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