Battle of the Bilge

“Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.” -Sun Tzu

Another TFL & Medicare Email

An article that appeared on January 9th on GOPUSA has been picked up by Tea Party sites and forwarded as a viral email raises once again the issue of TFL and retiree health care. Unfortunately, the piece contains scare tactics and assumptions, and paints military organizations in a bad light. The MOAA response is listed below in full from our Director of Government Relations.

The Email

Subject: TriCare For Life & Medicare
Military Retirees, Victims of a Congressional Shell Game

Military piece by Thomas D. Segel Harlingen, Texas, January 9, 2010

Military retirees are very close to losing their hard won Tricare for Life health insurance…and it is their own fault. The sad truth about military retirees is they usually fail to respond when their rights are violated or their futures placed in jeopardy. When viewing voting constituencies, the most dossal and inactive people are found among the retired military members and their dependents.

Any politician engaged in the deceitful practices of Washington D. C. knows one of the easiest targets to attack is the retired military community. Politicians view this group as the least harmful of any who make up the ranks of the voting public. They place those who served in uniform at the top of their least harmful list, thus making them political targets whenever there is a search being conducted to show the public what the political elite call meaningful dollar savings.

There are some strong military retiree advocates who are speaking out on the dangerous situation facing their former comrades-in-arms. One of these is Colonel Wayne Morris, USMC (Ret), who says, “We know that nothing is safe right now when considering the ongoing efforts of the current administration especially in any and all areas aligned with health care! Military retirees will quickly become a ‘soft target’ for those who would take away from one group and give to another.

I personally see a marked effort on the part of the current administration to divide us on this issue – to cause those who are NOT military retirees, (even those now on active duty) to eventually play against us and the benefits we have thus far been able to retain.”In support of this idea, the colonel points out there are some ‘so-called’ veteran support organizations already advising retirees to calm down and not worry about our health benefits.

These groups are telling the veterans that Tricare for Life benefits are safe and that retirees have nothing to worry about. The falseness of such statements can be understood when it is realized that under current legislative plans Medicare will be cut by $500 billion and Tricare for Life is linked solidly to Medicare.

Doing the math anyone can see that such a devastating cut in services and benefits to Medicare would mean similar cuts in Tricare for Life.Additional searching into this healthcare legislation will reveal that, as now drafted, new healthcare rules would require our advanced aged military retirees on Medicare and Tricare for Life to pay the fist $525 of medical costs for the beneficiary and identical costs for any dependent.

The retiree would then pay 50% of the next $4,725 of medical charges up to a total of $6,301 per year. This is the additional financial load our Congress will place on those who have already given twenty and more years of service to their country. Many of who left their blood and body parts on the fields of battle.The Washington version of the old Shell Game has already started. This is a confidence trick where three shells and a pea are used in what is claimed to be a gambling game.

Actually, as the shells are shifted from position to position, the pea is removed from the table…and the player ends up picking NOTHING. In the 2,000 plus page Obamacare health insurance bill, congressional lackeys tell us time and again that Tricare for Life is protected. But hey keep shifting those shells. The service organizations have already swallowed the snake oil and are echoing administration claims that TFL is safe. They have already bought into the Shell Game.

We also know everyone in the Democrat Congress is keeping those shells moving and not letting us see that pea. The end result will be another case of “nothing is too good for those who served in uniform”…and that is what they will get. NOTHING!

Response from MOAA’s Legislative team

Much of the specific information in his message is patently untrue. The TFL changes he mentions are not, repeat NOT, in the current health care reform bill.

What he describes was one option in a list of options prepared by the Congressional Budget Office more than a year ago…well before the current administration took office.

That idea didn’t go anywhere – as we predicted it wouldn’t. It never appeared in any legislation anywhere on the Hill, and was never supported by anyone in the Administration or Congress.

Further, we would never say there’s nothing to worry about on military health care. Of course there is. The ongoing budget pressures (which will only get bigger with mounting deficits) will create tremendous pressures in 2010 and beyond to cut all kinds of federal spending. There’s a lot of talk about setting up an entitlements commission to review changes needed to preserve the financial viability of Medicare and Social Security when millions of baby boomers become eligible for those programs in the coming decade.

I believe there will be such a commission, and once it starts reviewing possible Social Security and Medicare changes, it will inevitably lead to review of possible changes for military and federal retirement, military and federal health care, military and federal survivor benefits, VA benefits, etc., etc., just as we saw during the last budget/deficit crunch in the early and mid-90s. We had a huge fight to dodge most of those proposals back then, and it will be a much bigger challenge in light of the much bigger deficits we face now.

