Medical reform for elderly military delayed till 2001

Congress this year will establish a significant beachhead for elderly military beneficiaries in their fight to win lifetime health benefits, said Sen. John Warner, R-Va., chairman of the Senate Armed Services Committee.

But these same 1.4 million Medicare-eligible beneficiaries will have to wait until at least next year, Warner said, to learn whether the new "TRICARE-for-Life" reforms will become a permanent benefit.

The Warner amendment to the 2001 defense authorization bill would open TRICARE Prime, the military’s managed care plan, and TRICARE Standard, its fee-for-service health insurance, to all elderly beneficiaries who have Medicare Part B coverage. The effective date is Oct. 1, 2001.

Beneficiaries now are dropped from Prime or lose use of Standard, formerly CHAMPUS, the day they turn 65. A year from now, Prime would be opened to all elderly living near military bases. Those who decline to enroll, or who live too far from a base to use Prime, could use the Standard plan as second payer to Medicare. Coverage usually will include all co-payments and deductibles.

To use these two options, elderly only would need to pay Medicare Part B premiums which, for individuals who enrolled at 65, are $45.50 a month.

Warner and Sen. Tim Hutchinson brought their health reform amendment to the Senate floor last June expecting to make it permanent. Democrats, however, said the $40 billion cost, over 10 years, violated the Senate’s budget resolution. Warner opted to pare costs by limiting the TRICARE-for-Life program to two years, through September 2003. He also promised to find a way to make the reforms permanent so retirees by next October can feel comfortable deciding whether to drop their Mediplus insurance.

The House hadn’t passed such a robust health reform package in its version of the 2001 defense bill but Warner, for months, sounded confident the Senate version would prevail in negotiations.

On Sept. 21, as conferees put final touches to the bill, Rep. Steve Buyer, chairman of the House military personnel subcommittee, decided not only to embrace the Warner amendment but go it one better. In an unusual move while the closed-door conference continued, Buyer unveiled publicly a "Warner-Buyer" proposal to make TRICARE-for-Life permanent. He would remove Warner’s sunset provision and order the program funded after September 2003 as an "entitlement," using money outside the defense budget.

Warner led conferees to reject the Buyer proposal, arguing that Buyer’s attempt to end "uncertainty" for retirees not only would put their benefits at risk but the entire defense bill. Warner explained his concerns in a Sept. 27 interview.

"Next year if (Republicans retain the Senate majority and) I’m chairman, I will put in, as bill number one, to make this health program permanent," Warner said. "But right now I’ve got but a few days, before the Senate and the House stop for the year, to get through a conference report covering the entire military and $300-plus billion. I cannot risk the Senate stopping that bill on a point of order.

"I started this in February," Warner said. "Step by step, with the help of the great outside military organizations, I strengthened this bill three times. In the last four or five days of the conference, Buyer tried to establish this as a permanent situation. Certainly we all, including this senator, would like to see it permanent."

Though making TRICARE-for-Life permanent will be his top priority next year, Warner said reaching it won’t be easy. Program costs start out below the average of $4 billion per year over 10 years, but quickly build. The Joint Chiefs, Warner confirmed, are concerned about draining funds from programs with a more direct impact on readiness.

After introducing a bill next year to make TRICARE-for-Life permanent, Warner said he will hold talks with the chairman of the Senate Budget Committee, now Sen. Pete Domenici, R-N.M., on how to pay for it. "We have to spell out the dollar consequences for three or four years, to convince them," Warner said. There are other near-term pitfalls, he suggested.

"This retiree health program is a major accomplishment. At the moment, there’s no comparable program to fix Medicare and Medicaid. So a lot of folks, nonmilitary, are still hanging out there," Warner said. "That’s another reason I don’t want to get into points-of-orders on the floor, and have somebody get up and say, ‘Wait a minute. Before we fix the military, let’s fix Medicare and Medicaid.’ "