Health Care Happenings

Earlier this week, I attended a joint hearing of the Special Committee on Aging by the Subcommittee on Oversight of Governmental Management, The Federal Workforce, and the District of Columbia, Committee on Homeland Security and Government Affairs. This was chaired by Senator Akaka of Hawaii. The purpose of the hearing was to hear witnesses testify on the rescent decision by the federal government’s Office of Personnel Management’s (OPM) to raise one of their long-term care insurance product’s premiums by as much as 25%. This unexpected rise in premiums affects approximately 144,000 individuals holding a policy with this particurlar option. The option is the Automatic Compound Inflation Option, or ACI.
Over seven years ago, OPM provided an insurance product for long-term insurance through a contract with John Hancock and Metropolitan Life as the insurance underwriters. This product was designed to help protect enrollees against the high costs of long term healthcare. Most Federal and Postal Service employees and retirees, active and retired members of the uniformed services and qualified relatives are eligible to apply for the insurance coverage. The program offered flexible benefit options to meet the diverse needs of the Federal family. The covered benefits included at-home formal and informal caregiver services, adult day care, assisted living facility care, hospice care etc.
Many individuals selected the aforementioned ACI option. This option stated in the published literatureby OPM at the time, that “Your premium will not change because you get older or your health changes or for any other reason related solely to you”. Which clearly implied to the enrollees that their premium’s would remain static and their benefits the same over the course of time if they paid their scheduled premiums on time. However, this year that proved not to be the case. OPM, due to some faulty assumptions and calculations on inflation, discovered that without an adjustment, the long term program would face a projected shortfall in funding for enrollees with the ACI option. Hence, their decision to raise the premiums. Their “original estimates appear inadequate”.
I can tell you that the Senate Sub-Committee was incensed with OPM that this could have occured and placed so many well intended federal retirees at risk! A representative from John Hancock Insurance Company also testified with proposed amends for these individuals, but these were met with a tepid response by the Committee members.
This brings us to some rescent proposed legislation by Senator Kohl D-WI. “the Confidence in Long Term Care Insurance Act of 2009″. This bill is designed to strengthen the consumer protections afforded to purchasers of long term care insurance, specifically by implementing protections, regulations, data collection, providing criteria for the creation of a “model” disclosure form which will provide consumers with consistent information regarding the insurance product which will be in an easily understandable format, as well as other protections for consumers.
In summary, I put this out to our members for their awareness, and suggest that we all become as educated as we can in the planning of our future long term needs.

The New York Times reported today that under rules to be proposed this week the Department of Veterans Affairs plans to add Parkinson’s disease, ischemic heart disease and hairy-cell leukemia to the growing list of illnesses presumed to have been caused by Agent Orange, the toxic defoliant used widely in Vietnam.

These illnesses will be added to the list of more than a dozen conditions the VA already recognizes as being presumptively linked to Agent Orange exposure in Vietnam, including Hodgkin’s disease, prostate cancer and Type 2 diabetes.

According to the Times article, the most common of the three illnesses, ischemic heart disease, restricts blood flow to the heart, causing irregular heartbeats and deterioration of the heart muscle.

Parkinson’s disease is associated with a loss of cells that secrete dopamine, a brain chemical essential for normal movement. Patients develop tremors, rigid posture, impaired balance and an inability to initiate movement.

Hairy-cell leukemia, a rarer condition, is a slow-growing cancer in which the bone marrow produces too many infection-fighting cells, lymphocytes, that crowd out healthy white blood cells, red blood cells and platelets.

The Institute of Medicine released a report in July that found “limited or suggestive evidence” of an association between exposure to herbicides and an increased chance of Parkinson’s disease and ischemic heart disease in Vietnam veterans. The report also found “sufficient evidence,” a stronger category, of an association between herbicides and hairy-cell leukemia.

The report, written by a 14-member panel appointed by the institute, was based on a review of scientific literature. The institute is required by Congress to monitor the health effects of herbicides used in Vietnam and produce updates every two years.

