MILITARY UPDATE
Veterans initiatives gaining
By Tom Philpott
In years past, Bush administration proposals to charge low-priority Veterans Affairs healthcare users a $250 annual enrollment fee and higher co-payments on prescription drugs were declared dead on arrival on Capitol Hill.
Not this year.
The initiatives, to boost VA revenues by $424 million, appear to have survived a first vigorous round of attacks by veterans service organizations.
Credit new, more fiscally conservative chairmen of the House and Senate Veterans Affairs committees and a strategy to paint the VA enrollment fee as "only fair" given TRICARE enrollment fees for retirees.
Both the change in tone by chairmen and the equity argument for VA enrollment fees were on display during mid-February budget hearings.
The Department of Veterans Affairs budget once again seeks two cost-sharing increases for VA healthcare users in priority categories 7 and 8, veterans who have no service-connected disabilities and incomes above geographic poverty thresholds set by the federal government.
Besides paying a $250 enrollment fee, 2.4 million priority 7 and 8 enrollees would see co-payments on VA-filled prescriptions rise to $15, from $7, for a 30-day supply. VA estimates that 213,000 would disenroll rather than pay the higher fees.
Jim Nicholson, the new secretary of veterans affairs, described the enrollment fee as "similar to the fee legally required of military retirees enrolled in the TRICARE system."
Given that military retirees must have served at least 20 years, and VA enrollees "as few as two years," Nicholson suggested the VA fee is "more justified."
Sen. Larry Craig (R-Idaho), new Senate committee chairman, said "such proposals have been declared dead on arrival perhaps even before they were analyzed. I do not intend to take that approach."
The cost-saving initiatives, particularly affecting priority 7 and 8 veterans, drew vehement opposition from veterans service organizations. But at the House VA committee hearing the next day, new chairman Rep. Steve Buyer (R-Ind.) embraced Nicholson's argument for enrollment fees.
"We've got an inequity in the system that we're going to need to address," Buyer announced.
Nicholson presented a chart showing that military retirees under 65 pay $230 for individual TRICARE Prime coverage and, thereafter, monthly Medicare Part B premiums now set at $78.20.
At both hearings, Nicholson acknowledged that VA's proposed $70.8 billion budget could be $1.8 billion short if assumptions about new efficiencies and streamlining aren't met and if Congress fails the cost-savings initiatives, including limiting VA long-term care to veterans with service-connected disabilities and cutting VA nursing home capacity and state grants.
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