For most Americans who oppose Obamacare, the
constitutionality of the law’s mandate to buy insurance is less
important than the power government has under the law to rob them
of medical freedom. Ironically, those that lose
freedom under Obamacare first could be the wounded warriors who
fought for our freedom.
In 2010 President Obama promised Obamacare wouldn’t
diminish health benefits for service families or retirees. He told
the 9.6 million veterans and active duty personnel, who use TRICARE
— the Defense Department’s health plan — or go to Veterans
Affairs (VA) hospitals and clinics, that they would be better
off:
“If you’re in the VA or TRICARE, this will not force you
to change systems…veterans would be eligible, potentially, for this
health care exchange where they could select from a different set
of plans and get some help in paying for their premiums depending
on income levels.”
Yet, last week the administration unveiled a
plan to remake TRICARE that breaks that promise. Most observers
have focused on a proposal to raise premiums for
military retirees younger than 65 from $460 a year to as much
as $2,048 by 2017 (if they’re receiving more than $45,178 in
retirement pay).
But that change is only part of a broader proposal that
could weaken TRICARE and force many veterans into health exchanges
and Medicaid. It assumes most of the three-quarters of
military retirees who are eligible to receive health care through
their employer would do so. However, if wealthier and healthier
veterans migrate to private health plans, it will leave TRICARE
caring only for veterans with lower incomes and more battle-related
diseases such as traumatic brain injury, post traumatic stress
disorder, lost limbs and physical disabilities. More expensive and
smaller group coverage will lead to even higher premiums and
co-pays.
Additionally, the administration wants to steer more
TRICARE patients into military treatment facilities (MTFs). It also
wants to close more military bases. That will reduce the number of
MTFs and base clinics. There are already long wait
lists at MTFs for veterans suffering from battlefield injuries and
illnesses. Obama’s proposals compound this tragedy.
The administration is also cutting payments for private
doctors who participate in TRICARE. Those who do participate are
already paid much less than they get in private health plans. A
2008 Defense Department reported warned:
Since the TRICARE population is much smaller, there is
less motivation to take on these patients at the low Medicare
rates. In fact, among providers who are accepting new patients
while turning away TRICARE patients, the Survey of Civilian
Physician Acceptance of TRICARE… found reimbursement rates were the
most commonly cited reason for not accepting TRICARE
beneficiaries.
Without adequate reimbursement, there is a concern that
dependents and retirees will face an ever-shrinking pool of
providers willing to treat them. Particularly for the active duty
and mobilized reserve populations, limited access to health care
providers could have a significant negative impact on recruiting,
retention, and readiness.
Reducing TRICARE enrollment and reimbursement will leave
veterans with fewer choices and less care. While many veterans
could get coverage through employers or a health exchange,
thousands more could be forced into Medicaid.
Nearly 12 percent of Iraq and Afghanistan veterans live in
poverty. A staggering 30 percent are either unemployed or have
stopped looking for work altogether. Medicaid is their only
non-TRICARE alternative. Veterans with family who with a
combination of military pension (available after 20 years of
service) and income make up to $32,000 a year would be required to
enroll in Medicaid if they forgo TRICARE. Anyone earning above that
could pay more out pocket under Obamacare than the $3,000 TRICARE
cap on such costs.
Finally, the military health system too often
misdiagnoses or ignores the increase in the number of veterans
with severe physical and mental health disabilities. Even
controlling for perverse incentives to discourage recovery (you
lose benefits if you are well), nearly 20 percent of
Iraq and Afghanistan veterans since 2001
suffer from PTSD or
TBI. (Six percent have both.) Hundreds of
thousands of veterans have lost limbs or have physical injuries
requiring long-term rehabilitation.
At present, the number of veterans seeking care for these
conditions already overwhelms MTFs. While more veterans are
receiving specialty care, a recent study showed that a majority of
those with a diagnosis do not get such treatment. Shifting them to
Medicaid could even be worse: waiting lists for Medicaid treatment
of brain injuries and physical disabilities are growing even
without veterans. Limits on coverage are often worse than the
VA’s.
Veterans should be given more liberty to get the care the
need, when they need it. Whether or not the Supreme Court
decides Obamacare is constitutional, one thing is
certain: The president’s proposal forces our veterans to fight one
more battle to get the care our nation owes them.
