National Guard February 2011 : Page 28

Weak Pulse NGAUS fought for years to have TRICARE health coverage extended to every Guard soldier and airman. Why are so few taking advantage? By Andrew Waldman I T WASN’T LONG ago that one in five drill-status National Guardsmen had no access to affordable health insurance. The figure mirrored that for the general public, but members of the general public don’t have to be healthy enough to respond at a moment’s notice to emergencies around the globe. Guardsmen were eligible for TRI-CARE, the U.S. military health care program, when they were mobilized on federal orders, but not one day before or after. Many corporations and some gov-ernmental agencies offered health insur-ance to their part-time employees, but the Pentagon balked at offering coverage to its part-time troops, even though it had a considerable stake in their medi-cal readiness. A seven-year fight changed all this. Working with NGAUS and defying senior Defense Department officials, 28 Congress provided every part-time member of the Guard and Reserve with the opportunity to purchase deeply discounted medical coverage through TRICARE. The resulting product, TRICARE Re-serve Select, lifts much of the financial burden of health care from Guardsmen who wouldn’t otherwise be able to af-ford coverage, while providing the force with valuable recruiting, retention and medical readiness tools. Today, TRS covers thousands of Guardsmen, but Guard medical officials wonder aloud why tens of thousands more who lack health insurance have yet to sign on. Demand for the product is less than the Guard had hoped for and dramatically less than the Pentagon feared. The TRS plan is available to drill-status Guardsmen and generally follows the same guidelines as the TRICARE Standard plan available to active-com-ponent family members and retirees. | Na tional Guard

