Military family members take health care cost concerns right to the top

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The Military Coalition, a group representing millions of service members and their families has appealed right to Defense Secretary Lloyd Austin. Their concern: Rising out-of-pocket costs for TRICARE, planned cuts to medical billets, and possible lower funding for the Uniformed Services University of the Health Science. With more, the director of health affairs for the Military Officers Association of America, Karen Ruedisueli, joined Federal Drive with Tom Temin.

Interview transcript:

Tom Temin: Ms. Ruedisueli, good to have you on.

Karen Ruedisueli: Good morning. Nice to be on with you today.

Tom Temin: And you’re also speaking on behalf of the coalition itself, correct?

Karen Ruedisueli: I am, yes, together with Eileen Huck from the National Military Family Association. I co-chair TMC’s health care committee, and we developed the flutter that went to Secretary of Defense Austin.

Tom Temin: Alright. And the top issue in that letter is increases in TRICARE fees that have occurred after several years of congressional and bureaucratic reorganizations of the whole military health care system itself. Tell us basically what’s going on and what the effects have been on people that are covered by the Military Health System.

Karen Ruedisueli: The coalition just wanted to get out ahead of the budget process and make clear our position that there should be no further disproportionate fee increases to TRICARE. The benefit, the TRICARE out of pocket costs were stable, unchanged for more than 20 years as people fulfilled an entire career of military service. And then starting in 2018, we saw a series of pretty dramatic increases, office visit co-pays more than doubled, pharmacy co-pays increased, we had an unprecedented enrollment fee established for one of the TRICARE plans, the catastrophic cap went up. So you can imagine for people who saw one version of TRICARE during their entire careers to see these dramatic fee increases once they were retired and had fulfilled an entire career of military service was pretty upsetting.

Tom Temin: And I would guess that the effect is more pronounced on those coming out at the lower ranks with lower pensions, lower salaries than those of the, say, flag rank.

Karen Ruedisueli: Absolutely. I think it’s really important for people to understand that the majority of retirees come from the enlisted ranks, they are not retired general or flag officers.

Tom Temin: So basically, you’re looking for stable fees. But sometimes, along with that, we’ve heard the suggestion from members of Congress and different groups, that perhaps a fewer number of people should be eligible because TRICARE is getting and the Military Health System is getting very expensive. What’s your take on that?

Karen Ruedisueli: Well, first of all, I would say our organizations are not unreasonable. We are not demanding absolutely no fee increases ever. What we’re saying though is that they should not ever exceed the retiree cost of living adjustment that occurs every year, because otherwise, you’re really cutting into the value of the retirement benefit and to reduce the retirement benefit after somebody has fulfilled the terms of service is unacceptable. We don’t believe that constrained eligibility is the way to go either. And in fact, we believe it’s very important that TRICARE eligibility keep up with benchmarks that are set by commercial plans. For instance, right now, commercial plans are required to cover child dependents up to age 26 and TRICARE does not. TRICARE ends eligibility for military kids when they reach age 21 or 23. If they’re enrolled in college full time, we are advocating right now, the TMC, is to expand eligibility for young adult dependents to match what’s out there in the civilian sector.

Tom Temin: Good point there to that mismatch between what everyone else in the world seems to have and what those in the military have. And the idea of this cut that is anticipated, 18,000 people out of the military roster of health care providers, that’s something your group is not too happy with either, is it?

Karen Ruedisueli: That’s right, those medical billet cuts were proposed in the last two administration budget requests, and they have been quite alarming to our organizations who not only represent beneficiaries, but also count many former uniformed medical personnel among our members. We are very concerned that this could impact not only the access to care for military families and other beneficiaries, but it could also be a threat to readiness.

Tom Temin: And we don’t know precisely what’s going to be in the 2022 budget request, except the military is a giant number, will be basically flat except for salary increases. You don’t have any early warning drumbeats on what they might do in that particular issue yet, do you?

Karen Ruedisueli: I wish we did. There are some indications that these bullet cuts are being reconsidered. Last year, we spent months trying to raise awareness of the fact that the military medical system has to have a certain level of surge capacity. And we’ve seen that during the COVID pandemic, a lot of military medical personnel were deployed to set up field hospitals to staff civilian hospitals that were overburdened. Most recently thousands of military personnel have been deployed to support FEMA vaccination sites around the country. So I think that COVID has really underscored the need to maintain that surge capacity within the system. And when those folks deploy, we need to make sure that our military families and other beneficiaries maintain access to care, that’s also important.

Tom Temin: And the third issue with the letter is sustainment of funding to the uniformed services, University of the Health Sciences. indications are that those are under consideration for cuts — or what’s going on there?

Karen Ruedisueli: Well, the defense-wide review that was initiated by former Secretary of Defense Esper targeted the Uniformed Services University for cuts, there were cuts that were proposed during last year’s administration budget requests. And fortunately, those were restored during the NDAA process. We advocated for that last year, we sent letters in support of USU because it’s a critical pipeline for uniform medical providers. The USU produces physicians who are more likely to serve full careers, they are more likely to deploy more often than physicians from other assertion sources. So the USU plays a critical role, and we need to make sure that it’s protected during the budgeting process.

Tom Temin: Alright. And so all of these concerns, again, went directly to Lloyd Austin, the Secretary of Defense, has he gotten back to you yet on any of it?

Karen Ruedisueli: Yes, we did receive a response from the Secretary of Defense, acknowledging our concerns and emphasizing that they are taking them under consideration.

Tom Temin: Yeah, so good least he acknowledged them, but no promises yet. And, of course, he is a retired general officer so he must feel the same pain that everyone else does from a personal standpoint.

Karen Ruedisueli: Right. I would imagine he does. But as you’ve mentioned before, I think the impact of some of these out of pocket costs increases has really been more pronounced on the folks who don’t retire as general officers, but I’m confident that he has the well being of the military in mind.

Tom Temin: Sure. And are you also the group, the TMC, The Military Coalition, and the various subgroups — are you also making a plea to Congress to look at some of these issues also?

Karen Ruedisueli: Oh, absolutely. We have been meeting with Armed Services Committee staff and member offices to emphasize our positions on these issues. We really want to make sure that we’ve seen the end of disproportionate TRICARE fee increases and other cuts to the Military Health System.

Tom Temin: Karen Ruedisueli is the director of Health Affairs at the Military Officers Association of America. Thanks so much for joining me.

Karen Ruedisueli: Thanks so much, Tom.

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