But there’s a vast difference between being (a) alert to potential coming threats and (b) claiming that those threats are embodied in current legislation – which they’re not. There are some smoke and mirrors issues in the current legislation – as there is in almost any big bill Congress passes, and there are some things to keep an eye on in the future (such as assumptions that Medicare and its providers will achieve some pretty optimistic “efficiency” goals in the coming years). But most of the changes to Medicare in the current health reform legislation are actually relatively modest and pretty doable ones. The real problem is that those savings will be used to fund health care for the current uninsured rather than to build the Medicare bank to meet the coming expenses of the baby boomers. So when the boomer tide hits, Congress will have to come up with far more significant cuts or tax increases to meet that need, because the relatively easier savings options will have been used up.

So there’s a reason to be worried, but it’s difficult to put much stock in most opinions being passed around the internet about the health care bills, because most start from a highly partisan standpoint, and many just pass on pieces of misinformation that have long since been proven untrue – as in this case.

Unfortunately, once such things get out on the internet, they acquire a life of their own, and well-intentioned people pass them on and help perpetuate the misinformation.

Steve Strobridge
Colonel, USAF (Ret)
Director, Government Relations

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Update on Medicare Payment Issue

In the last CBO/TRICARE article, we mentioned the failure of the Medicare Physicians Fairness Act (S. 1776).

That bill would have permanently repealed Medicare’s Sustainable Growth Rate. If the SGR is not repealed or pushed back, Medicare providers would see a 21.5% cut in payments in January, 2010.

We also predicted that it would be placed into another bill by the end of the year to push off the problem until a later date. While we thought the HCR bill would be the most likely candidate, it turns out that the language for the SGR push back was included in the FY2010 Defense Appropriations Act (H.R. 3326), a ‘must pass’ bill that is now awaiting the president’s signature.

A temporary fix was placed in the bill, extending SGR by a period of only 2 months, so the battle is far from over, just delayed as Congress tends to do with these types of fiscal issues.

Last Friday’s Legislative Update provides the details:

Big Medicare/TRICARE Cuts Delayed – For 60 Days
The Senate has been so consumed by the partisan politics of national health reform that other end-of-year crises have had to take a back seat.

In recognition of one urgent issue, the Senate will pause Saturday morning to pass the FY2010 Defense Appropriations Act (H.R. 3326) – a mere 80 days after FY2010 actually started.

Included in that legislation is an emergency measure to delay a 21% cut in Medicare and TRICARE payments to doctors that otherwise would take effect on January 1.

Unfortunately, because Republicans and Democrats can’t agree on funding issues, the new legislation will only delay the Medicare/TRICARE payment cuts until the end of February.

That means two more months of wrangling in hopes that Hill leaders can work out a longer-term doctor payment fix. This is crucial to Medicare and TRICARE beneficiaries, because a 21% payment cut would cause thousands of doctors to stop taking them as patients.

Nobody in Congress wants that to happen. But their continuing squabbles over how to fund a fix – and their continuing games of last-minute budget “chicken” – continue to put millions of beneficiaries at risk.

Meanwhile, the Senate still hasn’t addressed another issue that will affect millions of Medicare-eligible beneficiaries if Congress doesn’t act in the next 13 days.

Under current law, people turning age 65 in 2010 and those with incomes above $85,000 ($170,000 for a married couple) will face steep Part B premium increases (scroll to the middle of the page) as of Jan. 1. Other Medicare-eligibles are protected by a law that bars Part B premium hikes in years when there’s no Social Security COLA. But there’s no such protection for the 25% of beneficiaries who will first become eligible for Medicare next year or who have higher incomes. And those groups will get hit with extra premiums to help make up for the fact that the other 75% won’t be paying more.

The House passed legislation (H.R. 3631) in September to bar Part B premium hikes for all Medicare-eligibles. But the Senate has not acted on it because of an objection by Senator Tom Coburn (R – OK). You can press your senators for action by sending them a MOAA-suggested message.

