Monday, October 12, 2009

TO ALL MILITARY RETIREES

(Analyst's note:   Earliest possible action is absolutely required on this one.)


This is true. It is on pages 77, 172, 218, and 434. You have to dig to see the charges. We (retirees) would lose the Medicare for life benefit and would have to pay. We would lose TRICARE as a total care package. We would not be allowed to keep TRICARE so when Obama stands and says if you like what you have you can keep it, he lies.

             This is a "Heads Up" on a battle we are facing now and down the road with the new Administration. The Congressional Budget Office (CBO) has already drafted proposed legislation that would basically reduce our TRICARE for Life benefits to a system whereby we pay deductibles and co-pays up to $6,301 the first year for you and your spouse, with future years being indexed to increase with inflation. What can we do?  The article below, obtained from an Air Force Association and written by BG Bob Clements, best describes what we can do.  Please read it and check the links for CBO language and do what Bob says-Send this email to every Military Retiree you know and write and email your Congressman often. For those of you that might have voted for "Change", you should do it more than often!

             

             TRICARE FOR LIFE'S FUTURE . . .

             TRICARE For Life was instituted to correct the broken promise that military retirees would receive free healthcare coverage for life and it covers the Medicare co-pay. Now a heavy assault has begun on Veterans'/Retirees' benefits to pay for other programs our President promised during the campaign. And it is a high priority of his administration. The one item of most interest to Retired Military is in Article 189. If approved by Congress the first assault wave would hit in 11 and would hit hard. It would initiate cost sharing to require retirees to pay the first $525 of medical cost and 50% of the next $4,725 for a first year cost of $2,888 per person.  It would be indexed to increase with inflation A reason given for this action (for PR effect) is "overuse" by Retirees

             For those of you who are covered by TFL you will want to pay attention (Below) to what BG Bob Clements has surfaced about the future of TFL. In any case, on page 189 of the Congressional Budget Office report, see the note below on how to get to that spot, there is a strong recommendation to eventually eliminate the program as it is too expensive. Just another move to slight those of us who dedicated much of our adult lives to the defense of our country.
      


             Strongly recommend that you contact your elected officials and register your strong opposition to the elimination of the TFL program. Heads-up from BG Bob Clements, USAF Ret (P38 Bob)

                 The following has been added to the Congressional Budget Office Web Sitewww.cbo.gov/   a. Budget, Options, Volume 1: Health Care
www.cbo.gov/doc.cfm?index=9925


                 For those who have never opened one of these web sites from OMB :

                 1. double click on the above URL

                 2. click on PDF

                 3. click on the binoculars

                 4. do a search for TFL

                 Now here it is folks and I will guarantee if you sit around on your behind and do nothing about it as they bring these options forward this coming year, you will lose one of the best healthcare benefits that the Medicare eligible retired military have. It   is short of the promises made that we fought so hard for back in the late 90s and early 00s but it is still the best healthcare program that anyone in the United States has, bar none.

                People who are professionals always look for the channel of least resistance when it comes to cutting money out of the Federal and DOD budget. I can tell you this straight on, military retirees are one of those channels of least resistance noted for sitting around, doing nothing, and waiting for ole Joe to do it for them. You had better wake up Your medical benefits are prime target. If you lose them, you have nobody to blame but yourself. Let me repeat that . . . you have nobody to blame but yourself.

                 The way to secure your benefits is to write to your members of Congress and to keep writing and writing and writing. ONCE IS NOT ENOUGH!! Keep repeating the above statement until you are blue in the face.

                 Now I'm going to make one more statement to all of you younger people out there who are not yet eligible for TRICARE for Life. HEALTH CARE WILL EVENTUALLY BECOME THE DOMINATING FACTOR IN YOUR LIFE. Remember that . . . it will impact you big time with the utmost in cruelty unless you are fortunate enough to die from a heart attack or get run over by a truck.

                 The service organizations will put up a fight, but, they will need your help and can't do it by themselves. I hope this makes it clear as to what you can expect if you do nothing.

                 To show you how stupid these professionals can be at times just read the data on the noted sites closely. You will see that in spite of the MTFs (Military Treatment Facility) need to get patients back to keep their doctors busy and the hospitals from going to clinic status, these people from OMB would employ a means to keep retirees from using MTF facilities by charging them a fee for services. How dumb can you get.

