A grassroots effort by elderly military retirees to force the government to fulfill promises of free lifetime healthcare is likely to result this year in significant healthcare gains for beneficiaries 65 and older.
The two most prominent initiatives nearing congressional approval would provide a vastly improved pharmacy benefit and would grant elderly the same healthcare options available to under-65 retirees, including enrollment in Tricare Prime, the military managed-care program, or use of Tricare Standard, the fee-for-services insurance plan also called Champus.
On 7 June 2000, the Senate voted to end what Senator Tim Hutchinson (R-AR) described as "age discrimination" in military healthcare. Older beneficiaries no longer would be disenrolled from Prime or lose eligibility for Standard when they turn 65.
"It is time we let retired military personnel know that the United States Senate hears their plea for justice and equity," said Hutchinson. He had joined Senator John Warner (R-VA), Chairman of the Senate Armed Services Committee, in co-sponsoring the amendment to the fiscal year 2000 defense authorization bill. The Senate approved it with a 96-to-1 vote.
If the amendment becomes law, said Hutchinson, "No one will be kicked out of the military healthcare system just because they turn 65." As written by the Senate, the change would take effect 1 October 2001.
The Senate also approved for service elderly a comprehensive mail-order pharmacy program and a discount retail drug benefit. The House earlier had approved a slightly better pharmacy benefit but had not gone as far as the Senate in opening health programs to beneficiaries 65 and older.
The differences between the House and Senate bills will have to be reconciled by a House-Senate conference committee.
Warner said the Senate's health package for service elderly would cost $40 billion over ten years, not counting whatever spending might be required to beef up medical staffs and expand facilities to accommodate more retirees. Because projected costs to expand retiree access accelerates over time, and quickly would exceed budget ceilings set in law, Warner was forced to limit the effective date of his amendment to cover just two years. The authority would expire 30 September 2003. He did this to avoid a "budget point of order" that could have killed the amendment based on cost alone.
Some senators expressed concern that retirees will see the two-year Limit and conclude new access to Tricare Prime and Standard is just another in a series of "test" programs. That is not the sponsors' intent, however. Indeed, Warner challenged prospective presidential candidates-Republican George W. Bush and Democrat Al Gore-to assure retirees that, if elected, they will support extending Warner-Hutchison "in perpetuity."
A more ambitious initiative for service elderly did fall victim to a budget point of order. Senator Tim Johnson (D-SD) introduced as an amendment his "Keep the Promise" bill that would allow retirees and their families to enroll in the Federal Employees' Health Benefit Plan, the popular menu of health insurance plans offered to federal civilians. The government would pay all premiums for those who entered service before 7 June 1920, the day a law was signed limiting retiree in-service health benefits to "space available" care.
Johnson supported Warner's amendment, but said only his bill-which would cost $90 billion over ten years-fulfilled the promise of free lifetime healthcare made to generations of retirees. Budget surpluses could cover the cost easily, Johnson said.
He anticipated the budget point-of-order challenge and said he welcomed it.
"After all these years of Veterans' Day and Memorial Day rhetoric, about how important our veterans are, this will be an opportunity for every member in this body to stand up and be counted," Johnson told colleagues. "Is that rhetorical support? Or are you, in fact, willing to put these [retirees'] priorities ahead of other budget priorities?"
The Senate answered by casting only 52 votes, rather than the 60 needed, to waive the point of order. As a result, Johnson's amendment never came up for a vote.
Overall, however, the Senate went further than first expected this year in voting to boost healthcare benefits for service elderly. Momentum began to shift to do more on 18 May, when the House voted 406-to-10 for an amendment from Representative Gene Taylor (D-MS) to allow, within five years, nationwide access to military managed care for service elderly.
"We're going to get back to the day where [military] folks can make a conscious decision to retire near a military healthcare facility with knowledge that that is there for them for the rest of their lives," Taylor said.
Under both the House and Senate plans, Medicare-eligible retirees would enroll in the managed-care program, Tricare, as though it were a Medicare-approved health maintenance organization. Both plans also agreed on an improved pharmacy benefit. Under both versions of the 2001 defense authorization bill, beneficiaries 65 and older would become eligible for both a comprehensive mail-order pharmacy program and a discount retail-drug benefit, no matter where they live.