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Preventive care plan omits Tricare for Life

Budgetary rules forced a House subcommittee to take the unprecedented step of creating a new Tricare preventive health care program that does not apply to 1.5 million for Medicare-eligible retirees and their families in the Tricare for Life program.

Rep. Susan Davis, D-Calif., chairwoman of the House Armed Services military personnel panel, said the plan, approved Wednesday as part of the 2009 defense authorization bill, is aimed at cutting the military’s long-term health care costs by providing preventive care.

The personnel portion of the defense policy bill, approved by voice vote and with no debate, includes:

* A 3.9 percent military pay raise.

* Increases in Army and Marine Corps active-duty personnel and in Army National Guard and Army Reserve support personnel on full-time active duty.

* A tuition assistance program for military spouses.

* Permission for a Pentagon-proposed experiment under which active-duty members could take a break of up to three years in their military career.

The full armed services committee will take up the bill next week.

Davis said her subcommittee rejected a Pentagon request for a $1.2 billion increase in Tricare health and pharmacy fees but wants to look for other ways to hold down costs, which is why expanding preventive care is attractive.

“Preventive health care is important to the long-term health of our beneficiary population, and may reduce the amount of care required,” Davis said.

She called the initiative “preferable” to the Pentagon’s proposed increase in Tricare fees.

The preventive care plan would waive co-payments for certain treatments such as vaccinations, smoking cessation help, and breast and colorectal cancer screening. It would apply to Tricare Standard, Tricare Select and Tricare Reserve beneficiaries — but, because of budgetary procedures, not Tricare for Life.

Aides named two areas in which Tricare for Life beneficiaries would be treated differently than other Tricare users: shingle vaccinations and MRIs for mammograms.

Younger retirees would receive these services for free, but Tricare for Life users would have to pay, either directly or by buying supplemental Medicare insurance, aides said.

Rep. John McHugh of New York, the subcommittee’s ranking Republican, said this would be the first instance of differences in what is covered under Tricare, and also promised to work to try to find funding to offset that action.

There are two kinds of spending in the defense budget: discretionary, which applies to personnel, operating and acquisitions costs and construction programs; and mandatory, also known as direct spending, for programs such as retired pay, GI Bill benefits for reservists, and some health care expenses, including Tricare for Life.

Davis said only congressional leaders can resolve the funding problem because direct spending involves programs such as Social Security, Medicare, Medicaid and federal civilian retired pay that fall outside the jurisdiction of the armed services committee.

Congressional leaders could agree to an offset by cutting other direct spending or could find another way to fund preventive care, subcommittee aides said.

Steve Strobridge, government relations director for the Military Officers Association of America, said he understands the dilemma facing the subcommittee and agrees that what they did “is certainly preferable to not doing anything.”

“We have been very supportive of preventive care programs,” he said. “It only makes common sense that if you come up with programs like smoking cessation that it is going to save money in the long run.”