Weak Pulse

Andrew Waldman

NGAUS fought for years to have TRICARE health coverage extended to every Guard soldier and airman. Why are so few taking advantage?<br /> <br /> IT WASN'T LONG ago that one in five drill-status National Guardsmen had no access to affordable health insurance.<br /> <br /> The figure mirrored that for the general public, but members of the general public don't have to be healthy enough to respond at a moment's notice to emergencies around the globe.<br /> <br /> Guardsmen were eligible for TRICARE, the U.S. military health care program, when they were mobilized on federal orders, but not one day before or after.<br /> <br /> Many corporations and some governmental agencies offered health insurance to their part-time employees, but the Pentagon balked at offering coverage to its part-time troops, even though it had a considerable stake in their medical readiness.<br /> <br /> A seven-year fight changed all this. Working with NGAUS and defying senior Defense Department officials, Congress provided every part-time member of the Guard and Reserve with the opportunity to purchase deeply discounted medical coverage through TRICARE.<br /> <br /> The resulting product, TRICARE Reserve Select, lifts much of the financial burden of health care from Guardsmen who wouldn't otherwise be able to afford coverage, while providing the force with valuable recruiting, retention and medical readiness tools.<br /> <br /> Today, TRS covers thousands of Guardsmen, but Guard medical officials wonder aloud why tens of thousands more who lack health insurance have yet to sign on. Demand for the product is less than the Guard had hoped for and dramatically less than the Pentagon feared.<br /> <br /> The TRS plan is available to drillstatus Guardsmen and generally follows the same guidelines as the TRICARE Standard plan available to active-component family members and retirees.<br /> <br /> Monthly fees are set at 28 percent of program costs. That's $53.16 a month for a single soldier or airman and $197.76 per month for a family. The military picks up the other 72 percent.<br /> <br /> The cost of premiums doesn't begin to measure the quality of the care, says Col. Jill Faris, the deputy surgeon general at the Army Guard Readiness Center in Arlington, Va.<br /> <br /> She says the coverage is "very comparable" to the better commercial providers. And for the price, it's a steal.<br /> <br /> According to a Kaiser Family Foundation survey, individuals buying private insurance paid an average of more than $3,600 annually in premiums for their plans.<br /> <br /> "I will tell you that TRS, for what you pay for it, you are getting a very good benefit," she says.<br /> <br /> The plan allows the Reservist or Guardsman to choose any doctor. The annual deductible is $50 or $150, depending on rank. Family members on the plan pay more. The maximum out-of-pocket cost is $1,000 per year.<br /> <br /> Maj. Vickey Shelton, a member of the Oklahoma Air Guard, has been enrolled in TRS for several years.<br /> <br /> A nurse in the 137th Aeromedical Evacuation Squadron, she says her care is much better than it was when she was on a private plan. "It's awesome," she says. "The private insurance I purchased didn't pay preventative care, but TRS does." And because she has TRS, she can spend more time at her unit and work only part time in her civilian job as a hospital nurse without fear of losing her employer-provided health care.<br /> <br /> "This is really more flexible," she says.<br /> <br /> The legislative effort that eventually led to TRS started in 1999 during a meeting of the Adjutants General Association of the United States.<br /> <br /> Retired Brig. Gen. Stephen M. Koper, the former NGAUS president, says the adjutants general were discussing shortfalls in Guard service.<br /> <br /> They formed a working group that found "one of the largest shortfalls for soldiers and airmen was a lack of a reasonably priced health care coverage." It also contributed to many soldiers being deemed medically nondeployable for combat.<br /> <br /> "We had people showing up for mobilization who routinely ignored preventative health care because they were younger and couldn't afford it," Koper says.<br /> <br /> The working group included Koper, a former Ohio Guardsman, and a number of other Ohio Guard leaders, including retired Maj. Gen. John Smith, then the former Ohio adjutant general.<br /> <br /> "We began on a small scale," Koper says, meeting with Ohio senators and "a couple key members of Congress."<br /> <br /> By the early part of the 2000s, a NGAUS legislative resolution addressed health care for Guardsmen.<br /> <br /> When Guardsmen began to deploy for the war on terrorism following the Sept. 11 attacks, Guard medical readiness became an issue.<br /> <br /> "That was a turning point because very quickly it became evident that there were Guard people serving in various Title 32 jobs, and there was no commensurate activity to see that they had reasonable coverage," Koper says.<br /> <br /> Beginning in 2004, Congress began to slowly extend TRICARE to drillstatus Guardsmen.<br /> <br /> The fiscal 2004 National Defense Authorization Act gave the green light for a limited TRICARE benefit for Guardsmen who had deployed.<br /> <br /> In 2005, lawmakers created a tiered system that allowed all Guardsmen to purchase TRICARE, but at different monthly rates depending on whether they had deployed and if they had any other access to coverage.<br /> <br /> The fiscal 2007 NDAA simplified matters by making the benefit available to all drilling Guardsmen at the same price, as long as they were actively drilling and not eligible for a federal health care plan.<br /> <br /> Progress was slow due in large part to fierce Defense Department resistance, says both Koper and retired Col. Pete Duffy, the deputy legislative director at NGAUS.