President George W. Bush's 2002 budget request, unveiled in early April 2001, calls on Congress to require all military retirees eligible for health care both through the military and Veterans Administration (VA) hospitals to "enroll with the agency of the retiree's choice and obtain care exclusively from that agency's health care system."
Robin Cleveland, associate director for national security at the Office of Management and Budget, said through a spokesman that the intent is to provide retired veterans with the care they need as efficiently as possible.
Military associations oppose forcing 700,000 retirees, many of them disabled, to choose between the VA health system or the military medical system.
Under the President's plan, "dual-eligible" retirees would be allowed once a year to shift enrollment between VA and TriCare, the military's managed-care program, based on individual needs. Families of retirees would remain under TriCare.
Advocates for retirees described the proposal as a clumsy attempt by White House budgeteers to offset some of the multibillion-dollar cost of the TriCare for Life and TriCare Senior Pharmacy programs approved last year. Retirees with service-connected disabilities, the groups said, should not have to chose between critical VA services—prosthetics, blind rehabilitation, spinal cord injury therapy, custodial or psychiatric care, and free or inexpensive medicines—and more traditional health services provided, often more conveniently, by the military.
Mark Olanoff, legislative director for the Retired Enlisted Association, said he hesitates to attack the new President but believes President Bush is a victim of "poor staff work."
"What they're saying is, `We now have two kinds of veterans. If you retired from a career in service, then you're not really a veteran; you're a military retiree. You don't get [full] benefits.' Well, that's unfair."
Sue Schwartz, a healthcare policy expert for the Retired Officers Association, described herself as "fired up" over the "mandated choice" proposal.
"What are we going to tell the beneficiary who needs prosthetic care, for which the VA is renowned, and travels 90 minutes once a month to receive it? But he also has a cardiac condition, so he goes to his [TriCare] doctor near his home. So we're going to deny this beneficiary prosthetic care?"
The idea will not even save money, Schwartz said. The VA would "have to expand its capacity to be all things to all people," she noted. TriCare would have to contract, at significant cost, the kinds of special services that the VA now provides to disabled retirees. The big surprise of the plan, said Schwartz, is the target: disabled retirees.
"These are beneficiaries who have risked life and limb [and] sustained a physical impediment in service to country. We've taken away their retirement with [the federal ban on] concurrent receipt [of both military retirement and VA disability pay]. Now we're going to take away their health care? Why not just kick these people down the street?"
Representative Christopher H. Smith (R-NJ), chairman of the House Veterans Affairs Committee, wants veterans hospitals and clinics to expand access to care and broaden their range of specialty services, particularly with VA-led advances in treatment of Alzheimer's disease and other mental health disorders. With that kind of agenda, he suggested he is not inclined to support the Bush administration proposal.
"There are some areas where the VA really has dominance, particularly with some of the specialty care," he said. "It would be a shame if it was [made] an either-or proposition."
Representative Smith said the House Armed Services Committee, rather than his committee, would get the forced-choice proposal for action. But he said his "gut sense" is he will not support it should it come up for a vote on the House floor. Indeed, if he gets his way, areas of specialty care in which the VA is "unsurpassed" will expand, "particularly in the mental health area.
One congressional staff member, however, saw merit in the plan.
Too many retirees, the official said, "shop" among federal health care options for the lowest out-of-pocket costs. That is understandable, but it affects continuity of care and wastes resources, he said. For example, a Medicare-eligible military retiree might visit his civilian doctor. If the ailment found requires expensive medicines, the retiree might decide to be examined all over again by the VA, where he can get drugs either for free or for $2 per 30-day supply. Even military retirees with no service-connected disability are eligible to use the VA if they pay a $50 copayment per visit. Those with a service-connected disability, even if rated as low as 10%, receive free health care and medicines.
On 1 October, TriCare for Life, a second-payer plan to Medicare for military beneficiaries 65 and older, takes effect. The administration expects it to entice 47,000 "dual-eligible" military retirees to stop using VA benefits, thereby shifting $235 million in costs to the Defense Department. But administration officials hope millions more can be saved if retirees are forced to pick either TriCare for Life or the VA.