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Too Old for Health Care
When Richard Templeton, a retired naval reserve officer in Port Ludlow, Washington, injured his foot last spring, he called Madigan Army Medical Center at Fort Lewis to see a podiatrist. He couldn’t get in.
“They said, ’We don’t treat people over 65,’ recalled Templeton. “I was upset. I put time in the Navy, including service in World War II, and was promised something in return.”
Joann Laurents, wife of a retired Air Force colonel, tried to arrange a routine gynecological exam at DeWitt Army Community Hospital on Fort Beivoir, Virginia. The scheduler chirped
that she had several openings before asking Laurents, now 71, her age. Suddenly nothing was available. “That was the first time anyone there had ever asked my age,” said Laurents. “I figured since my husband spent 30 years in service, I should be seen. It wasn’t fair.”
Thousands of retirees and dependents—65 and older—have been turned away from military hospitals and clinics in recent years and forced to rely on civilian care providers, using Medicare insurance with its higher out-of-pocket costs. But what began as an occasional nuisance at selected locations could become a permanent and universal lockout of Medicare-eligible retirees, dependents, and survivors. Hardest hit would be an estimated 230,000 beneficiaries, age 65 and older, who receive regular care from military hospitals. Their space-available privileges could disappear by late 1997 as TRICARE Prime, the military’s new health maintenance organization, is phased in throughout the United States.
Retirees who see what’s happening “are frustrated and they’re frightened,” said Dorsey Chescavage, a health-care specialist for the National Military Family Association (NMFA). Yet many are still unaware of the changes ahead. Pentagon officials blame the situation on tighter medical budgets that won’t allow them to offer TRICARE Prime to older beneficiaries, unless Medicare reimburses the military for the cost of such care—an estimated $1.2 billion a year. That transfer would have occurred under President Clinton’s health reform bill. With that plan now dead. Pentagon receipt of Medicare funding appears unlikely. Yet the TRICARE phase-in is on schedule, and those not enrolled could soon see a sharp decline in space-available care.
Oliver Frakes, a retired Navy corpsman who cared for wounded Marines during the 1950 landing at Inchon, Korea, says he already feels locked out. Although Tyndall Air Force Base is ten minutes away from his home in Panama City, Florida, Frakes says neither he nor his wife, Norma, can get a medical appointment. And Frakes’s eligibility for CHAMPUS, the military’s standard health insurance, ended in July when he turned 65. Since then, he says, his medical costs have jumped. Frakes pays $46 a month for Medicare Plan B coverage and $72 a month for supplemental health insurance. Neither plan covers prescription drugs for which Frakes paid $1,000 over the last four months. “I thought as long as we lived near a military base, we’d have free medical care for the rest of our lives,” he said. “Now that’s not true.”
Retiree associations are urging their members to pressure the 104th Congress to support a transfer or Medicare funds so older beneficiaries aren’t shut out of TRICARE. But Chescavage of the NMFA says Pentagon could be looking for other solutions to protect retirees. “Predicating health care for Medicare-eligi- bles on Medicare reimbursement is blatantly unfair and, in fact, unconscionable,” she said. “These people earned a health-care benefit that should be paid for by the Department of Defense, not Medicare.”
At some point, she said, the government has lost sight of what it owes to aging retirees and their families. “Any health insurer would love this plan, because it eliminates the old and the sick,” she said. “In terms of saving money, what a deal! In terms of health-care coverage that people have earned, it stinks!”
TRICARE Prime Details Unveiled
Active-duty families and CHAMPUS-eligible retirees will be eligible for TRICARE Prime, beginning 1 March, in Oregon and Washington state. Defense officials say on average, enrolled families will save over standard CHAMPUS $170 a year for junior enlisted, $240 for E-5 and above, $100 for CHAMPUS- eligible retirees and dependents.
Active-duty families will pay no enrollment fee. Fees for junior enlisted families will range from $6 per outpatient visit to $25 per outpatient surgery. Fees for dependents of E-5 and above will range from $12 for outpatient visit to $30 for emergency room visits. Eligible retirees, survivors, and their families will pay an enrollment fee of $230 per individual, $460 per family, besides the service fees.
Military hospital visits will remain free at least through late 1997. Then, says Deputy Defense Secretary John Deutch, the department should consider imposing fees to help control demand, free up space, and reduce health-care costs.
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Proceedings / February 1995