Study suggests serious TRICARE reforms, but will Congress bite?

A new report recommending vast changes to the military personnel system is trying to change health care for those working for the Defense Department and their dependents.

The study by the Bipartisan Policy Center gives 39 recommendations to DoD, some of which involve making changes to TRICARE and bettering the overall health of the military force.

The most dramatic suggestion proposes increasing TRICARE enrollment fees for military retirees to 20 percent of the cost of coverage.

The change would only apply to retirees who enter military service in 2018 or later, meaning most beneficiaries would not feel the effects until 2038.

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“Since the current TRICARE benefit was implemented, retiree contributions to the cost of their health care have declined precipitously in real terms,” the March 20 study stated. The change “would improve the long-term sustainability of the TRICARE program, encourage working-age military retirees to enroll in workplace health insurance for which they are eligible and honor the expectation that current service members and military retirees have regarding health benefits.”

TRICARE costs are generally on the rise, Bipartisan Policy Center Senior Policy Analyst Sean O’Keefe said during an interview with Federal News Radio. The Congressional Budget Office seems to agree with that sentiment.

The organization’s most recent report on the issue stated DoD spent $52 billion in health care for service members, retirees and their families in 2012.

“The cost of providing that care has increased rapidly as a share of the defense budget over the past decade, outpacing growth in the economy, growth in per capita health care spending in the United States and growth in funding for DoD’s base budget,” the report states.

The cost of providing health care to military and their families rose 130 percent from 2000 to 2012, the report states.

The report stated expanded benefits, medical costs of wars and the increased use of TRICARE are all causes of the cost increase.

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Members working on the study made other recommendations to shore up costs as well. One suggestion is to give health insurance options to dependents of service members.

The suggestion would allow dependents of service members to decline TRICARE and instead take an up to $250 per month reimbursement for premiums and cost sharing related to other health insurance.

The study states the reimbursement would “encourage dependents who have access to other coverage to enroll in and use that coverage, leveraging their employer’s contribution to health insurance premiums and reducing costs for TRICARE.”

Finally, creators of the study made one recommendation for ease of use. The 2017 defense authorization act starts an open enrollment process for TRICARE, where beneficiaries must explicitly affirm they want to use the insurance program.

The report suggests automatically enrolling people already in TRICARE. If they do not respond during open enrollment, beneficiaries will automatically be enrolled in their previous plan.

TRICARE is only one area where healthcare can improve in the military. The new study also suggests implementing evidence based programs that promote healthy behaviors.

“We’ve seen obesity rates rising just like in the civilian population, in the military population,” said Hannah Martin, policy analyst for the Bipartisan Policy Center. “Obesity rates are around 10 percent right now in the military based on self-reported height and weight. … We know that service members with obesity in Afghanistan are 40 percent more likely to get injured than their counterparts.”

Martin said smoking rates are still higher in the military as well and hover around 25 percent.

The study suggests implementing nutritional programs as well as physical and mental health programs to help service members lead healthier lives.

“Wellness is … one of the military’s best opportunities to improve performance and control costs,” the study stated.

The appetite to actually make these changes is in question, however.

“I think there is a recognition that [military health care] needs to be dealt with,” O’Keefe said. “We’re unclear as to exactly what that means on the Hill. The Defense Department over the years has come back asking for some relief, at least with regard to cost increases and proposed some changes. … As the defense budget looks to increase that will probably relieve some of the pressure on the department in terms of health care, but that doesn’t mean it should be any less important of an issue.”

Asking service members, retirees and their families to pay more for health care isn’t exactly a popular political move.

The 2017 defense authorization act added new fees and copays for military retirees, but it also expanded care that costs more money.

House Armed Services Committee aides told Federal News Radio earlier this month that there is no interest in revisiting additional fees and that such fees are taken very seriously.

That’s despite the House bill’s failed attempt last year to try to add premiums to active duty military family members’ plans. That provision was taken out in the final version of the bill. The Senate has not tipped its hand as to what it is planning for TRICARE for next year.