Members of the Task Force on the Future of Military Healthcare learned last week why The Military Coalition may be the most formidable lobbying force ever to fight on behalf of servicemembers, retirees and families.

Representing more than 30 service associations, TMC leaders appeared before the congressionally created task force like a steel wall of opposition to plans to raise Tricare fees, co-payments or deductibles.

Tricare rates haven’t been adjusted since they were set in 1995. But rather than concede a single point to panel economists that an increase is past due, coalition representatives attacked on multiple fronts.

Their new theme for deflecting higher fees, expressed often during the March 7 meeting and in a glossy brochure from the Military Officers Association of America, is that retiree premiums have been “paid in full” by retirees “through decades of arduous service and sacrifice.”

Five coalition witnesses presented now-familiar arguments for rejecting higher fees, including that Department of Defense officials have failed to act on a host of alternative cost-saving moves. Also, it’s not right to raise fees in wartime and the treatment of outpatients at Walter Reed Army Medical Center is fresh evidence of the strain on members and families. But the coalition also had new arguments.

If defense officials are so worried about flat fees, said retired Air Force Col. Steve Strobridge, TMC’s co-chairman and director of government relations for MOAA, why haven’t they raised the 15-cents-a-mile reimbursement rate that has been paid since 1985 to servicemembers moving personal vehicles during stateside change-of-station moves?

Also, given DOD’s call to raise Tricare fees on retirees under age 65, Strobridge asked the task force to consider the financial impact that population felt from active-duty pay caps imposed in the 1980s and ’90s.

“People who retired in 1995, the year that the current Tricare fees went into effect, lost 12.6 percent of their retired pay,” Strobridge argued. A senior enlisted (E-8) who left after 26 years is “forfeiting $3,700 a year this year and that will grow every year for the rest of his life. … The government has no plans to make up those years of pay losses.”

Joseph L. Barnes, the other TMC co-chairman and National Executive Secretary of the Fleet Reserve Association, presented five health care cost “principles” the coalition supports:

Active-duty members and families should be charged no fees except retail pharmacy co-pays and to the extent they make the choice to participate in Tricare Standard, the fee-for-service option, or use out-of-network providers under Tricare Prime.Any annual adjustment to fees, deductibles and co-payments for retirees and survivors should not exceed inflation as measured by the Consumer Price Index.The Tricare Standard co-pay should not be increased.No enrollment fee should be attached to Tricare Standard because it does not assure access to participating Tricare health care providers.There should be one Tricare fee schedule for all retirees and not vary by rank as DOD proposed. Any adjustment should still leave fees well below the lowest tier DOD officials recommended last year.Barnes complained that Defense officials chose a holiday weekend late last year to request nominees to fill the lone task force slot designated for a beneficiary advocate. Officials chose Army Reserve Maj. Gen. Robert Smith, past president and current board member of the Reserve Officers Association. At the meeting, ROA national president, retired Navy Reserve Capt. Michael P. Smith, affirmed ROA’s conditional support for raising Tricare fee increases “as needed.”

But Rick Jones, legislative director of the National Association for Uniformed Services, a coalition member, put the task force itself on the defensive, citing widespread concern that it had been “hand selected” by Defense officials to endorse steep Tricare fee increases.

Jones referred to remarks made by some task force members that suggest they favor fee hikes. He also noted that the fiscal 2008 defense budget request assumes $1.9 billion in Tricare savings on the basis of recommendations expect from the task force later this year.

Gail R. Wilensky, task force co-chair, reminded Jones that it was Congress that directed Defense officials to select task force members. It set some specific selection criteria regarding health and management expertise.

As to the $1.9 billion in assumed budget savings linked to the task force, Wilensky said “that was done without our knowledge or advice. I look on that as [DOD’s] problem, not our problem.”

Larry Lewin, a health efficiency consultant, was one of several task force members to assure the coalition they are looking for ways to control defense health costs with an open mind. But Lewin challenged coalition arguments that military people should have only positive incentives to make cost-effective health choices such as eliminating co-payments on mail-order drugs. The coalition testified against disincentives like a sharp rise in co-payments for drugs dispensed in the Tricare retail network.

“We’re saying why use the stick before you use the carrot,” said Strobridge.

“In reality you need both,” said Lewin. Experience “with both Medicare and commercial insurance will bear that out,” he said.

Robert Hale, another task force member, challenged the coalition’s call to index Tricare fees, if at all, only to the Consumer Price Index rather than to changes in health care premiums nationwide.

“I think that guarantees a continuing, declining cost share” for beneficiaries, Hale said. Coalition witnesses weren’t too concerned.

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