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Military Coalition Presentation

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(Brown, R-SC, Ortiz, D-TX) Military Healthcare. Healthcare Legislative. Wins for 2008 ... S.491 (Sen. Jim Webb) Medicare/TRICARE. Provider Payments ... – PowerPoint PPT presentation

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Title: Military Coalition Presentation


1
  • Military Coalition Presentation
  • to the
  • USCG National Retiree Council
  • May 12, 2009

2
AGENDA
  • Overview
  • Wins Goals
  • Retiree / Survivor Issues
  • Healthcare Issues
  • Q A

3
Current Hill Environment
  • Iraq / Afghanistan War Debate
  • Obligations to Wounded Survivors
  • Recruiting/Retention Concerns
  • Member vs. Family Perspectives
  • How Big The Defense Budget?
  • People vs. Weapons Costs
  • Health Cost-Shifting to Retirees
  • PAYGO Spending Rules

4
Declining Military Experiencein Congress
  • 103rd 105th 107th 108th 109th
    110th 111th
  • Senate 60 48 38 35 31 29 25
  • House 41 32 30 27 25 23 22

5
Key Wins Since 2000
  • 46 Cum. Pay Raise (vs. 33 Pvt Sector)
  • Major GI Bill Upgrades
  • End Strength Increases
  • Disability Retirement Improvements
  • Death Benefit Upgrades (SBP, SGLI, et al)
  • Reserve TRICARE Coverage
  • Defeated Major TRICARE Fee Hikes
  • Drill Expense Deduction/Reimbursement
  • G/R Rtmt Age Credit for AD Svc (Prospective)
  • Concurrent Receipt
  • Repealed Age-62 Military Widows Tax
  • TRICARE For Life/TRICARE Senior Pharmacy

6
2009 Top Issues
  • Minimize Health Cost-Shifting
  • More Concurrent Receipt Progress
  • SBP-DIC Offset
  • Match End Strengths to Missions
  • Guard/Reserve Retirement / TAP
  • Medicare/TRICARE Access/Funding
  • Family Support Programs/Funding
  • Seamless DoD/VA Transition

7
Pending Challenges
  • Economic Downturn Impact
  • Peace Dividend Threat to Def. Budget
  • Entitlement Reform Threats
  • Medicare/TRICARE Payment Formula
  • 10th QRMC New Mil Rtmt Proposal

8
Heard on the Hill
  • Congress has added politically popular pay
    raises and increased benefits for military
    personnel, while stifling repeated effortsto
    raise fees for the militarys TRICARE health care
    system
  • House Budget Committee Testimony of Feb 4, 2009

9
Personnel Cost More
  • Pay Raises 6 yrs of ECI1/2 (2006), ECI
    (2007), ECI1/2 (2008)
  • 4 Rounds of Pay Table Reform
  • BAH Increases
  • TRICARE For Life
  • Concurrent Receipt for VA Disability Rating of
    50 or Greater
  • Repeal of Redux
  • Repeal of SBP Offset to Soc Sec After 62

10
10th QRMC Retirement Plan
  • Features
  • Vest Retirement at 10 YOS
  • Shift to 401k-Style Plan
  • Delay Ret Pay Until Age 57-60
  • Flexible Gate Bonus Deposits As Needed
  • Issues
  • Civilianizing Ignores Service Conditions
  • No Predictability of Benefit
  • Rob Career Mbrs to Pay Separatees
  • Undermine Long-Term Retention/Readiness

11
RETIREE / SURVIVOR ISSUES
  • Background
  • Disabled Retirees Tax
  • Concurrent Receipt
  • Military Widow(er)s Tax
  • SBP DIC Offset

12
Retiree/Survivor Goals
  • End Disabled Veterans Tax
  • Repeal SBP-DIC Offset
  • Bar Excess Health Cost-Shifting
  • Upgrade Health Care Access
  • Guard Against Devalued Rtmt
  • More Consistent Disability Rtmt System
  • Restore DIC If Remarry after Age 55
  • Final Retired Paycheck for Survivors

13
Disabled Retiree Tax
  • Thousands of Disabled Retirees Forced to Fund
    Their Own VA Disability Comp
  • Lose 1 Retired Pay
  • for Each 1 From VA

14
Congress Has Fixed For Some
  • Cmbt Non-Cmbt
  • Related
    Related
  • 20 Yrs/100 Disabil Yes
    Yes
  • 20Yrs/50 Disabil Yes In
    Process
  • 20 Yrs/0-40 Disabil Yes No
  • Under 20 Yrs Yes
    No

15
Concurrent Receipt Haves and Have-nots
16
The FIX
  • Further Expand Concurrent Receipt
  • Senate S. 546 (Reid, D-NV)
  • House H.R. 303 (Bilirakis, R-FL)
  • H.R. 333 (Marshall, D-GA)
  • White House Budget Submission

17
SBP Progress
  • Passed Law Three Years Ago Phasing Out Age-62
    SBP Widows Tax (1 Apr 08)
  • FY 08 NDAA 50 mo. added to SBP. Increase to
    100 over 10 yrs.
  • H.R. 1804 (House Passed 1 Apr)
  • Increases Allow to 345 by 2016
  • But SBP Inequity Remains
  • VA Indemnity Payment (DIC) Offsets Paid Insurance
    on Retired Pay (SBP)

18
SBP-DIC Offset
  • SBP Paid by DoD
  • 55 of Covered Retired Pay for Survivors of
    Retired Members
  • 41 of High-3 Base Pay For Survivors of Active
    Duty Deaths
  • DIC Paid by VA if Death is
  • Service-Connected
  • Flat Rate for All (1,154/Mo)

