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Issue Raised: Should TRICARE Be Replaced by Commercial Insurance?

by U.S. Medicine

March 9, 2015

By Sandra Basu

WASHINGTON – DoD should replace TRICARE with a selection of commercial insurance plans, similar to the Federal Employees Health Benefits Program, a recent report suggested.

Last March, Alphonso Maldon, Jr., chairman of the DoD Military Compensation and Retirement Modernization Commission, asks for servicemembers' ideas for improvement at Camp Pendleton, CA. Photo by Lance Cpl. Caitlan Bevel

Last March, Alphonso Maldon, Jr., chairman of the DoD Military Compensation and Retirement Modernization Commission, asks for servicemembers’ ideas for improvement at Camp Pendleton, CA. Photo by Lance Cpl. Caitlan Bevel

Such a change should apply to families of active duty members, reserve component members, retirees not eligible for Medicare and their families, according to the Military Compensation and Retirement Modernization Commission (MCRMC), an independent panel established by law to make recommendations to modernize military compensation and retirement, including healthcare.

“Under an insurance model, the ease and timeliness of patients’ access to healthcare would improve because beneficiaries would not be subject to DoD’s lengthy and frustrating process for making appointments and obtaining referrals,” the report explained.

As part of this recommendation, beneficiaries would continue to have access to MTFs as a venue of care, with MTFs included in health insurance networks and reimbursed as any other provider.

The TRICARE proposal was only one of 15 recommendations made by the panel.

At a Senate hearing last month, MCRMC Chairman Alphonso Maldon, Jr., explained that the commission’s work “represents the most comprehensive review of military compensation and benefits since the inception of the all-volunteer Force.”

The highly anticipated commission report came shortly before President Barack Obama announced his proposed FY 2016 DoD budget request of $585.3 billion in discretionary budget authority to fund both base budget programs and Overseas Contingency Operations. That budget request included a proposal to consolidate TRICARE healthcare plans and seeks changes to the pharmacy copay structure.

DoD leaders said the independent commission’s recommendations were not reflected in the proposed budget request but that they planned to review the commission’s recommendations.

“The department owes the president our views and analysis, and then he in turn owes a recommendation or an opinion on these recommendations to the Congress, I believe, in 60 days,” Under Secretary of Defense Mike McCord said at a budget briefing last month.

Both the House and Senate Armed Services Committees also were holding hearings on the details of the commission report, as of last month.

“As this committee evaluates the commission’s recommendations to modernize military compensation and benefits, we must carefully consider how any changes in compensation and benefits will motivate young people today to serve in the 21st century,” Senate Armed Services Committee Chairman John McCain (R-AZ) said at a hearing last month.

Much to Debate

Congress, DoD and advocacy groups will likely have much to debate when it comes to the far-reaching proposals.

In addition to replacing TRICARE, the report recommends creation of a new four-star Joint Readiness Command (JRC) to manage the readiness of the military, including medical issues. The commission explained that the JRC “should focus on the military personnel aspects of DoD’s ability to train, mobilize and deploy an integrated and ready active and reserve component force to support assigned missions.”

When it comes to the readiness of the medical force, JRC should “include a subordinate joint medical function whose primary responsibilities include advising the JRC commander on the readiness status of the medical force, determining joint medical doctrine and requirements and advising joint sourcing of medical assets,” the report explained.

“Ensuring that the hard-fought progress achieved during the past decade in the delivery of combat casualty care on the battlefield, the global capability for evacuating casualties and providing critical care while in transit, and the research that has led to advances in wound care and hemorrhage control, requires strong oversight at the highest level,” the document stated.

As part of its recommendations, the commission also said that “beneficiary care might not sufficiently provide ideal training opportunities” for the medical force to sustain and maintain medical capabilities. It suggested that “attracting a different mix of medical cases into MTFs could better support combat-care training and medical readiness,” and that “new tools” could be used to achieve this.

“For example, alternative prices could be established for certain procedures that would provide the necessary access to complex medical cases and contribute directly to maintaining the readiness of the medical force. Establishing commercial reimbursement rates and associated billing systems, improving authorities and allowing greater access to veterans and civilians with relevant complex medical cases and trauma that contribute to essential medical capabilities all would provide military hospitals and clinics more opportunities for training the military medical force,” the report stated.

Unified Formulary

The commission also said that DoD and VA needed to create a uniform formulary to include all the drugs identified as critical “for transition, beginning immediately with the pain and psychiatric classes of drugs.” Currently, DoD and VA do not have all of the same medications on their formularies.

Retired Army Gen. Peter Chiarelli, one of the nine commissioners on the panel, told lawmakers at a Senate hearing last month that this is an issue especially important to addressing suicides.

“If there is anything we can fix to get at this suicide problem, it would be to make sure that when we get a kid on the right drug, at the right dosage, wherever he goes in the system, he is able to get that same drug and not be told ‘I’m sorry that is not on our drug formulary,’” Chiarelli said.

 


4 Comments

  • Marshall says:

    I think not. As a retired member of the armed services I find Tricare fairly easy to use for myself and my family. Replacing it with commercial insurance will surely lead to increased costs for something that was always supposed to be free in the first place.
    Just give the military and retired members a cost of living adjustment similar to that of the congress and we might all stop complaining.

  • Marshall says:

    I think not. As a retired member of the armed services I find Tricare fairly easy to use for myself and my family. Replacing it with commercial insurance will surely lead to increased costs for something that was always supposed to be free in the first place.
    Just give the military and retired members a cost of living adjustment similar to that of the congress and we might all stop complaining.

  • Georgia Gill says:

    There is no lengthy frustrating process of making appointments and obtaining referrals with tricare standard. This is just another round of attacks targeting the retirement healthcare benefit promised to volunteer service members. The healthcare benefit served as a major motivator to career service. Now after the member has paid their part with many years of dedication, sacrifice and risk and often injury, the benefit is again under fire.
    Most likely, benefits will also be based on “need” not provided as an earned benefit much like the current VA care which is not available as the free benefit previously promised for service but instead provided at a charge to those who continue to work and earn a living after completing their military career.

  • Georgia Gill says:

    There is no lengthy frustrating process of making appointments and obtaining referrals with tricare standard. This is just another round of attacks targeting the retirement healthcare benefit promised to volunteer service members. The healthcare benefit served as a major motivator to career service. Now after the member has paid their part with many years of dedication, sacrifice and risk and often injury, the benefit is again under fire.
    Most likely, benefits will also be based on “need” not provided as an earned benefit much like the current VA care which is not available as the free benefit previously promised for service but instead provided at a charge to those who continue to work and earn a living after completing their military career.


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