<br /> <br /> At one point, Defense Secretary Donald Rumsfeld threatened to recommend a presidential veto if Congress passed TRICARE for the Guard and Reserve. He estimated that health care for the Guard and Reserve would be more than $5 billion, or about 15 times what the Pentagon spent on TRS in fiscal 2010.<br /> <br /> "The Pentagon's resistance to TRS was largely cost-driven," Duffy says. "There is also the perception that National Guard health and benefit issues during dwell times are issues that belong at the state level."<br /> <br /> Koper says the Defense Department "terribly overstated the level of premiums required."<br /> <br /> That was proven, he says, by a 2007 Government Accountability Office report that found TRS premiums were too high.<br /> <br /> As the years have gone by, TRS demand has increased. In fiscal 2005, before the plan was open to all on a drill status, only 9,100 Reservists and Guardsmen were enrolled.<br /> <br /> About 28,000 Guardsmen were enrolled in fiscal 2010, according to the TRICARE Management Activity [TMA]. In all, more than 155,000 Guardsmen, Reservists and family members were covered by TRS.<br /> <br /> In the Guard, demand for TRS is highest among the younger soldiers and airmen. The majority of Guard enrollees are under the age of 34. Of those, Guardsmen ages 25 to 34 are the largest group, according to TMA (see chart page 31).<br /> <br /> Despite its slowly growing popular popularity, too few Guardsmen take advantage of TRS, Faris says.<br /> <br /> The 28,000 Guardsmen using TRS is just a sliver of those in need. A 2008 study undertaken by the National Guard Bureau found that between 20 and 40 percent of Guardsmen are without medical insurance. The percentage equates to between 94,000 and 188,000 personnel.<br /> <br /> Duffy believes there are a variety of reasons why more Guardsmen aren't enrolling. One is a lack of publicity, which contributes to many not knowing TRS exists. Another is cost. Even at a deep discount, the premiums may seem steep for those struggling to make ends meet. Others simply opt to roll the dice and trust they won't ever need a doctor, let alone hospitalization.<br /> <br /> The way to increase enrollment, Faris says, is to continue to promote TRS. She says the best way is to inform Guardsmen at as many "touch points" as possible, including pre- and post-deployment briefings, drill formations and medical readiness checks.<br /> <br /> Currently, there is no standardized way for Guard commanders to determine which of their soldiers or airmen are without health insurance.<br /> <br /> "We have increased the education piece about [TRS] during mobilization briefings to family members, and we have been working initiatives with the TMA, going through and validating the briefings and presentations," says Faris.<br /> <br /> The Guard also faces the challenge of educating members and their families about the ins and outs of military health care, especially as Guardsmen move on and off deployment.<br /> <br /> Right now, if a Guard soldier is tapped for deployment, he or she has access to TRICARE Prime for themselves and their family for 180 days before and after the deployment period. If that same Guardsman has TRS, he must leave it, enroll in TRICARE Prime, and then re-enroll in TRS after the 180- day post-deployment TRICARE Prime period ends.<br /> <br /> Shelton knows that firsthand. She deployed a few years ago for a mission less than a month long. She was automatically removed from TRS without her knowledge and later had to re-apply.<br /> <br /> But the system has been improved, Shelton says. On her second deployment, the TRS enrollment process went much more smoothly.<br /> <br /> Another issue, Faris says, is that TRS was originally designed to cover the strategic reserve. As Guard members move back and forth from deployment to civilian life more regularly now, the program has had to adapt to match the change in service members' lives.<br /> <br /> "We have health care through a continuum, but there are occasionally hiccups," says Faris.<br /> <br /> There are still some Guardsmen who are missing out on the benefits of TRS. Those are most notably federally funded technicians, who are not eligible for TRS. They enroll in the Federal Employee Health Benefits program, which costs more.<br /> <br /> Duffy says that wrinkle has the attention of many in the Guard. It is a popular topic on the NGAUS Facebook page, where a number of people say they wish they were eligible for TRS.<br /> <br /> A NGAUS resolution addresses the issue, but congressional rules about offsetting costs to add new expenditures has held up the measure, Duffy says.<br /> <br /> And Duffy says NGAUS is working with Congress to write legislation that would allow employers to directly deduct, before taxes, employees' TRS costs if they enroll in the program through the Guard.<br /> <br /> The most looming problem with TRICARE might be the rates it reimburses to doctors. Rates are aligned with those of Medicare and Congress is trying to come up with a fix to prevent the reimbursement to doctors from falling too far as part of a deficit-reduction plan.<br /> <br /> That probably would cause many physicians to stop seeing Medicare and TRICARE patients. Lawmakers have provided a temporary fix to that problem, but something more permanent is required.<br /> <br /> "The shoe is going to drop there," Duffy says.<br /> <br /> Staff writer Andrew Waldman can be contacted at (202) 408-5892 or at andrew.waldman@ngaus.org.<br /> <br /> "We had people showing up for mobilization who routinely ignored preventative health care because they were younger and couldn't afford it."<br /> <br /> – Retired Brig. Gen. Stephen M. Koper<br /> <br /> Former NGAUS president<br /> <br /> "TRICARE Reserve Select is awesome. The private insurance I purchased didn't pay preventative care, but TRS does."<br /> – Maj. Vickey Shelton<br /> Oklahoma Air National Guard<br /> <br />

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