Battle of the Bilge

Health Care Bill Q&A

In response to rumors and a flood of inquiries, MOAA put their legislative and communications teams together to provide answers to some of the most prevalent questions we’ve received this week. The Questions & Answers given below were transmitted to all subscribers of MOAA’s bi-weekly e-newsletter News Exchange. Anyone wishing to stay on top of important issues such as these are encouraged to subscribe to News Exchange or our weekly Legislative Update by visiting here. And if you’ve held a commission in the military and aren’t a member yet, see the ‘Join MOAA’ link at the top of this page.

General Effects on TRICARE and VA care

Q: I heard the new legislation will roll TRICARE into a massive government health care program. Is this true?
A: Definitely not.

Q: I’ve seen message traffic saying the new legislation poses a “sneak attack on TRICARE.” Is that true?
A: The Senate bill language has been public for months, and we don’t believe there was any intent to disadvantage TRICARE beneficiaries, though it didn’t explicitly state that TRICARE is “qualifying coverage.” Just to make it clear, the House unanimously passed separate legislation on March 20, deeming TRICARE as “qualifying coverage” under the new law. The Senate is expected to pass the same legislation shortly. Defense Secretary Gates has issued a statement asserting that health reform “won’t have a negative effect on TRICARE.” Everyone in the Administration and in the House and Senate, of both parties, agrees TRICARE and VA coverage must be held harmless. But there’s been inevitable debate among legislators about who cares most and who’s doing what to protect troops and vets.

MOAA doesn’t care who gets the credit for making sure TRICARE is protected, and we take political hyperbole on both sides with an appropriate grain of salt.

Q: What does deeming TRICARE as “qualifying coverage” mean?
A: Under the new legislation, people who don’t have qualifying coverage will have to pay a financial penalty. Since TRICARE and VA coverage will be qualifying coverage, those beneficiaries won’t be subject to the penalty.

Q: How about VA care?
A: The new legislation states that care rendered under title 38 of the US Code (VA care) is also qualifying coverage.

Q: I’ve seen message traffic saying that the new law will end TRICARE as of 2014, and that TRICARE beneficiaries will then have to buy other coverage. Is that true?
A: That’s definitely NOT true. There’s nothing like that in the new law.

Q: Can I expect my TRICARE enrollment fee, premiums, deductibles or co-pays to go up because of this legislation?
A: No, there’s nothing in the legislation that would change any TRICARE fees. That said, it’s unrealistic to think that TRICARE fees will never go up, even if retired pay doubles or triples over a retiree’s lifetime. But it will be deficit concerns and DoD budget problems, not national health reform, that drive any future changes in TRICARE fees.

Q: What’s MOAA doing to make sure beneficiaries aren’t negatively affected by the national health reform legislation?
A: MOAA has pushed House and Senate leaders for much of the past year to make sure that language was included in any health care debate to protect the unique nature of military and VA health benefits and prevent taxation of those benefits. We’ve generated more than 100,000 messages to Congress on that topic so far – more than any other association. That strong membership support has gotten results, as the combination of legislation already passed and legislation about to be finished by the Senate substantially accomplishes those objectives.

Effects on TRICARE For Life and Medicare

Q: Is TFL also “qualifying coverage” under the new law?
A: Yes. Both Medicare and TFL are expressly deemed as such under the legislation already passed by both the House and Senate.

Q: I understand Medicare is cut $500 billion under the new law. Won’t that have to cut payments to doctors and threaten TFL?
A: It’s true that the new law reduces Medicare spending by about that much, but most of those changes are relatively less painful ones that probably won’t affect TRICARE or TFL beneficiaries much. They include $118 billion from eliminating the extra subsidy to the Medicare Advantage HMO program (which was sold to Congress as a cost-saver, but actually costs 14% more per person than Standard Medicare), cutting about $150 billion from non-rural hospitals (which the hospital associations say they can handle because expanding insurance coverage to most Americans will mean they won’t have to eat the cost of serving the uninsured), and cutting back abuses in medical equipment (under current systems, Medicare will buy you a wheelchair you may only need a few months, or allow a company to rent you one for life for a permanent condition). These are things most of us would probably push to consider if it were our own money paying for them (which it actually is).

