By Sandra Basu

Army Surgeon General Lt. Gen. Patricia Horoho

Army Surgeon General
Lt. Gen. Patricia Horoho

WASHINGTON—DoD and military healthcare officials warned lawmakers last month that a recent report’s recommendation to replace TRICARE with a selection of commercial insurance plans would be detrimental to medical training and readiness of military medical personnel.

“The loss of these beneficiaries from our direct system would pose tremendous risks to our training programs and negatively impact our medical forces readiness posture,” Army Surgeon General Lt. Gen. Patricia Horoho explained, telling lawmakers that the patients treated at MTFs are “vital to the sustainment of our 148 graduate medical and health professional education programs.”

Horoho made her comments at a hearing before a House Armed Services panel. In addition to Horoho, the two other military surgeons general and the assistant secretary of defense for health affairs also weighed in on recommendations made to DoD by the Military Compensation and Retirement Modernization Commission (MCRMC), an independent panel established to make recommendations on modernizing military compensation and retirement, including healthcare.

Among the report’s far-reaching recommendations is to replace TRICARE with a selection of commercial insurance plans, similar to the Federal Employees Health Benefits Program.

Jonathan Woodson, MD Assistant Secretary of Defense for Health Affairs, acknowledged during the hearing that “elements of TRICARE can be improved and must be improved,” but expressed concern about how a loss of patients would affect training of military medical personnel.

“The availability of case mix, volume and complexity and diversity is vital to having a trained and ready medical force,” added Deputy Navy Surgeon General Rear Adm. C. Forrest Faison III.

The report, which was released earlier this year, recommended that families of active duty members, reserve component members, retirees not eligible for Medicare and their families be given a variety of plans to choose from.

“AC families, RC members, and retirees could receive a better health care benefit by allowing them to choose from a selection of commercial insurance plans offered through a DoD health benefit program administered by the Office of Personnel Management,” the report explained.

As part of the recommendation, beneficiaries would continue to have access to MTFs as a venue of care, with the report recommending that insurance companies “should include MTFs in their networks and reimburse MTFs for the care delivered as they do any other provider.”

More Healthcare Options

During the recent hearing, lawmakers asked DoD officials what they thought about the idea of giving beneficiaries more healthcare options.

Air Force Surgeon General Lt. Gen. Mark Ediger told lawmakers he thought that the proposed change would “increase stress on airmen and families by requiring them to navigate a complex insurance marketplace on a recurring basis.”

Woodson, meanwhile, told lawmakers he did not think that beneficiaries were looking for more coverage options to sort through, but the ability to “see the provider that I want when I want.”

“When I go out and talk to folks and when I look at surveys, choice is not about wanting to navigate through 250 health plans,” Woodson recounted. “Choice is expressed to me as ‘ensuring I have a robust health benefit that will take care of my health needs when I want it,’” he said.

During the hearing, some of the legislators asked what other changes could be made to TRICARE without an act of Congress.

“How can we give you more flexibility today?” Rep. Tom MacArthur (R-NJ) asked.

Woodson cited the need for “new authorities” to “allow patients to flow from the markets to the MTFs,” including new ways of attracting Medicare-aged patients.

He further said the military health system needs broader authority to care for veterans and DoD civilians in MTFs.

“I think in fact that there is even an opportunity for us to take care of DoD civilians,” he said. “We have a lot of dual eligible folks who work for the federal government and have TRICARE benefits. Why not allow them to use TRICARE benefits within the MTFs? I think this would lead to proper utilization of the MTFs, proper market management and meet the case mix/skill mix issue.”

Military medical officials also told lawmakers they rejected a proposal in the report for a new four-star Joint Readiness Command (JRC), that would be created to manage the readiness of the military, including medical readiness.

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.

A joint statement from Woodson and the three surgeons general said DoD “believes that it currently has sufficient processes and governance structures to identify, track, and measure the readiness status of enterprise-wide and Service specific EMCs [essential medical capabilities] and therefore does not support creation of an additional new four-start combatant command.”