WASHINGTON, DC—A parade of military medicine top brass went before a House subcommittee last month to trumpet U.S. Defense Secretary Robert Gates’ latest attempt to increase TRICARE premiums in the FY 2012 budget. Previous efforts were rejected by Congress, but DoD officials anticipate that the more modest increase this time will have a better chance of passage.

“I would remind the committee that between 2001 and 2008 the rise of the cost of health care was about 11.8% per year. We are really desperately trying to bend that curve,” said Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD. Woodson testified before a House subcommittee last month alongside Undersecretary of Defense for Personnel and Readiness Clifford Stanley, PhD, and the Surgeons General from the Army, Navy and Air Force.

The cost-control initiatives would increase out-of-pocket costs for working age retirees for TRICARE and adjust prescription drug copayments. In addition, DoD is proposing internal efficiencies, such as reducing the number of TRICARE contractors, to reduce costs.

Armed Services Military Subcommittee Chairman Joe Wilson, R-SC, noted that the plan is a “more comprehensive approach than previous cost cutting efforts,” but that the challenge is finding “the right balance.”

“We must be sure to remember these proposals have complex implications that go beyond beneficiaries. They will also affect the people who support the defense health system, such as pharmacists, hospital employees and contractors,” Wilson said.

Stanley reminded the subcommittee that changes being currently proposed are “minimal efficiencies” compared to the more significant changes in previous years that were rejected by Congress. The proposed increases, which would not affect active-duty members and their families or Medicare-eligible TRICARE for Life enrollees, would move the annual fee from $230 a year to $260 a year for an individual and $460 a year to $520 a year for a family.

Stanley said the department had looked at other cost-cutting options, such as curtailing medical research, but ultimately had rejected them.

Subcommittee Chairman Questions Hiring Decision

Wilson also wanted to know whether the recent hiring of a former governor to study the military’s heath care costs was necessary. Former Maine Gov. John Baldacci is being paid $163,000 to review DoD health care programs for one year.

“Why is having a military health care czar not a duplication of the duties already assumed by Undersecretary Stanley and Assistant Secretary Woodson,” he asked.

He also questioned why Congress should enact the defense health costs efficiencies proposed by the Administration, if that work “could be overturned” by Baldacci’s review.

Stanley defended the hiring and said that the efficiencies proposed are not related to the work that Baldacci will do. Rather, he will provide an “objective” outside look to help with Guard and Reserve issues, as well as readiness, wellness, patient satisfaction and costs. Woodson also added that he did not believe that Baldacci’s mandate would interfere with his role as assistant secretary for health affairs.

TBI Care

The issue of traumatic brain injury (TBI) treatment also came up during the House subcommittee meeting, specifically on the use of hyperbaric oxygen therapy to treat TBI.

Rep. Allen West, R-FL, said that he had heard anecdotal evidence that the treatment is helping servicemembers with TBI who are seeking it outside the military. He wanted to know what the obstacles are in using the treatment within military facilities and whether the committee could do anything to remove those obstacles.

“I don’t think there is anything the committee can necessarily do for this,” Army Surgeon General Lt. Gen. Eric Schoomaker, MD, PhD., responded. “Hyperbaric oxygen is currently an FDA-regulated treatment and it is not currently approved by the FDA for treatment of either concussive injury or PTSD.”

While the treatment is being assessed in ongoing studies, without appropriate evidence it cannot be offered as a treatment by the military, he explained. “Despite a series of published and unpublished anecdotes there really remains no medical evidence that hyperbaric oxygen has a therapeutic role in the relief of symptoms of poor brain dysfunction for warriors with post concussive syndrome, TBI or PTSD. We can’t in good conscience provide care—which is quite expensive—without knowing its ultimate safety and utility.”

West said that he hoped “more emphasis” and “more speed” could be put to that research process. Rep Walter Jones, R-NC, also urged a speed up of the process. He said he too had talked with family members of injured servicemembers who had improved after having the treatment outside of the DoD medical system. “When do we get to the point that we say in DoD that this protocol does help, it does work?”

Navy Surgeon General Vice Adm. Adam Robinson said that study data has suggested that the therapy is safe, which is a “clear improvement” in knowledge about the use of hyperbaric oxygen in TBI treatment. He added that an Air Force study on the therapy has also been conducted and should provide more data when the results are released.

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