19
SBP-DIC Offset (cont)
  • DIC Now Deducted from SBP Dollar For Dollar
    (1,154/Mo)
  • Wipes Out Most SBP for E-6 and Below Active Duty
    Deaths
  • Can Assign SBP to Children
  • Only AD Deaths since 7 Oct 2001
  • Lose All SBP When Child is 18

20
DIC Should be Added to SBP, Not Substituted for It
DIC 13,848
DIC 13,848
SBP Lost 13,848
SBP 1,423
E-6 SBP 15,271
Survivors Should Get
But Only Receive
They Lose
21
SBP-DIC Offset (Retiree Deaths)
  • SBP DIC Paid for Different Reasons
  • SBP is Purchased Insurance
  • DIC Should Be Added Indemnity for Service-Caused
    Death
  • Survivors of Fed Civ Vets Dont Forfeit SBP When
    DIC Payable

22
The FIX
  • Repeal SBP-DIC Offset
  • Senate S. 535 (Nelson, D-FL)
  • House H.R. 775
  • (Brown, R-SC, Ortiz, D-TX)

23
  • Military Healthcare

24
Healthcare LegislativeWins for 2008
  • TRICARE Copays/Fees
  • Medicare/TRICARE Provider Pymnts
  • Preventative Service Copays/ Deductibles
  • ECHO Cap to 36,000/year
  • Require TRICARE to Cover Smoking Cessation
    Programs for under 65

25
Healthcare LegislativeWins for 2008
  • Defeated Proposal to Charge VA Enrollment
    Fee/Increase Rx Copay
  • VA Counseling Svc Extended to Fam Mbrs of Wounded
    Warriors
  • TRICARE Reserve Select Premiums
  • Authorize Transitional TRICARE Coverage for
    Separatees Who Enter Selected Reserve

26
Healthcare Legislative Goals for 2009
  • Stop Unfair Cost-shift to Beneficiaries
  • Improve TRICARE Access
  • Fix Medicare/TRICARE Pay Formula
  • 3 Yrs AD TRICARE for Disabl Ret Fam
  • Expand DoD-VA Joint Office Mission
  • Family Caregiver Supp/Comp
  • Gray Area Reserve TRICARE

27
TRICARE Fees
  • Good News
  • No Fee Increases in Proposed DoD Budget
  • Solves a Budget Issue for Congress
  • Bad News
  • DoD to Push Congress for Increase

28
TRICARE Fees
  • DoD Arguments for Fee Increases
  • Need to Restore 1995 Share of DoD Cost
  • Need to Reflect Civilian Practices
  • Cost of Legislated Benefit Increases
  • Need to Free Funds for Weapons

29
Retiree Perspective onNo Fee Increase Since
1995
  • Many Mil. Pays Fixed/Rarely Adjusted
  • PCS Mileage Allowance only 24
  • 1983-98 Pay Caps Cut Ret Pay Avg 10
  • 1995 Retirees Lost 12.6
  • E-8, 26 Yrs 3,700/Yr Loss
  • O-5, 20 Yrs 4,600/Yr Loss
  • No Intent to Make Up Those Losses

30
Proposed Increases Are Disproportional
  • Far Exceed Retired Pay Increases
  • Would Erode Retired Pay/SBP Value
  • Congress Rejected Far Smaller Fees for
    Non-disabled Vets VA Care
  • Congress Knew TFL Wasnt Cheap
  • OMB/DoD Ignoring TFL Funding Law

31
Beneficiary Fees vs.DoD Costs
  • Fees Should NOT Reflect of DoD Costs
  • Bureaucracy Doesnt Incentivize Efficiency
  • Ops/Readiness/Inefficiency Costs Are Cost of
    Natl Defense, Not Patient Responsibility

32
Positive Ways to Cut DoD Health Costs
  • Incentivize Preventive Care
  • Eliminate Copays/Deductibles for Cost-Saving
    Treatments/Meds
  • Offer Case Mgmt for Chronically Ill
  • Promote Mail-Order Rx
  • Successful EHR that includes information from
    private sector

33
Positive Ways to Cut DoD Health Costs
  • Promote Retention of Employer Ins.
  • Make TRICARE True 2nd-Payer
  • Provide Optional Subsidy for G/R
  • Maximize Use of Military Medical Facilities
  • Overhaul PreAuth and Referral Sys

34
TRICARE Fee Legislation
  • Need to Establish Principles In Law
  • Primary Offset for Service Conditions
  • Military Pre-Pay Very High In-Kind Premiums
    Through 20-30 Yrs of Sacrifice
  • Key Bills
  • H.R. 816 (Reps. Edwards/Jones)
  • Expect Sen. Lautenberg Bill

35
Gray Area Reservists
  • TRS Coverage Until Non Drilling
  • No Coverage Until Age 60
  • Need Interim Coverage
  • Fix
  • TRS Buy in at Full Premium
  • H.R.270 (Rep. Robert Latta)
  • S. 731 (Sen. Ben Nelson)

36
Premiums PreTax
  • Fed/Mil Retirees unable to pay health insurance
    premiums pretax
  • Fix
  • H.R. 1203
  • (Rep. Chris Van Hollen)
  • S.491 (Sen. Jim Webb)

37
Medicare/TRICARE Provider Payments
  • Prevented a 10 Rate Cut Jul 2008 Added a 1.1
    Increase Jan 2009
  • As of January 2010, Rates Will be Cut 21 Unless
    Congress Acts
  • Short-Term Reverse Cuts
  • Long-Term Fix Payment Formula

38
TRICARE Fee Conclusion
  • Have not Dodged Bullet
  • No Budget Battle but Still Pressure on Congress
    to Increase Fees
  • Potential Savings Could be Used for Other
    Priorities
  • Shift debate to What Service Members Have Earned
  • Allow Reasonable Dialogue and Trade-Offs

39
Questions ?
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