You Can Help

To help MOAA speak in a loud and clear voice, please take the time to contact congress on these issues:

Stop 21% Medicare/Tricare Payment Cut

Pass the Medicare Premium Fairness Act

Protect Military/VA Beneficiaries Under Health Reform

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BotB Verdict

“Myth is, after all, the neverending story.” – Joan Vinge

Such Long Legs This Has

The better to fool people with. What started as an impassioned yet unrealistic review of the Congressional Budget Office’s recommendations to President Obama has continued to gain traction in the email world. Although we’ve already discussed this subject twice in previous articles, some changes have been made in the language of the introduction and the email title, giving it new legs. But this doesn’t change the fact that the CBO report was a recommendation to the administrations that was flatly rejected, TRICARE and TFL funding have made it through the NDAA so far, and the Health Care Reform bill contains no language that would affect military health care.
Continue Reading »

“There are no whole truths: all truths are half-truths. It is trying to treat them as whole truths that plays the devil.” – Alfred North Whitehead

Background Information

On Thursday, August 27th, the news outlet Washington Times ran a story in print and on line in their ‘Citizen Journalism’ section that seriously misrepresented the facts of last December’s CBO report on TRICARE and the Health Care Reform bill. When the article was published, members of MOAA’s Government Relations staff (and apparently other individuals) contacted the paper’s staff and brought the inaccuracies to their attention. The pressure was strong enough that the article was removed and if you follow the original URL, you’ll receive the following message:



Fortunately, it was up long enough that you can still see the article via Google’s cached stories feature by clicking here.

Unfortunately, it wasn’t taken down quickly enough for it to go viral, and emails have been coming in at a steady pace.

The Article Text

CITIZEN JOURNALISM: Tricare benefits
Medical care sought for retired military
By Brenda Hurley SPECIAL TO THE WASHINGTON TIMES | Thursday, August 27, 2009

CITIZEN JOURNALISM:
President Obama and his party have endorsed legislation that would drastically cut the Tricare for Life benefits of retired and veteran service members. If it is approved by Congress in a vote next month, retired and veteran service members will be obliged to pay high deductibles and co-pays. Military treatment facilities currently do not charge eligible persons co-pays for medical services or pharmaceuticals.

The concept of providing medical care for families of active-duty members of the uniformed services dates back to the late 1700s. In 1884, Congress declared that “medical officers of the Army and contract surgeons shall whenever possible attend the families of the officers and soldiers free of charge.” There was very little change until World War II, when family members could not be treated. Most draftees in that war were young men who had wives of childbearing age; the extremely large number of babies being born caused a burden on the system. The Korean War again strained the capabilities of the military health care system, and it was not possible to provide free medical care for military families.

On Jan. 1, 1967, Congress passed legislation giving military retirees, their family members and qualified surviving family members of deceased military members free medical care. That promise was broken in the 1980s, when Congress revoked the legislation in order to cut the budget.
Tricare for Life was instituted by Congress in 2002 to reinstate the broken promise that military retirees would receive free health care coverage for life. It was introduced as a supplement to Medicare for military retirees and their family members who are eligible for Medicare. The program pays nearly all medical costs not covered by Medicare.

Now, however, the benefits of retired service members and veterans are in danger again. Tricare comprises three options: one similar to a health maintenance organization, called Tricare Prime; an option with a preferred-provider network, called Tricare Extra; and a traditional fee-for-service plan, called Tricare Standard. Military retirees who are not yet eligible for Medicare may enroll in Tricare Prime by paying an annual enrollment fee of $230 for individual coverage or $460 for family coverage.

In addition, those enrollees in Tricare Prime make a $12 co-payment for each outpatient visit to a civilian physician or other civilian health care provider; visits to military providers are free. Those who do not enroll in Tricare Prime may receive benefits under Tricare Extra or Standard. Beneficiaries who use either of those two plans must pay an annual deductible of $150 for individual coverage or $300 for family coverage. The Tricare enrollment fees, co-pays and deductibles have remained unchanged since 1995.

A Congressional Budge Office study states that “… if the savings that would accrue from reduced spending for Medicare were included, the introduction of cost sharing under this option would reduce the federal spending devoted to Tricare for Life beneficiaries by about $14 billion through 2014 and by about $40 billion through 2019. Approximately 22 percent of those savings would come from a reduced demand for medical services rather than from a transfer of spending from the government to military retirees and their families.

“An advantage of this option is that greater cost sharing would increase Tricare for Life beneficiaries’ awareness of the cost of health care and promote a corresponding restraint in their use of medical services. Research has generally shown that introducing modest cost sharing can substantially reduce medical expenditures without causing measurable increases in adverse health outcomes. Among its disadvantages, this option could discourage some patients, particularly low-income patients, from seeking preventive medical care or from managing their chronic conditions under close medical supervision, which might negatively affect their health.”

