Veterans cautious of health reform

By Tom Philpott: PNT columnist

As House and Senate Democrats negotiate a final compromise national health care reform bill, military people across the nation — and their advocates in Washington D.C. — remain vigilant for side effects.

The Obama administration and Democratic congressional leaders have tried to reassure military members, retirees and veterans that national health care reform won’t negatively impact them — in fact it will help veterans.

Indeed Democrats contend that if the Senate-passed Patient Protection and Affordable Care Act (HR 3590) becomes law, many of 16 million veterans not enrolled in VA health care “will have access to quality, affordable health insurance choices through [new] health insurance Exchanges…and may be eligible for premium tax credits and cost-sharing reductions as well.”

A two-page list of reassurances from the Senate Finance Committee can be read online at: http://dpc.senate.gov/healthreformbill/healthbill51.pdf

Many military retirees and veterans don’t believe it. Their skepticism is reinforced by statements from Republicans who oppose the president’s health initiative, and by scary e-mails including one from a retired brigadier general who wrongly asserts that the Congressional Budget Office (CBO) already has drafted a bill to eliminate TRICARE for Life. It has not.

The House-passed Affordable Health Care for America Act (HR 3962) states in Section 311 that “nothing” in the bill “shall be construed as affecting” authority of the Defense or Veterans Affairs department to provide TRICARE or VA health care. The final compromise is almost certain to include this language to protecting TRICARE and veterans’ health care, Capitol Hill sources said.

Behind the anxiety of many older retirees is memory of a broken promise over free health care for life, said Joe Barnes, national executive director of the Fleet Reserve Association. That, combined with the endless loop of misinformation on the internet, has deepened concerns, Barnes said.

Joyce Raezer, executive director of the National Military Family Association (NMFA), believes legitimate concerns do remain for the military community.

Health reform plans would create health insurance “exchanges” from which individuals and small business will buy coverage. Raezer wants to know what will happen if participating insurance companies try to entice physicians to be part of these plans by paying fees higher than Medicare allows. TRICARE fees, by law, are tied to Medicare reimbursement rates.

So Raezer worries that TRICARE beneficiaries will see access to civilian providers tighten, particularly access to family physicians who serve as gatekeepers to specialty care.

Told of Raezer’s concern, a Democratic aid to the Senate Finance Committee said the Senate bill does include a 10 percent increase in Medicare fees for primary care physicians. Also, she said, insurance exchanges won’t compete for providers any differently than insurers do now.

A House staff member who works with TRICARE agreed. Insurers, he said, won’t compete by “ratcheting up rates for doctors.” Most companies already have large physician networks. The competition will occur in knocking down doctor reimbursements to keep beneficiary premiums low.

Some civilian physicians do turn Medicare and TRICARE patients away because of reimbursement levels, he said. But other doctors prefer TRICARE because it pays most claims fast, “typically within 36 hours of when a claim is submitted versus 240 days for your average health insurance company.”