Bush seeking higher TRICARE fees

By Tom Philpott

President’s Bush final defense budget, for fiscal 2009, asks a reluctant Congress for a third time to raise TRICARE co-payments on drugs dispensed at retail pharmacies and to increase TRICARE enrollment fees and deductibles for working-age military retirees and their families.

Defense Secretary Robert Gates and Adm. Michael Mullen, chairman of the joint chiefs, soft-pedaled arguments for fee increases this year while presenting the ’09 budget to the armed services committees on Feb. 5.

Indeed, both said they will reexamine the Defense Department’s opposition to Sen. James Webb’s (D-Va.) bill (S. 22) for a World War II-style GI Bill education package for the current force.

Meanwhile, Gates said, DoD will get behind some sort of expansion to a program that allows transfer of unused Montgomery GI Bill benefits to spouses and dependent children.

Savings of $1.2 billion from higher TRICARE fees are assumed in the budget, even though Defense officials aren’t ready to share specific details.

Tina Jonas, the DoD comptroller, said the fee increases will be based on recommendations of the Task Force on the Future of Military Health.

But Defense officials have given themselves until June to study those recommendations and decide which ones DoD wants Congress to approve.

If that sounds like a health budget built backwards, well, it is, say some influential lawmakers.

New York Rep. John McHugh, ranking Republican on the House armed services’ military personnel subcommittee, said no lawmaker he knows wants to support the administration’s final try to raise TRICARE fees. But the challenge again this year will be finding money to plug the $1.2 billion hole left that DoD left in service medical budgets.

“My gut is that there are very few, if any, members either on the personnel subcommittee or the full committee who want to do this,” said McHugh. “The question that remains is, ‘Where do we find the money not to?’ The tyranny of the proposal is that, if you refuse to enact it, the revenue-slash-savings embodied in it has to be made up somewhere.”

Rep. Carol Shea-Porter, D-N.H., a freshman on the House Armed Services Commission and former military spouse, suggested to Gates that the projected TRICARE savings are “a shell game” because they assume many retirees under age 65, when faced with higher out-of-pocket costs, will go elsewhere for health insurance, shifting most likely to employer plans.

“Can you imagine that people will pull away from a (military) health care policy?” she asked.

Comptroller Jonas, sitting at Gates’ side, responded for him that the fee increases will be based on recommendations of the task force that Congress commissioned. She added that military health care spending “has doubled since 2001. In fact, we spend more on our health care than Germany spends on its entire defense. So this is something that has to be looked at. Obviously it’s something that we cannot do without the help and engagement of Congress.

Our purpose is to put it on the table and try to get some discussion going about how we maintain a very important benefit.”

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: