The PJ Tatler

Pentagon Moves Forward on Cutting Prime Health Coverage for Vets

The Defense Department has moved ahead with a reduction in healthcare coverage for veterans in select areas of the country.

Starting Oct. 1, 2013, the Pentagon will reduce the number of Prime Service Areas (PSAs) where it offers the TRICARE Prime managed care option to retirees and their family members. This change will affect approximately 171,000 military retired beneficiaries in 41 states currently enrolled in TRICARE Prime, but not active duty service members and their families.

“The Department of Defense (DoD) has planned to make PSA reductions since 2007, when proposals were requested for the next generation of TRICARE contracts (known as T-3). Bidders for the three U.S. regional contracts were only required to establish PSAs around military hospitals or clinics and in areas that lost military hospitals or clinics due to BRAC decisions,” TRICARE said in an announcement of the change.

TRICARE Prime services will be offered only to those living within 40 miles of a Military Treatment Facility as a result of the incoming contractor, United Healthcare, not planning on covering the services.

Rep. Mark Amodei (R-Nev.) said he’s requested a briefing next week with Defense officials in an effort to push the department to evaluate and mitigate the impact on military retirees and their families.

“It concerns me that the administration would implement a policy without fully understanding the impact on more than 170,000 veterans and their families nationwide, including more than 1,000 Nevadans,” said Amodei. “My responsibility is to help ensure that these veterans continue to receive the high-quality health care they earned and are accustomed to.”

“That is why I will reintroduce, along with Congressman Greg Walden (OR-2), the TRICARE Protection Act and will take additional steps to keep those affected appraised with the latest information.”

The lawmakers originally introduced on Dec. 5 the bill that would have given the secretary of Defense 90 days to submit a report to the Armed Services committees in the House and Senate on the future availability of TRICARE Prime under the TRICARE program for eligible beneficiaries in all TRICARE regions throughout the United States.

The upcoming reintroduction would establish a navigator service to assist affected eligible beneficiaries in locating primary care providers and enroll eligible beneficiaries in TRICARE Prime Remote if it is determined that the beneficiaries would not otherwise have access to primary care providers who meet TRICARE access standards.

The rumors of the changes were confirmed by the Pentagon only after passage of Sen. Dean Heller’s (R-Nev.) amendment to the defense reauthorization bill last month, which required a full report on the termination of coverage.

“I look forward to a full report from the Department of Defense detailing changes to TRICARE Prime and their plan to make sure no veteran suffers from these changes in benefits. I’m concerned that veterans in Northern Nevada will be forced to undertake longer drives to receive care and that access to medical providers will be limited,” Heller said today. “I hope this is not the case, and am hopeful that the Department of Defense will provide answers in a timely manner.”

The lawmakers most vocal about the issue represent areas with wide rural areas most targeted by the changes.

Members of Congress from right and left have been sounding off to Dr. Jonathan Woodson, assistant secretary of Defense for Health Affairs, about the plans to nick healthcare in select TRICARE markets.

Walden joined in an October letter to Woodson penned by the greater Oregon delegation, including Sens. Ron Wyden (D-Ore.) and Jeff Merkley (D-Ore.) and Reps. Kurt Schrader (D-Ore.), Suzanne Bonamici (D-Ore.), Earl Blumenauer (D-Ore.) and Peter DeFazio (D-Ore.).

“While this might not have a significant impact in a smaller state, or one with more active-duty military installations, this will have a major impact on Oregon TRICARE users,” the delegation wrote. “The only 2 MTFs in Oregon are both located on the coast, leaving tens of thousands of retirees and others with the more expensive TRICARE Standard as their only choice.”

The delegation asked for a meeting with Woodson to discuss proposed changes and explore possible alternatives.

“We understand that there is concern about the costs associated with medical care for military members and retirees, but this proposal unfairly penalizes residents of select states and areas,” they wrote. “In addition, imposing these changes without significant prior notice is simply wrong.”

TRICARE Prime users already saw a 17 percent increase in the cost for most retirees on the plan as of Oct. 1, only the second hike since the program’s inception in 1995.

The Obama administration had pressed for even greater fees, but bipartisan majorities in the House and Senate Armed Services Committees struck down that attempt.