MILITARY UPDATE
Military works on implementing healthcare changes for National Guard, reservists

By Tom Philpott

Dr. William Winkenwerder, the Defense Department's top health official, has a task force working to implement healthcare gains for reserve and National Guard forces that Congress approved this month. That includes opening TRICARE, on a cost-share basis, to non-mobilized reservists who are unemployed or have no employer-provided health insurance.

But Winkenwerder is wary of how far Congress went this year in boosting reserve health benefits. The changes are costly, he said, and won't solve the problem of some reservists being physically unfit when mobilized.

"I don't think those two issues are related," he said. "The issue that occurred at Fort Stewart and other mobilization sites (involved) command and medical accountability and responsibility. But they're management issues that have solutions that don't require benefit changes."

Congress planned to boost reserve health benefits anyway this year, but that took on added import in October after news reports that hundreds of reservists and National Guard soldiers, sick or wounded from tours in Iraq or medically unfit for call up, were in "medical hold" at Fort Stewart, Ga., waiting weeks or months for care while living in rundown barracks. Some reservists reported their morale was sinking.

Members of Congress demanded an investigation. The Army confirmed a shortage of medical staff and adequate housing. Stewart had processed 22,000 reservists for mobilization and 14,000 for demobilization since 9/11. Yet Army wide, they said, fewer than 4,000 of 200,000 soldiers mobilized were placed in medical hold.

The Army ordered extra medical staff to Stewart to relieve the backlog. Army wide, officials beefed up medical staff and sent more patients to other service hospitals or VA facilities. At Stewart, $3 million was found to improve living conditions for medical hold soldiers.

David Chu, under secretary of defense for personnel and readiness, ordered medical commanders to provide medical hold patients with specialty care within two weeks, half the TRICARE standard of 30 days. If care isn't available on base, reservists are to be referred to other military, VA or civilian physicians. Also, they are to be billeted in the same quality of housing as active duty members.

The 2004 defense authorization bill directs four other major improvements in reserve medical coverage. The one that most bothers Winkenwerder will open TRICARE to about 170,000 inactive reservists who are unemployed or have no employer-provided coverage.

Mobilized reservists deserve active duty benefits and are getting it, he said. But this change appears to ignore differences between non-mobilized reservists and active duty.

To enroll in TRICARE, the uninsured reservists will have to pay an extra premium on top of co-payments and deductibles. Per year, the premium will be about $420 for self coverage, $1,440 for a family.

Because of budget restraints, the TRICARE initiative is to expire Dec. 31, 2004, which might be before officials can launch it, given the time needed to issue rules and modify contracts. But lawmakers expect to make it permanent before then.

Service associations argued Congress didn't go far enough. They wanted TRICARE opened to all drilling reservists. They also wanted any reservist with civilian health insurance, when mobilized, to receive a reimbursement for premiums.

The other significant changes are:

• Transitional military health benefits for reservists will be available for up to 180 days after active duty, for separations that occur after the bill is signed. The current limit is 60 to 120 days.
• The services will be able to screen and provide medical and dental to reserve personnel as soon as units are alerted that they will be mobilized. Reservists now need to be on active duty to get such care.
• Coverage for reservists and their families could begin up to 90 days before planned mobilization. TRICARE coverage now is available only during active duty.

Congress ordered the General Accounting Office to prepare a detailed report on reserve healthcare needs by May 1, 2004.

For 2004, Congress capped spending on these initiatives to $400 million. After that, Winkenwerder said, costs could soar depending on how many personnel make use of the options.

Questions, comments and suggestions are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com. Or visit Tom Philpott's Web site.