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.
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