Lawmakers took steps this past week to put servicemembers and their families at ease over how Tricare benefits will be protected and, for older children, how coverage could be expanded as the Obama administration implements health care reform.

But Congress continued to take temporary steps to relieve another source of anxiety for Medicare and Tricare users — a scheduled 21.2 percent reduction in reimbursements to participating doctors. If such a cut were to take effect, it could severely crimp access to care.

First, some good news.

• Expanded child coverage: A key feature of national health care reform is a requirement that commercial health insurance firms allow family plans to cover children until age 26. Gathering steam now, separately, is a similar expansion of Tricare to older military children.

Sen. Mark Udall, D-Colo., was joined by three Democratic colleagues Wednesday in introducing a bill to allow Tricare coverage to children until age 26 for what Udall called a “reasonable premium.”

Tricare now covers children until age 21 or, if they are full-time college students, until age 23. Udall’s bill is identical to the Tricare Dependent Coverage Extension Act (H.R. 4923) introduced in the House last month by Rep. Martin Heinrich, D-N.M.

Both Udall and Heinrich serve on the armed services committees, which are expected to embrace the bill and make it part of the fiscal 2011 defense authorization act to be passed later this year.

The start date proposed for expanded child coverage is Oct. 1, 2010. But that likely will be pushed back to give Tricare officials more time to implement the change.

• Tricare protection affirmed: The Senate passed and sent to the president the Tricare Affirmation Act which explicitly states what Democrats say they did not doubt: that Tricare meets minimum requirements for individual health insurance under the health reform law.

Sen. Jim Webb, D-Va., introduced identical legislation in the Senate, which was approved by unanimous consent April 12. Webb said it should reassure Tricare beneficiaries, as well as Defense civilian workers in non-appropriated fund activities including military exchanges, that their health benefits satisfy and are not negatively harmed by national health reform.

• Medicare/Tricare reimbursements: A Medicare fee formula Congress adopted more than a decade ago has been mandating cuts in doctor fees for years. Lacking political will either to impose the cuts or to replace the formula, lawmakers voted year after year to suspend the formula’s effect.

The result has been a growing budget hole for Medicare and a chronic threat of deeper and deeper fee cuts for physicians who treat Medicare and Tricare patients. Tricare fees are limited by Medicare rates.

The formula, if allowed to take effect this year, would drop Medicare fees for doctors by 21.2 percent. Congress passed temporary measures to delay its effective date from Jan. 1 this year to March 1, then to April 1. But the Senate left for Easter recess without approving the last delay, leaving the rate cuts to take effect in mid-April unless retroactive relief is passed.

Medicare officials did delay sending out reimbursement checks for several days in April awaiting tardy Senate action to suspend the reduced doctor fees.

To replace the formula and make a permanent doctor pay fix, Congress would need to find $240 billion in offsets or allow the budget deficit to climb by suspending pay-as-you-go deficit reduction rules.

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