                 Even if you are an Obama fan, and believe that changeth cometh, TFL option from OMB will not go away. They need the money they spend on you for other programs for people who produce nothing but vote to keep their boss in office. If you know of anyone who is Retired Military, please forward this on to them.

             Remember- TFL is an "Earned Benefit" that's been granted by a previous Congress.

CHAPTER NINE BUDGET OPTIONS, VOLUME 1: HEALTH CARE 175
9
Option 96
Introduce Minimum Out-of-Pocket Requirements Under TRICARE For Life
TRICARE For Life (TFL) was introduced in 2002 as a
supplement to Medicare for military retirees and their
family members who are eligible for Medicare. The program
pays nearly all medical costs not covered by Medicare
and requires few out-of-pocket fees. Because the
Department of Defense (DoD) is a passive payer in the
program—it neither manages care nor provides incentives
for the cost-conscious use of services—it has virtually no
means of controlling the program’s costs. In 2008, DoD
spent about $8 billion on TFL-eligible beneficiaries in addition
to amounts spent for those individuals by Medicare.
This option would help reduce the costs of TFL, as well
as costs for Medicare, by introducing minimum out-of pocket
requirements for beneficiaries. Under this option,
TFL would not cover any of the first $525 of an enrollee’s
cost-sharing liabilities for calendar year 2011 and would
limit coverage to 50 percent of the next $4,725 in Medicare
cost sharing that the beneficiary incurred. (Because
all further cost sharing would be covered by TFL, enrollees
could not pay more than $2,888 in cost sharing in
that year. Those dollar limits would be indexed to growth
in average Medicare costs for later years.) The true out of-
pocket provisions in Medicare’s prescription drug program,
or Part D, are an example of how this option could
work in practice. Under that program, any amounts paid
by Medicare or by any other insurer are not included
when calculating whether a beneficiary has reached the
level of eligibility for catastrophic coverage.
Currently, military treatment facilities (MTFs) do not
charge eligible individuals copayments for medical services
or pharmaceuticals. In order to reduce beneficiaries’
incentive to switch to MTFs and avoid the minimum
out-of-pocket requirements that are central to this
option, DoD would need to establish procedures for collecting
payments from TFL beneficiaries seeking care
from MTFs.
If the savings that would accrue from reduced spending
for Medicare were included, the introduction of cost
sharing under this option would reduce the federal
spending devoted to TFL beneficiaries by about $14 billion
through 2014 and by about $40 billion through
2019. Approximately 22 percent of those savings would
come from a reduced demand for medical services rather
than from a transfer of spending from the government to
military retirees and their families.
An advantage of this option is that greater cost sharing
would increase TFL beneficiaries’ awareness of the cost of
health care and promote a corresponding restraint in
their use of medical services. Research has generally
shown that introducing modest cost sharing can substantially
reduce medical expenditures without causing measurable
increases in adverse health outcomes.
Among its disadvantages, this option could discourage
some patients (particularly low-income patients) from
seeking preventive medical care or from managing their
chronic conditions under close medical supervision,
which might negatively affect their health.
«CBO»
Option 97
Increase Medical Cost Sharing for Military Retirees Who Are Not Yet
Eligible for Medicare
a. Some of those estimated revenues would come from Social Security payroll taxes and so would be classified as off-budget.
b. Estimates exclude the potential effect of changes in discretionary spending.
In the mid-1990s, the Department of Defense (DoD)
instituted a plan called TRICARE to provide health care
for members of the military and their dependents, as well
as for eligible military retirees and their families.
TRICARE comprises three different options: an option
similar to a health maintenance organization (HMO),
called TRICARE Prime; an option with a preferred-provider
network, called TRICARE Extra; and a traditional
fee-for-service plan, called TRICARE Standard. When
most military personnel enter the armed forces, they are
between 18 and 22 years of age, and they are able to retire
after serving 20 years. Military retirees who are not yet
eligible for Medicare (generally those ages 38 to 65) may
enroll in TRICARE Prime by paying an annual enrollment
fee of $230 (for single coverage) or $460 (for family
coverage). In addition, those Prime enrollees make a
$12 copayment for each outpatient visit to a civilian physician
or other civilian health care provider (visits to military
providers are free). Those who do not enroll in
TRICARE Prime may receive benefits under TRICARE
Extra or Standard. Beneficiaries who use either one of
those two plans must pay an annual deductible of $150
(single coverage) or $300 (family coverage) before typical
cost-sharing rates apply. The TRICARE enrollment fees,
copayments, and deductibles have remained unchanged
since 1995.
