After the election next Tuesday, Congress will be coming back to Washington to take care of some of its unfinished business.
That includes the 2017 defense authorization bill, which the House and Senate are still trying to come to amicable terms on.
Within that bill are some serious reforms to the military health care system, but one former Navy Surgeon General thinks congressional meddling is a making more of a problem than a solution.
For military health care, “It’s a very exciting and interesting time, but it’s like being exciting and interesting in a pressure cooker. The financial and political pressures on the [Defense Health Agency] are difficult,” Michael Cowan, executive director of AMSUS, The Society of Federal Health Professionals told Federal News Radio.
Congress established DHA three years ago.
The agency “brings together the services in the military treatment facilities … and allows them to leverage their size, basically, and gets rid of these unintended conflicts within the services that prevent the system from being efficient. Vice Adm. [Raquel] Bono, who is [leading DHA] now, I believe is making tremendous progress implementing features of a high reliability organization,” Cowan said.
But for the past few years Congress has been trying to change the way TRICARE works. Cowan said Congress is getting too hands on with a system that is already working.
The 2017 defense authorization bill includes measures that would add enrollment fees and fixed dollar co-payments for active duty family members and retirees who join the military in 2018 or beyond.
“The goal is to see the changes in structure and function be rolled out and evolve in the next two to four years,” said House Armed Services Military Personnel Subcommittee Chairman Joe Heck (R-Nev.). “Potential increases in enrollment fees and deductibles will be put into place because we will have increased access and increase the product.”
The Senate version of the bill does not add fees to active duty family members, but does require higher fees from working-age military retirees.
Cowan said DHA is already on its way to becoming far more successful than it had any right to expect. The agency made progress on a number of fronts and consolidated functionalities.
“I think we are in the middle of a huge sea change, as we would say in the Navy, that is in the process of being successful. My understanding of many of the discussions of Congress is that on top of that they want to come in and do other things and make other reorganizations or make large changes with the assumption that TRICARE is broken and it really needs drastic surgery to fix it. I simply don’t see it that way,” Cowan said.
Critics of TRICARE claim that if the system isn’t reformed; military health care costs will swell to 18 percent of the defense budget in the next 20 years.
“That’s an unsustainable path. We are trying to create sustainability, higher quality, better access and quite frankly expand the services,” said Senate Armed Services Personnel Subcommittee Chairman Lindsey Graham (R-S.C.) in May.
Cowan said the addition of new TRICARE fees are simply cost shifting. The possibility of new co-pays and fees are ways of pushing down TRICARE costs by putting the burden on military families.
He added TRICARE gets a bad name because while there have been increases in the cost of TRICARE, those increases are due to Congress adding benefits.
“Over a decade, not a year went by without some new benefit and some new additional category of beneficiaries was added by Congress,” Cowan said. “That accumulation of services is what drove the cost up. If you look at the per capita cost of delivering TRICARE, it’s really very comparable to the private sector.”
While Cowan admits there are duplications and issues TRICARE and military treatment facilities could address to save money, he thinks DHA is able to handle those on its own.
While Congress might add fees and co-pays, it’s also adding benefits again.
The Senate bill authorizes a $400 million increase in the defense health program budget for military health system reform and another $40 million increase to maintain provider reimbursement rates for TRICARE beneficiaries.