Military Update
Veterans fight plan to limit health care options
By Tom Philpott
Military Update focuses on issues affecting pay, benefits and lifestyle of active and retired servicepeople. Its author, Tom Philpott, is a Virginia-based syndicated columnist and freelance writer. He has covered military issues for almost 25 years, including six years as editor of Navy Times. For 17 years he worked as a writer and senior editor for Army Times Publishing Co. Philpott, 49, enlisted in the U.S. Coast Guard in 1973 and served as an information officer from 1974-77.
Military associations are attacking a proposal in President Bush's 2002 budget plan that would force 700,000 military retirees, most of them disabled, to choose between the VA health care system or the military medical system but they could no longer use both in the same year.
If Congress enacted the Bush plan, "dual-eligible" retirees would be allowed once a year to shift enrollment between VA and TRICARE, the military's managed care program, based on individual needs.
Advocates for retirees describe the proposal as a clumsy attempt by White House "budgeteers" to offset some of the multi-billion dollar cost of the TRICARE for Life and TRICARE Senior Pharmacy programs, approved last year. Retirees with service-connected disabilities, the groups said, shouldn't have to chose between critical VA services — prosthetics, blind rehabilitation, spinal cord injuries, custodial or psychiatric care, and free or inexpensive medicines — and more traditional health services provided, by the military.
Sue Schwartz, a health care policy expert for The Retired Officers Association, described herself as "fired up" over the "mandated choice" proposal.
"What are we going to tell the beneficiary who needs prosthetic care, for which the VA is renowned, and travels 90 minutes once a month to receive it? But he also has a cardiac condition, so he goes to his (TRICARE) doctor near his home. So we're going to deny this beneficiary prosthetic care?"
The idea won't even save money, Schwartz said.ÊVA would "have to expand its capacity to be all things to all people," she said. TRICARE would have to contract, at significant cost, the kinds of special services that VA now provides to disabled retirees.
The big surprise with the plan, said Schwartz, is the target: disabled retirees.
"These are beneficiaries who have risked life and limb (and) sustained a physical impediment in service to country.ÊWe've taken away their retirement with (the federal ban on) concurrent receipt (of both military retirement and VA disability pay).ÊNow we're going to take away their health care? Why not just kick these people down the street?"
A congressional staff member, however, saw merit in the proposal. Too many retirees, he said, "shop" among federal health care options for the lowest out-of-pocket costs, affecting continuity of care and wasting resources.
On Oct. 1, TRICARE for Life, a robust second-payer plan to Medicare for military beneficiaries 65 and older, takes effect.ÊThe administration expects it to entice 47,000 "dual eligible" military retirees to stop using VA, thereby shifting $235 million in costs to the Defense Department. But Bush officials assume millions more can be saved.
The proposal is said to have originated in White House's Office of Management and Budget, and carries little support from VA or DoD.
"The administration believes that (forced) enrollment will allow DoD and VA to know how many people will obtain health care from them, and to budget correctly," said an administration talking paper. "This will lead to the more efficient provision of health care to our deserving veterans and military personnel."
But Kerri Childress, a VA spokeswoman, said, "If this legislation passes, it will pose a difficult choice for many retirees receiving VA care." She said the VA has "the largest, integrated system of geriatric care in the nation" while DoD "focuses on a much younger population."