Military retirees enrolled in TRICARE Prime bear
smaller costs than would be owed under typical civilian
plans. DoD has estimated that a typical military retiree
and his family who enrolled in the Prime plan faced
about $780 in annual out-of-pocket costs (that is, TRICARE
copayments and the enrollment fee) in 2007,
whereas a comparable family enrolled in an HMO
through a civilian employment-based plan paid $3,950
(as the employee’s share of the premium plus copayments).
TRICARE Prime beneficiaries also use the system
more than comparable civilian beneficiaries do: DoD
estimates that the rate of utilization of inpatient services
is 58 percent higher and the outpatient utilization rate
39 percent higher for Prime enrollees than for civilian
HMO enrollees.1
This option would raise the enrollment fees, copayments,
and deductibles for younger military retirees who wished
to use TRICARE. Single beneficiaries could enroll in
TRICARE Prime by paying a $550 annual fee, and families
could enroll for $1,100 annually. The family enrollment
fee of $1,100 per year is approximately equivalent
to the $460 fee first instituted in 1995, after an adjustment
for the nationwide growth in health care spending
per capita. Under this option, each medical visit to a civilian
Prime provider would entail a copayment of $28,
which, again, is approximately equivalent to the amount
that was established in 1995. Copayments for mental
health visits and inpatient care would also be adjusted
accordingly. Single retirees (or their surviving spouses)
who used TRICARE Standard or Extra would face an
annual deductible of $350; the deductible for families
would be $700. Those increases would also be consistent
with the nationwide growth in per capita health care
spending. In addition, and for the first time, users of
TRICARE Standard or Extra would be required to enroll
and pay a $50 annual fee for single coverage and a $100
annual fee for family coverage. For people currently serving
in the military and for their families, enrollment fees,
copayments, and deductibles in the three plans would
remain at their current levels.
The option would reduce DoD’s outlays in three ways.
First, the increased fees would be used to directly offset
the costs of treating military retirees. Second, the higher
out-of-pocket costs would induce some retirees who
would otherwise have used TRICARE to enroll in a civilian
health plan instead. Third, the higher copayments
and deductibles would reduce the use of health care services
by military retirees who remained in TRICARE.
DoD’s precise cost savings under the option are difficult
to predict because they would depend on how strongly
people responded to the new fee structure. The net effect
on the federal budget is also difficult to predict because
increased fees may cause eligible retirees to switch to
other federal programs, such as Medicaid (if an individual
has low income), the Federal Employees Health Benefit
(FEHB) program (if a person is employed as a civilian by
the federal government), or the Veterans Health
Administration. An estimate of the effects of increasing
TRICARE fees, copayments, and deductibles is that
discretionary outlays would be reduced, on net, by
about $25 billion over the 2010–2019 period, under the
assumption that appropriations were reduced
accordingly. This option would increase mandatory
spending for Medicaid and for FEHB annuitants by
$1 billion over the same period, and it would reduce revenues
by $4 billion. The drop in revenues would occur
because some of the retirees who left TRICARE would
switch to employment-based health benefits, leading to a
shift in compensation from taxable wages to nontaxable
fringe benefits.
The increased fees for retirees would not affect service
members currently on active duty or in the reserves. In
fact, only about 15 percent of enlisted service members
and approximately 50 percent of officers remain for an
entire career and qualify for retiree health benefits.
Much of the estimated savings under this option stems
from increasing the enrollment fees charged for TRICARE
Prime, with the expectation that some current
users would leave the system and some potential users
would seek care elsewhere. Although researchers have
found that increasing cost sharing can reduce medical
expenditures without adversely affecting the health of the
average person, an argument against implementing the
higher fees set out in this option is that they could discourage
some people from seeking health care or treating
their illnesses in a timely manner.
«CBO»
RELATED CBO PUBLICATIONS: Evaluating Military Compensation, June 2007; Military Compensation: Balancing Cash and Noncash Benefits,
Issue Brief, January 16, 2004; and Growth in Medical Spending by the Department of Defense, September 2003
Total
(MILLIONS OF DOLLARS) 2010 2011 2012 2013 2014 2010-2014 2010-2019
Change in Mandatory Spending 10 30 50 70 80 240 1,040
Change in Revenuesa -40 -130 -260 -300 -350 -1,080 -4,000
Net Effect on the Deficitb 50 160 310 370 430 1,320 5,040
Change in Discretionary Spending
Budget authority -200 -1,400 -2,000 -2,200 -2,500 -8,300 -26,000
Outlays -200 -1,200 -1,800 -2,100 -2,400 -7,700 -24,800
1. Department of Defense, Evaluation of the TRICARE Program:
FY2008 Report to Congress (February 29, 2008).