Some doctors and researchers say the expansion of Agent Orange benefits has been based on weak or inconclusive science, given the lack of studies on Vietnam veterans. Those skeptics argue that diseases like prostate cancer or Type-2 diabetes are just as likely the result of aging, lifestyle or genetic predisposition as exposure to Agent Orange.

The MOAA Healthcare Team attended a TRICARE Beneficiary Panel briefing earlier this morning.  We were reminded of an item of interest which actually took effect last Thursday the first of  October. 

This is the recent DoD policy which is aimed at cleaning up TRICARE Prime enrollment at military treatment facilities (MTF’s) and represent changes for what could be many TRICARE Prime enrollees.

TRICARE has long had established travel access standards to assist beneficiaries to recieve timely healthcare.  The standards require that enrollees shouldn’t be assigned a primary care manager (PCM) at a military hospital or clinic that is more than a 30 minute drive from the beneficiary’s home address.

As a practical matter, DoD never really enforced that policy.  But it will be enforced now.

If you as a beneficiary want to continue to be seen in the MTF, current Prime enrollees in the U.S. (except if you live in Alaska, you will be exempt from this policy) who live farther away than a 30-minute drive from the MTF will have to request a waiver of the drive-time standard from the MTF Commander or the TRICARE Regional Office.  Drive times will be determined by a computer program similar to MapQuest.  Approved waivers will have to be renewed annually from now on.  If you have not filled one of these out and you fit this category, you will be automatically assigned a civilian PCM closer to your residence. 

If you live over 40 miles from the MTF and have not submitted a waiver, you will automatically be disenrolled from Prime and will revert to TRICARE Standard.  We were informed that the TRICARE contractors have been mailing out letters to all affected beneficiaries providing detailed instructions on the waiver process.  To date 49% of those eligible have not submitted the required waiver request.

Many folks may not find out about this until they try to make their next appointment at the MTF!

Last week, the Pentagon announced that the TRICARE Standard inpatient copay for retirees and survivors under 65 and their families would be increased $110 a day — from $535 to $645.

MOAA viewed that as violating the Secretary of Defense’s pledge earlier this year not to propose any TRICARE fee increases.  After MOAA protested to Secretary Gates, some contended that the Pentagon had no choice under the wording of current law.   So MOAA sent letters to Congressional leaders and generated a grass-roots alert to urge a legislative fix.

We’re pleased to report today’s late-breaking news that Congress  has, in fact, included a provision prohibiting the proposed copay hike in the FY2010 Defense Authorization Act, which could be coming up for a final vote as early as this week.

Humm, thought I’d catch up on some reading while at the gym—so I pulled out my TRICARE Health Matters Newsletter, Issue 7: 2009 issue.

It was a pretty quick read and I flipped through the pages in short order. But when I got to the last page, for some reason, the box in the upper right hand corner of the back page spoke to me.

It said:

TRICARE
An Excellent Value
• Generous coverage
• Superior health care
• Decisions health driven, not insurance driven
• High satisfaction with care
• Low out-of-pocket costs
• Easy access

I struggled some with these words. Do you?

Humm, look forward to hearing your thoughts on “TRICARE—An Excellent Value”—Any after thoughts?

The ravages of the current war aren’t always apparent to those untouched by the conflict.

But, for those troops or their families who are suffering from the consequences of an unseen injury of war, the war rages on in their minds, hearts, bodies, and souls.

That holds particularly true for Sgt. Loyd Sawyer and his family. Sawyer left his job as a funeral director to join the Army to give honor those who lost their lives in service to their country.

His six months working at the morgue at Dover Air Force Base, Deleware and six months in mortuary affairs at Joint Base Balad in Iraq forever changed his life.

Kelly Kennedy, a Military Times reporter writes about the Sawyer family, and Loyd’s struggles in the first of a 12-part series on posttraumatic stress disorder (PTSD) at MilitaryTimes “Living with PTSD: a former sergeant’s personal hell.”