Q: Are you saying that the funding cut won’t affect Medicare beneficiaries at all?
A: No. But the implications are probably longer-term ones than shorter-term ones. The real issue under national health reform is that the money from these Medicare savings will be used to fund expansion of health insurance coverage to those who don’t have it now instead of being used to pay for needed fixes to Medicare. It’s hard to argue that reducing the number of uninsured would be a bad thing. But using the relatively “easy” Medicare savings initiatives to fund that means that when the baby boomers start swamping Medicare and Social Security in the next few years, Congress will be forced to look at more painful ways to fund that need. And that’s something that will be considered by the debt commission that is supposed to make recommendations by Dec. 1 on how to reduce the national debt. It’s that coming commission that we think will really create some tough options for all Americans, and the military is unlikely to escape unscathed. We’ll be keeping an eye on that and keeping our members informed.

Medicare/TRICARE Payments to Doctors

Q: Is it true that the new legislation cuts payments to doctors by 21%?
A: No, that’s NOT true. In fact, it’s PREVIOUS law that calls for a 21% cut in Medicare and TRICARE payments to doctors as of April 1. Congress is working on separate legislation to prevent that from happening.

Q: What’s the status of legislation to reverse the 21% cut in Medicare/TRICARE payments to doctors?
A: The Senate has passed legislation putting off the date of the cut from April 1 until October 1. The House has passed legislation putting it off only until May 1. Our sources tell us the Senate will pass the May 1 legislation. One problem is that Congress is scheduled to take a two-week recess, and the April 1 deadline will occur right in the middle of the recess. So the short-term solution likely will be to “kick the can” for a month and take it up again when Congress returns after recess. Getting a longer-term fix for the doctor payment problem remains MOAA’s #1 health care priority.

Q: Are there any changes in the new law that will affect payments to providers?
A: Yes, there are some changes to periodic “market basket” and other assumptions that affect annual adjustments. These would generally tend to dampen annual increases over time, based on the assumption that productivity will improve over time. This is probably a weak assumption, given past experience with such things. If the expected productivity increases don’t materialize, Congress may have to revisit these assumptions in the future. On the other hand, the new legislation sustains a 5% increase in payments to mental health providers.

Physical, Speech, and Occupational Therapy

Q: Does the new legislation do anything to fix the current $1,860 cap on annual Medicare payments for outpatient physical, speech, and occupational therapy?
A: Yes, the new legislation allows an exception to the cap (until Dec. 31, 2010) for medically necessary therapy. That’s a big relief for accident and stroke victims who can run up big therapy bills quickly. But it means we’ll have to get another extension before the end of the year.

Coverage for Children until Age 26

Q: I understand the new health care bill allows adult children to stay on their parent’s healthcare plan until age 26 if their employers don’t offer insurance. Will TRICARE adopt this policy?
A: Yes, we expect TRICARE will do that.

Q: When would I be able to take advantage of that new TRICARE option?
A: It’s hard to say at this point. In all likelihood, it will take a law change, and the vehicle would be the FY2011 Defense Authorization Act, which probably won’t become law until at least October, if not later. Then, the Pentagon would have to negotiate a change to the TRICARE contract and issue new regulations, and get computers and finance systems changed. For past changes, that has taken anywhere from 12 to 24 months. So it could be 12 to 24 months or more before the change takes effect for TRICARE.

Q: Is there anything I can do now to cover a child who is about to “age out” of TRICARE?
A: Yes. TRICARE already offers coverage for people who lose TRICARE eligibility because of separation or children who lose eligibility because of age. It’s called the Continued Health Care Benefit Program (CHCBP). CHCBP is renewable in quarterly increments and costs about $933 a quarter for an individual – but you have to sign up for it within a pretty short time after losing eligibility. If you have a child who’s now age 25, that child doesn’t qualify for CHCBP.

MOAA’s MEDIPLUS® TRICARE Supplement

Q: Will the new legislation affect my MEDIPLUS® TRICARE supplement in any way?
A: At this point it’s too early to know for sure. We don’t think there will be any negative impact, but we’re working to verify this with our insurance provider.

Discussion

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“It has always been my private conviction that any man who pits his intelligence against a fish and loses has it coming.” – John Steinbeck

Slow News Day?

A quick attempt to hopefully keep the viral emails from going around on this issue is in order. Although not directly related to the military, there are enough sport fishermen out there that this will catch their attention. Glenn Beck and Rush Limbaugh stated plainly that the president was targeting people’s right to fish. A direct quote from Beck was “Forget about the frickin’ fish. People are losing their rights. Who’s more important: the fish or you?” Other samplings across the blogosphere have been equally knee-jerk:

From the SayAnythingBlog: “Because He’s Not Unpopular Enough: Obama Pushes Ahead With Fishing Ban.”

From RedState: Obama: The Will Of The People Be Damned – I’LL Decide Who Can Go Fishing

From GatewayPundit: Obama’s Latest Assault on Freedom– New Regulations Will Ban Sport Fishing

The story that sparked the commotion originally ran as a blog article on ESPN that cited Phil Morlock of the New York Times in saying that:

“Morlock fears that “what we’re seeing coming at us is an attempted dismantling of the science-based fish and wildlife model that has served us so well. There’s no basis in science for the agendas of these groups who are trying to push the public out of being able to fish and recreate.

“Conflicts (user) are overstated and problems are manufactured. It’s all just an excuse to put us off the water.”

The issue is that the Obama administration has ceased accepting public input on a strategy to change the way our nation uses our water supply and natural resources. NOAA is leading the review and will give recommendations to the president. While there may be some changes to fishing sites and regulations, there has been no indication that any decision has been made. Task forces often close off public input at certain points in their mission to develop plans based on what has already been received. NOAA is extremely unlikely to recommend anything approaching a ban on sport fishing, and the president would have to be crazy to think a move like that would be politically viable. There are as many as 60 million voters in this country that enjoy fishing, and this would not be something easily forgotten.

That Smell is Not the Fish

As the rhetoric on the web and cable news got heated, ESPN took action to try to calm everyone down. Executive Editor ESPNOutdoors.com, Steve Bowman, issued this statement, which I’ll reproduce in full:

Firestorms get started in a variety of ways, especially on politicized issues.

ESPNOutdoors.com inadvertently contributed to a flare-up Tuesday when we posted the latest article in a series of stories on President Barack Obama’s newly created Ocean Policy Task Force, a column written by Robert Montgomery, a conservation writer for BASS since 1985. Regrettably, we made several errors in the editing and presentation of this installment. Though our series has included numerous news stories on the topic, this was not one of them — it was an opinion piece, and should have been clearly labeled as commentary.

And while our series overall has examined several sides of the topic, this particular column was not properly balanced and failed to represent contrary points of view. We have reached out to people on every side of the issue and reported their points of view — if they chose to respond — throughout the series, but failed to do so in this specific column.

This series started in October and has included several updates on how the creation of the task force and its actions could impact recreational anglers. ESPNOutdoors.com should have made it clear to all readers that this was part of a larger series, and — even though this was Montgomery’s opinion, and those of the sources quoted in the column — we should have taken more care to fairly represent opposing arguments.

We do feel it is our duty to cover issues surrounding outdoor sports to the best of our abilities, and given the nature of this task force and the potential impact on all fisherman, this was an appropriate topic to address for our audience. We take seriously the tenets of journalism that require we take an unbiased approach, and when we make mistakes in the presentation of a story or a column, it is our responsibility to admit them.

Any confusion on that part rests entirely on my shoulders as the executive editor of this site.

We have appended the original column to note that it was in fact a commentary, and we will institute more rigorous editing safeguards in order to prevent such issues in the future.

Discussion

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“A newspaper is a device for making the ignorant more ignorant and the crazy crazier.” – H. L. Mencken

Potential Disaster Averted

It can be assumed that if H. L. Mencken lived to see the modern invention of the internet, it would have undoubtedly taken the place of ‘newspaper’ in the above quote. And it would have been a perfect characterization of John Patrick Bedell, the man who attacked an entrance checkpoint at the Pentagon last Thursday evening. Excellent police vigilance and quick action stopped a possible mass casualty situation from happening, and ensuring that the only death from the incident was the shooter himself.

According to the Associated Press, John Patrick Bedell arrived at a Pentagon checkpoint on March 4th and opened fire on police officers with two handguns. A statement to the AP from J Richard Keevill, the chief of Pentagon police:

“He just reached in his pocket, pulled out a gun and started shooting… He walked up very cool. He had no real emotion on his face.”

While it would be easy to designate Bedell’s actions as an act of terrorism, and by definition, the use of violence to further a political or social message or goal, that appeared to be his intent, the legacy of his internet activity points more in the direction of a seriously deranged person detached from reality. Attempts by some elements of both traditional and alternative media outlets to paint him as a ‘right wing extremist’ just after the attack are not supported by his public (or at least virtual) persona. The original title of the Christian Science Monitor article linked in the previous sentence was ‘John Patrick Bedell: Did Right Wing Extremism Lead to Shooting?’

The cached and saved remnants of his online activity point more towards a left leaning ideology, if any of it can rationally be described as an ideology. Sometimes, crazy is just crazy. But crazy stupid is one thing. Until his act of violence, stupid is not a word that would aptly describe John Bedell, whom evidence indicates held a high IQ. And that is far more frightening.

Paranoia, Drugs and Conspiracies

Clearly, Bedell held strong distrust and anger towards the federal government and the military, and was a member of the ‘truther’ movement that believed the attacks of 9/11 were perpetrated by a criminal cabal within the U.S. He recorded a series of rantings on the subject in 2006 entitled ‘Directions to Freedom’ that can be found here. A snippet of the audio was transcribed by Patterico’s Pontifications and captures the essence of his message:

This criminal organization would use its powers to convert military, intelligence, and law enforcement bureaucracies into instruments for political control, and the domination and subjection of society, while discrediting, destroying, and murdering honest individuals within those services, that work to root out corruption, and faithfully serve their fellow citizens. This organization, like so many murderous governments throughout history, would see the sacrifice of thousands of its citizens in an event such as the September 11 attacks, as a small cost in order to perpetuate its barbaric control. This collection of gangsters would find it in their interest to foment conflict and initiate wars throughout the world, in order to divert attention from their misconduct and criminality. The true nature of such a regime would find its clearest expression in the satanic violence currently ongoing in Iraq.

You can see a full transcript of Bedell’s rant here. Although the questioning of the official explanation of 9/11 has been a continuing source of internet debate and speculation, the movement has been demonstrably non-violent, and very few of its members have ever advocated violence.

He was apparently obsessed with the monetary system of the world. From the same recording, he stated that “When the government can control how private property is used and especially when the government controls the monetary system that is use to exchange private property, the government has the mechanisms and the motivation to control individuals to the smallest detail.”

So what made Bedell cross the line? The answer may have more to do with his personal state of mind than a broader political battle. As reported by MSNBC:

Bedell was diagnosed as bipolar, or manic depressive, and had been in and out of treatment programs for years. His psychiatrist, J. Michael Nelson, said Bedell tried to self-medicate with marijuana, inadvertently making his symptoms more pronounced. “Without the stabilizing medication, the symptoms of his disinhibition, agitation and fearfullness complicated the lack of treatment,” Nelson said.

As more evidence emerged pointing towards a more left leaning philosophy by Bedell, the Christian Science Monitor backed off of its original speculation of his ‘Right Wing Conspiracy and put up an update: UPDATE Monday, March 8: As more information emerges about Mr. Bedell, the less it appears that any coherent ideology was behind his actions, except that he was deeply antigovernment. Much closer to the probable reality than their first iteration of the article, especially given the fact that he was a registered Democrat. But falling in to a right wing/left wing debate over his motivations would not be appropriate for this man or his actions. Sometimes, mental illness trumps politics and that seems to be the case here.

Discussion

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