Option 98
Require Copayments for Medical Care Provided by the Department of Veterans
Affairs to Enrollees Without a Service-Connected Disability
Note: Discretionary savings accrue to the Department of Veterans Affairs; increases in mandatory outlays are projected for the
Medicare and Medicaid programs.
In 2008, just over 5 million veterans received medical
care from the Department of Veterans Affairs (VA). All
VA patients are enrolled in one of eight priority care
groups, determined on the basis of income, disability status,
and other factors. Currently, veterans in Priority
Groups 6 to 8, the lower-priority groups, are charged
copayments (and the health plans of any who have private
insurance may be billed) for treatment of nonservice-
connected conditions.
This option would increase out-of-pocket costs for veterans
in Priority Group 5—those who do not have serviceconnected
disabilities and whose income is below a VAdefined
threshold. The option is targeted toward the largest
priority group (31 percent of VA enrollees) that consumes
the greatest share (33 percent) of VA’s medical
resources each year. Currently, those patients pay no fees
for inpatient or outpatient medical care, although veterans
in this group who earn more than the VA pension
level ($11,000 or more per year, depending on whether
the veteran has a spouse or dependents) pay $8 per prescription,
up to an annual cap of $960. This option
would maintain that prescription copayment for higherincome
enrollees but also institute copayments of $1 for
prescriptions that the lowest-income enrollees fill at VA
facilities and copayments of between $1 and $2 for each
health care encounter that veterans in Priority Group 5
have with the VA medical system. Such increased cost
sharing for Priority Group 5 veterans would reduce discretionary
spending for VA medical services by about
$3 billion over the five-year period from 2010 through
2014. Although VA-provided medical care would remain
less expensive than alternative care for many veterans,
some of those for whom VA facilities were less convenient
might switch to civilian providers and services funded
under Medicare or Medicaid, and mandatory spending
for those programs would increase by $200 million for
that same period. From 2010 through 2019, this option
would reduce discretionary outlays by $7 billion but
would increase mandatory outlays by $420 million.
A rationale for this option is that increased cost sharing
for veterans in Priority Group 5 could reduce VA’s spending
by making those veterans more cost-conscious in
their demand for health care services. An argument
against the option is that it focuses on one of the poorest
groups of veterans and leaves unchanged the out-ofpocket
expense of those in lower-priority groups. Veterans
in Priority Groups 6 to 8—a population that is
expected to equal 33 percent of VA enrollees and consume
15 percent of VA’s medical resources in 2009—
make copayments, and their insurance plans (if any) are
billed; however, the resulting revenue covers about a fifth
of the cost of their care. (Net of copayments, those veterans
are expected to consume 13 percent of VA’s medical
resources.) Veterans in Groups 6 to 8 have more income
than veterans in Group 5, lending support to the argument
that VA should concentrate first on recovering
additional costs from those lower-priority groups through
higher copayments and improved billing practices. However,
such changes are unlikely to substantially reduce the
growth in VA’s medical spending.
«CBO»
Total
(MILLIONS OF DOLLARS) 2010 2011 2012 2013 2014 2010-2014 2010-2019
Change in Mandatory Spending 40 40 40 40 40 200 420
Change in Discretionary Spending
Budget authority -580 -630 -650 -670 -700 -3,230 -7,060
Outlays -540 -620 -640 -670 -690 -3,160 -6,970
RELATED CBO PUBLICATIONS: Statement of Allison Percy, Principal Analyst, Congressional Budget Office, Future Medical Spending by the
Department of Veterans Affairs, before the House Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, Committee on
Appropriations, February 15, 2007; Potential Growth Paths for Medical Spending by the Department of Veterans Affairs, Letter to the
Honorable Larry E. Craig, July 14, 2006; and The Potential Cost of Meeting Demand for Veterans’ Health Care, March 2005     


No comments: