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thedrifter
06-20-06, 02:28 PM
June 26, 2006
Top doc defends Tricare fee hike, mental health services

By Gayle S. Putrich
Times staff writer

The Pentagon’s top health affairs official continues to insist that increasing health care fees for more than 3 million “working-age” military retirees and their family members is the only way to stabilize the rising costs of the military health care system, in spite of congressional opposition and an outcry from retirees.

But Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, said in a June 12 meeting with Marine Corps Times editors and reporters that the phased changes, when put in context with annual increases in military retired pay, would not be as painful as they have been portrayed by some.

Winkenwerder also said that contrary to what’s being said in some government studies and independent reports, all service members returning from combat are getting the mental health help they need.

Winkenwerder said some recent reports, particularly one by the Government Accountability Office, that have painted the Defense Department’s mental health services as inadequate are simply wrong.


“They looked at the percentage of people who went through the process, who were referred to either a psychiatrist or a psychologist,” Winkenwerder said.

Budget woes

When Tricare was created in 1995, the program had a built-in expectation that beneficiary costs would be adjusted incrementally over time, Winkenwerder said.

But that did not happen, partly because the military’s overall health care costs rose relatively modestly in the late 1990s.

That rapidly changed with the 2001 introduction of Tricare for Life, the program for military retirees and family members age 65 and older.

Since then, the Pentagon’s total health care budget has roughly doubled, to $38 billion this year, and at current rates would hit $65 billion by 2015.

The current plan to deal with the soaring medical budget would focus on retirees under age 65. Enrollment fees and deductibles for Tricare Prime and Standard would rise in most cases by several hundred dollars over two years. Each year thereafter, fees and deductibles would be adjusted based on changes in costs under the health insurance plan that covers federal civilian employees.

“The point is that retiree pay each year, as it goes up … more than covers any increased health care contribution,” Winkenwerder said. “I think that’s been lost in the debate so far.”

Some critics of the Pentagon proposal said such comparisons are flawed, because annual increases in retired pay are designed only to roughly keep pace with inflation.

Annual retired pay increases that are reduced by new health care fees do not translate into real pay increases, said John Class, spokesman for the Military Officers Association of America and a retired Navy commander.

“Retired pay and retiree health care are not two separate things,” he said. “It is devaluing the benefit if retired pay only keeps up with cost-of-living increases and doesn’t take health care into account.”

Indeed, data provided by the Pentagon show that a large chunk of projected increases in retired pay would be eaten up by proposed Tricare fee hikes in the first two years of the plan.

Officers who retired 10 years ago and have their families enrolled in Tricare Prime, for example, are drawing an average of $3,511 in monthly retired pay this year. Under current inflation trends, that would rise to $3,606 next year, an increase of $95 per month.

Under the Pentagon plan, their monthly health care premiums would jump from $38 this year to $83 next year, eating up nearly half of their monthly retired pay increase.

Similarly, E-7s and above who retired 10 years ago and now have their families enrolled in Tricare Standard draw an average of $1,702 in monthly retired pay, which is projected to rise to $1,748 next year.

Tricare Standard has no monthly premiums. Under the Pentagon plan, retired E-7s and above would pay $17 per month in premiums next year — erasing about 37 percent of their monthly gain in retired pay.

Criticism of the Pentagon plan from MOAA and other advocacy groups has led the House and Senate Armed Services committees to put on the brakes.

Both have placed one-year moratoriums on hikes in co-payments, deductibles and enrollment fees for Tricare Standard and Tricare Prime.

But Winkenwerder said some cost increase is inevitable if the quality of the health care benefit is to be sustained.

The costs of Tricare for Life are running about $11 billion a year, and he said the military’s medical budget is being further increased by large numbers of retirees migrating into Tricare as health insurance offered by private-sector employers continues to become more costly.

Most ‘got what they needed’

Regarding mental health issues among veterans, Winkenwerder said, “Every person — 100 percent of the people who went through the process — saw a medical professional. So the real truth is that 100 percent of people saw a medical professional, not one out of five,” Winkenwerder said. “What we believe is that most people, nearly all, got whatever they needed because they were seen by a professional after that screening and referred to the appropriate source of care.”

The GAO study, released in May, said that of those deemed at risk for developing post-traumatic stress disorder, only about 22 percent are actually referred for further mental evaluation.

The study said screening procedures are inadequate and there are no guarantees that those who are referred for more help get it, according to the study.

Winkenwerder said the GAO lacked a “full understanding of the way the process works in terms of the post-deployment health assessment,” and that the study did a disservice to the Defense Department.

Ellie