If this change is approved by Congress in September, the first curtailment of benefits would occur in 2011. Cost sharing would require retirees to pay the first $525 of medical costs and 50 percent of the next $4,725 for a first-year cost of at least $2,888 per person. The new charges would be indexed to increase with inflation.

The CBO report (which can be found at http://www.cbo.gov/doc.cfm?index=99255) recommends eventually eliminating the Tricare for Life program because it is “too expensive.”

“People who are professionals always look for the channel of least resistance when it comes to cutting money out of the federal and DoD budget,” retired Air Force Brig. Gen. Bob Clements said in an interview. “I can tell you this straight on: Military retirees are one of those channels of least resistance noted for sitting around, doing nothing, and waiting for ole Joe to do it for them. You had better wake up. Your medical benefits are the prime target. If you lose them, you have nobody to blame but yourself.

“Let me repeat that … you have nobody to blame but yourself,” Gen. Clements said. “The way to secure your benefits is to write to your members of Congress and to keep writing and writing and writing. Once is not enough! Keep repeating the above statement until you are blue in the face.

“Health care will eventually become the dominating factor in your life. Remember that it will impact you big time with the utmost in cruelty unless you are fortunate enough to die from a heart attack or get run over by a truck. The service organizations will put up a fight, but they will need your help and can’t do it by themselves. I hope this makes it clear as to what you can expect if you do nothing,” Gen. Clements said regarding younger people who are not yet eligible for Tricare for Life and may be oblivious to the impact of the proposed legislation.
Mr. Obama’s plan also has strong advocates who tout its overall beneficial impact.

“Obama’s health care plan is going to make large insurance companies be more competitive,” said small-business owner and Democrat Ruthie Hottenstein, a Manassas resident who is married to a retired service member. “Some small-business owners may be unable to provide employees with the best health care benefits if the insurance rates keep rising. With Obama’s health care plan, it will bring down the cost of medical benefits and make a more level playing field. Growing up, I had no insurance and didn’t go to the doctor because we had no insurance. A large number of people would be helped if Obama’s health care plan passes.”

Gen. Clements nonetheless said he fears that retired and veteran service members will be negatively affected and recalled the long struggle to maintain benefits. “Remember Tricare for Life is an earned benefit that’s been granted by a previous Congress,” he said.

Evaluation And Commentary

If you are a return visitor to this blog, you will recognize the quotes from General Bob Clements. They are from his original reaction to the CBO’s recommendations last year that became (and remarkably remains) one of the most forwarded emails of 2009. We have discussed the contents of that email on several occasions, namely here and here. It appears that the author of the Washington Times piece used quotes from General Clements and presented it in her article to support her inaccurate statements regarding TRICARE and the future of national health care. MOAA contacted General Clements and he stated that he was not contacted by Mrs. Hurley for the article.

Starting from the first sentence, the article gets the facts completely wrong. The CBO recommendations regarding TRICARE & TFL were never included in President Obama’s budget that was sent to Congress. Unlike previous years in which the White House included cuts to health benefits recommended by the CBO in its proposed budget and Congress was left to strip them out, President Obama took them out on his own. To state that the president and ‘his party’ endorsed the recommendations is a direct and unequivocal misstatement on the author’s part.

Additionally, there are no such changes in any of the versions of the national health care bill nor are there any in the Fiscal Year 2010 National Defense Authorization Act. There is nothing on the docket even resembling what is stated in her article that would come up for vote in September, as is claimed. Cuts to military benefits are something that we are always on the lookout for and there is a future threat (as there always is). But that threat will not come to a head this year, either via the NDAA or the NHCR bill.

In short, the author of the Times piece got duped by an old and widely circulated email that was warning about a future scenario that we now know has not materialized in the way it was originally portrayed. The Washington Times was right to pull the story from its website. Even ‘citizen’ journalists should be able to research their material enough not to include gross misrepresentations of the facts.

One Last Thought on Obama and the Military

If you haven’t heard about it yet, you will. There is a rumor going around that President Obama is forming a ‘Civilian Defense Force’ to quell political opponents and to set up (I’m not kidding you, this is what people are saying) concentration camps. The main source of the rumor seems to be a speech in July 2008 when the then Senator proposed the establishment of a ‘civilian national security force’, which would be more of an expansion of the Peace Corps and AmeriCorps. He was not talking about creating a military organization to replace or rival our currently serving forces, but more of a State department expansion. He echoed this idea with an interview with Military Times in the same month. But one other part of that interview stuck out in my mind and was repeatedly at the forefront of my thoughts while reading the Washington Times article:

“Precisely because I have not served in uniform, I am somebody who strongly believes I have to earn the trust of men and women in uniform.”

