime would be altered to incorporate copay-
ments that would cover, on average, about 10 percent of
the cost of health care services obtained either at military
facilities or from civilian providers. Each TRICARE plan
would include an annual cap on out-of-pocket expendi-
tures to control the financial consequences of cata-
strophic illness. Under the second alternative, military
family members could show proof of insurance and apply
the $500 allowance toward their share of the premiums,
copayments, and deductibles of another health insurance
Currently, military treatment facilities (MTFs) do not
charge eligible individuals copayments for medical ser-
vices or pharmaceuticals. In order to reduce beneficiaries’
incentive to switch to MTFs and avoid the minimum
out-of-pocket requirements, DoD would need to estab-
lish procedures for collecting payments from TRICARE
beneficiaries seeking care from MTFs.
If implemented, this option would save about $3billion
in discretionary outlays over the next five years and
roughly $7 billion from 2010 to 2019. That estimate
incorporates the cost of the cash allowances and accounts
for the decreased demand for medical care among enroll-
ees that would result under the new plan. (The higher
out-of-pocket expenses would be expected to encourage
restraint in health care purchases.) The estimate also
accounts for the increased cost of the benefit for a small
number of eligible family members of active-duty person-
nel who do not use TRICARE but instead rely on an
employment-based health plan. Those beneficiaries cur-
rently cost the system nothing but would still receive the
cash allowance.
This option would also result in a small increase in man-
datory outlays resulting from some military dependents’
increased use of Medicaid services. In addition, federal
tax revenues would decrease somewhat as more depen-
dents of active-duty service members enrolled in private
insurance plans, which would yield a shift in compensa-
tion from taxable wages to nontaxable fringe benefits.
The degree of those two effects would depend on the spe-
cifics of any enacting legislation.
This option would offer several advantages. First, enroll-
ees in TRICARE Prime would have a stronger incentive
to use medical services prudently because they would be
responsible for a share of the cost. Second, the ability to
use the allowance to pay the premiums of another health
insurance plan would induce some spouses to enroll in
their employer’s plan rather than in TRICARE. That fea-
ture of the option would mean that some health care
costs would be shifted to the civilian employers of mili-
tary spouses, thus reducing DoD’s spending. Finally,
because family members would commit annually to
enrolling in a health insurance plan, total utilization of
services would be easier to predict than it is under the
current system, which allows users to join or leave at any
time. Thus, this option would improve resource planning
within the military health care system and allow DoD to
negotiate firmer contracts for pharmaceuticals and civil-
ian medical services. That advantage would exist even if
most beneficiaries chose to remain in one of the three tra-
ditional TRICARE plans.
This option would also have potential disadvantages.
Enrollees in TRICARE Prime would assume additional
risks and might face financial difficulties, despite the
plan’s cap on families’ annual out-of-pocket expenditures.
Moreover, families that obtained health insurance
through a spouse’s employer might have their coverage
disrupted if the active-duty service member relocated to a
new post. DoD would have to develop methods to pro-
rate cash allowances and deductibles for beneficiaries who
were forced to change from a private health care plan to
TRICARE coverage (or vice versa) midyear.

1. One exception is for pharmaceuticals. Beneficiaries who have
prescriptions filled at retail pharmacies or through mail order face
copayments of $3, $9, and $22, respectively, for generic, brand-
name formulary, and brand-name nonformulary medications.
Prescriptions filled at out-of-network retail pharmacies are
reimbursed at 50 percent of the cost. Prescriptions filled at
military treatment facilities are free.
2. DoD estimates that among TRICARE Prime enrollees, inpatient
utilization is 58 percent higher and outpatient utilization is
39percent higher than a civilian HMO comparison group. These
results were adjusted to reflect differences in age and sex among
the populations being compared. See Department of Defense,
Evaluation of the TRICARE Program: FY2008 Report to Congress
(February 29, 2008).

Obviously my family is not 'typical' when it comes to our healthcare experiences. I will admit that we consider ourselves very lucky to have had military health insurance. Hadley's medical bills, over the course of 4 years, were/are astronomical. Hospital and doctor bills reached a million dollars in her first 6 months of care for her brain tumor. Her Hospice care (4 1/2 months) was just over $25,000. Hadley's average number of hospital and doctor visits each month was anywhere from 1-10+ a month. That is just outpatient visits. She had an MRI, on average, every other month for 4 1/2 years. She required anesthesia for each so the bill was usually around $8-10 thousand each. I tell you all of this to illustrate just how much the changes in military health insurance would effect a family like ours.

I realize that most people out there who are fortunate enough to have health insurance at all have deductibles and cost share etc. I would like to point out a few differences though between civilian and military lifestyles. My husband is in the Coast Guard. He has not seen combat. He has not come back from war wounded or disabled. He has not been gone for 18 months at a time. However, my husband has been gone for months at a time, sacrificing time with our children and myself and putting his own safety on the line. We have sacrificed plenty so that my husband could do a job he loves and serve our country in the process. One of the biggest benefits of this job is the healthcare. Yes, it is free. Yes, it does cost the government a lot of money. I understand that. But, please don't try and balance out the overspending of our government by taking away the military and veterans biggest perk. The pay is bad enough (my husband is an E-5 with 9 1/2 years in. His base pay is $2670.90/month) as it is. If you make us pay for our healthcare we'll all 'tank' for sure. Especially those who do have family members with special health concerns. You won't be discouraging us from 'overusing' our benefit. You'll be bankrupting us. What scares me the most is that there is mention of a catastrophic cap but, there's no mention of how high it is. Our annual pay raises don't even keep up with the cost on inflation every year(I believe it was 3.5% this year), now they want to add to our expenses? *sigh*

I am thankful that this proposed plan wasn't released until after Hadley passed away. I probably would have been a wreck. I suppose I'll just have to hope and pray that Brandon and the boys and I stay healthy. We wouldn't want to cost the government too much. After all, my husband's $32,050.80/year salary (base pay) is probably a huge burden as it is. *eye roll*

Before I close I would like to add that back when the kids were babies we had a co-pay. If I remember correctly it was $3. Any appointment with your provider or a doctor your primary care doc referred you to. That wasn't a big deal, obviously. But throw deductibles or a 20% co pay etc on that and WOW. Scary. So then we'll either be even more broke or sick without access to healthcare. It seems to me that's just not a good situation. Especially since our husbands/wives/etc can be deployed at a moments notice.

I'm done...for now. Thank you for your time.

If you'd like to contact your congressman follow this link:


Nissa said...

I emailed my congressman.

buddyclark said...

Angela, I will email my congressman as well. Tricare is wonderful and military personnel and families are deservent of it. My father was retired military and his cancer care of 1.5 months was out of this world and the last month was in hospital and hospice facilities and TRICARE took care of it. It would have left my mother broke if she would have had to absorb that cost. Military deserve it and I will do my part to help make sure it stays that way.

the Sisson's said...

I'm with you girl! I can't believe they would do this to us. You were right in saying that this is one of the last "perks" of the job. My husband and I are thankful everyday that we have the medical care available if needed. I know so many families with EFMP situations and have husbands that stay in just for the care - you're right in saying they'd "tank" - it's the truth. Our military and country could really suffer from this. Thank you for bringing this out into the light. I'm gonna write my congressman ASAP!