Influenced by that vote, the Senate was expected to cast its own floor vote in early June to upgrade a smaller FEHBP test endorsed by the Senate Armed Services Committee.
FEHBP is a coveted menu of health plans available to federal civilian employees and retirees. Benefits are not free, but they are expansive, and the government subsidizes almost three-quarters of the cost.
At one time, FEHBP looked inferior to the military benefit package which included free in-service care to many military retirees and their families. Now federal civilians are better off, said Representative Jim Moran (D-VA), because the "mission of FEHBP is to focus on the beneficiary and not on the mission of the agency."
Representative John L. Mica (R-FL), chairman of the House Civil Service Subcommittee which oversees FEHBP for civilians, gave military FEHBP a shot in the arm with a 28 April hearing, in which he took testimony from victims of declining access to care and urged Defense officials to drop their opposition to an FEHBP test.
Sydney Hickey of the National Military Family Association (NMFA) testified that TRICARE does not come close to providing the uniform benefit the Defense Department had promised. Medicare eligibles cannot enroll. Space-available care is disappearing. Many retirees under 65 live too far away to use managed care. And some who live near bases prefer their own doctors but still get pulled into the military system. Nothing like that occurs with FEHBP, Hickey said.
"NMFA believes it is time to relieve DoD of trying to provide both a peacetime health care benefit and to meet its readiness mission," Hickey added.
By 2003, Moran said after the House vote, FEHBP could be open to all military beneficiaries 65 and older. He joined with Republicans J. C. Watts, Jr., of Oklahoma and Mac Thornberry of Texas in sponsoring the FEHBP test as an amendment to the 1999 Defense Authorization Bill. As the vote neared, military associations applied pressure to other lawmakers with coordinated mail-gram campaigns. The Watts/Moran/Thornberry amendment was adopted by an overwhelming vote of 420-to-1. Only Rep. Bill Thomas (R-CA), peeved that the amendment hadn't cleared the House Ways and Means subcommittee on health he chairs, voted no.
"This is the first step in what I'm sure is going to be a nationwide health insurance program for [elderly] military retirees," Moran said.
The impact on the Senate was immediate. A senior staff member who earlier said senators did not view FEHBP as a good solution to the crisis facing elderly military beneficiaries reported that the Senate Armed Services Committee would back a floor amendment to expand and accelerate its own limited FEHBP test. "You certainly can't ignore a 420-to-1 vote," he said.
Watts, Thornberry, and Moran said an FEHBP test will not make up for broken promises of free, lifetime care. But each saw the House vote as a critical step toward treating older military beneficiaries at least as well as federal civilians. "If we can get FEHBP started, and the Medicare subvention program moves ahead, then we've got two pieces of the answer, and are making progress," said Thornberry.
The House test would run three years, from January 2000 through December 2002 at six to ten sites selected jointly by the Secretary of Defense and the Office of Personnel Management. The cost would be capped at $100 million a year and paid for by selling unneeded defense assets. At least one test site would be near a service hospital, another would not be, and a third would have to be one of the ten sites set to test Medicare subvention later this year.
A successful test of FEHBP is not easy to define. If older beneficiaries jump at the chance to enroll, perhaps attracted by low-cost Medigap options that wrap around Medicare, it might confirm Pentagon fears that FEHBP threatens the viability of the military system.
Gary Christopherson, acting health chief at the Pentagon, said Defense will not oppose an FEHBP test, but Congress should understand the implications. If forced to pay for an FEHBP option from current budgets, he said, the services would make deeper cuts in treatment facilities. As space-available care declined further, more retirees would rush into FEHBP to protect benefits. A younger, healthier, mix of patients would erode physician skills and readiness. At this point, no one is sure how many service elderly want FEHBP, said Thornberry. But he believes a test will prove dire Pentagon warnings are exaggerated. "The idea that if you offer FEHBP, every retiree [then] will run out of the system [ignores] the fact that a lot of them want to be treated in house," Thornberry said.
The current situation, Moran suggested, is intolerable. "If they want to offer adequate care, that's fine," he said. "But if they are going to put retirees at the end of the line at treatment facilities, and also prohibit them from using CHAMPUS or TRICARE, then retirees are going to find someplace else to get medical care."