Despite the fact that the president has rejected calls for cutting down veteran benefits, and despite the outreach he has made to veterans groups and the military in general, that trust has been extremely hard to come by.

Discussion

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“Years ago, fairy tales all began with Once upon a time… now we know they all begin with, If I am elected.” – Carolyn Warner

A Speech Full of Promises

On August 17th, President Obama spoke to a packed house in Phoenix at the national convention of the Veterans of Foreign Wars and delivered a speech that was meant to bring the White House and the military closer together. In his speech, he promised to improve the lives of active and retired military personnel in a multitude of ways. But it is action, not words, that will determine the course of the relationship between the two parties.

Selected Transcript via the White House

Whether you’ve left the service in 2009 or 1949, we will fulfill our responsibility to deliver the benefits and care that you earned. And that’s why I’ve pledged to build nothing less than a 21st-century VA. And I picked a lifelong soldier and wounded warrior from Vietnam to lead this fight, General Ric Shinseki.

We’re dramatically increasing funding for veterans health care. This includes hundreds of millions of dollars to serve veterans in rural areas, as well as the unique needs of our growing number of women veterans. We’re restoring access to VA health care for a half-million veterans who lost their eligibility in recent years — our Priority 8 veterans.

And since there’s been so much misinformation out there about health insurance reform, let me say this: One thing that reform won’t change is veterans’ health care. No one is going to take away your benefits — that is the plain and simple truth. We’re expanding access to your health care, not reducing it.

We’re also keeping our promise on concurrent receipt. My budget ensures that our severely disabled veterans will receive both their military retired pay and their VA disability benefits. And I look forward to signing legislation on advanced appropriations for the VA so the medical care you need is never held up by budget delays.

I’ve also directed Secretary Shinseki to focus on a top priority — reducing homelessness among veterans. After serving their country, no veteran should be sleeping on the streets. No veteran. We should have zero tolerance for that.

And we’re keeping our promise to fulfill another top priority at the VA — cutting the red tape and inefficiencies that cause backlogs and delays in the claims process. This spring, I directed the Department of Defense and Veterans Affairs to create one unified lifetime electronic health record for the members of the armed forces — a single electronic record, with privacy guaranteed, that will stay with them forever. Because after fighting for America, you should not have to fight over paperwork to receive the benefits that you’ve earned.

Today, I can announce that we’re taking another step. I’ve directed my Chief Performance Officer, my Chief Technology Officer and my Chief Information Officer to join with Secretary Shinseki in a new reform effort. We’re launching a new competition to capture the very best ideas of our VA employees who work with you every day.

We’re going to challenge each of our 57 regional VA offices to come up with the best ways of doing business, of harnessing the best information technologies, of cutting red tape and breaking through the bureaucracy. And then we’re going to fund the best ideas and put them into action, all with a simple mission: cut those backlogs, slash those wait times, deliver your benefits sooner. I know you’ve heard this for years, but the leadership and resources we’re providing this time means that we’re going to be able to do it. That is our mission, and we are going to make it happen.

Now, taken together, these investments represent a historic increase in our commitment to America’s veterans — a 15 percent increase over last year’s funding levels and the largest increase in the VA budget in more than 30 years. And over the next five years we’ll invest another $25 billion to make sure that our veterans are getting what they need.

These are major investments, and these are difficult times. Fiscal discipline demands that we make hard decisions — sacrificing certain things we can’t afford. But let me be clear. America’s commitment to its veterans are not just lines on a budget. They are bonds that are sacred — a sacred trust we’re honor bound to uphold.

These are commitments that we make to the patriots who serve — from the day they enlist to the day that they are laid to rest.

Note: Notations of ‘applause’ have been removed for clarity
For the full transcript of the speech, click here.

Action, Action, Action

While we applaud the promises and priority the White House places on the military community, the promises of keeping health care secure and expanding services must be followed up by real action on the Hill. Preside Obama is obviously reaching out directly to the military because of the rumors and emails that have been spread around concerning the CBO report and TFL. But this is no longer a campaign, this is the presidency, and rhetoric will not work with an extremely vigilant group such as our veteran community. We’ll follow up on this post and see how things are going a bit down the line…

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