TREA: The ENLISTED ASSN

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NEWS FOR THE ENLISTED

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1) DoD Rolls Out Its Proposals for Changes In Retirees’ TRICARE Benefits
Well, we finally can see what the Administration wants when it comes TRICARE for retirees. Most of it is expected; some is surprising; none of it is good. The Administration says that they are not proposing any cuts in benefits (and while that is not quite true) what they have primarily done is proposed increasing retiree beneficiaries out of pocket cost.

In 2012 there was an increase in the yearly enrollment fee for retirees and their families for TRICARE Prime that was passed into law. It is not a surprise that they are proposing further yearly increases in the enrollment fees. But it is slightly surprising that while creating these proposed fees they decided to set up 3 tiers based on a retiree’s retired pay. Below you can see a chart of the Administration’s proposal. As you can see the amount of the proposed fee goes up with the increase in retired pay. When they were talking about this idea a while back, DoD’s idea of tiers was going to be based on a retirees’ total yearly family income (which would have included subsequent jobs, spouses’ incomes, etc) so they clearly backed off that on that idea.

They have also exempted the medically retired and survivors of members of the military who died on active duty from these proposed increases.(That means the wounded warriors and the widows/widowers of those who died on active duty.) So this cuts out the people who the general public cares the most about. And, I am sure DoD believes that will make their proposals much easier to get through Congress.

Please note: When I asked the TMA representatives about survivors whose service member spouse died from service connected injuries, they said did not know. But we bet the answer will be (like last year’s go around) that they are not exempt.

From FY2016 the proposal is that the enrollment fees will go up by the National Medical Cost Index for the infinite future.

They are also proposing a yearly enrollment fee for retirees for TRICARE Standard and TRICARE Extra. At this time there is no yearly enrollment fee. DoD has tried to get this for years and years. If the proposal is adopted it would fundamentally change what the TRICARE Standard benefit is. It would make it just another insurance plan. One should remember that a retiree in TRICARE Standard is already paying 25% of the health care bill (a substantial amount.) Presently a retiree can start to use TRICARE Standard at any time in the year. If he is using a civilian insurance plan that does not cover something that TRICARE Standard does he can use it then. He (or she) always has it in his or her back pocket- so if they decide to leave a job or have an adventure they can use it. When I asked the TMA representative If there would be an open season; if a retiree would need to enroll during that season before using it the answer was again: we don’t know. They promised to get back to us and if we get an answer we will print it immediately. (but all of these gaps will probably be placed where they think they can negotiate.)

Proposed Yearly Enrollment Fee for TRICARE for Life (TFL)

The Administration is proposing that retirees on TFL should pay a yearly enrollment fee! The proposed fees listed below are per person. So a couple would need to multiply these numbers by 2 (just as they have to when paying the monthly Medicare Part B premium.) Again, there are proposed tiers and after FY2016 the increases are based on National Medical Cost Index. When asked what the basis of these numbers were TMA representatives said it was a percentage of the costs of a Medigap policy.

DoD emphasized that the tiers’ income levels will increase based on the COLA so no one will be moved up to a higher tier. But, again, from 2016 on they propose that the increases will be indexed to medical inflation rather than the COLA (remember last year’s fight) so the proposed increases will eat into the retired pay- since the medical index has been much higher than the COLA for the last 25 years.

The Administration’s FY2013 budget also has proposals to change the TRICARE Pharmacy plan and the catastrophic cap.

Proposed TRICARE Pharmacy Co-Pay Changes

The planned pharmacy co-pays are clearly to move beneficiaries to use mail order MTF Pharmacies (when possible) and generic drugs.

These proposals (if adopted as proposed) would apply to all beneficiaries except the active duty. There would still be no fees for the Active Duty’s prescriptions and MTFs would still have no co-pays for everyone.

Please notice that the proposal takes all Tier 3 Non- Formulary drugs (which are covered by TRICARE and should not, I think, be called non formulary) out of the retail stores. When questioned how people could get their first fill of a drug the doctor says they should start right away TMA said that that will be worked on. Also in 5 years all at once mail order generics go from a $0 co-pay to a $9 co-pay. This is the same as the retail generic co-pay. (With a 30 day prescription in retail and up to a 90 day prescription in home delivery.) After they bragged so much last year about having a $0 co-pay. We assume that they think after that length of time everyone will be switched over to home delivery.

Proposed Changes in the Catastrophic Cap

The DoD FY2013 proposed budget also includes changing the absolute limit that a beneficiary needs to pay out of his or her pocket in any single year for TRICARE no matter how much care is provided. They are proposing that the present $3,000 catastrophic cap will be indexed to medical inflation (the National Health Expenditure Index) and the enrollment fees will be excluded in the calculation (Presently enrollment fees are included in the calculation.)

More BRACs and a Military Retirement Commission

The budget also proposes creating 2 additional rounds of BRAC and a “Military Retirement Modernization Commission” that would propose to modernize (read civilianize and cut) the military retirement system and that it would be considered through a BRAC like system. (DoD would make a recommendation to the Commission, after considering that “and other inputs, the Commission would make a recommendation to the President; the President could request changes in the recommendation but not require them; the President chooses whether to send the recommendation to Congress; and Congress must vote up or down the recommendation without changes.)
Again and again DoD emphasizes that they were not cutting back on any part of the benefit (just shifting some “modest costs” (And even with these increases the costs would not be the 27% cost share that they allege was the percentage military medical beneficiaries were paying on 1996 when TRICARE was stood up. Again and again, they also say that we must all be ready to step up and sacrifice for the country in this bad financial and budgetary times. Clearly the Administration thinks that this will convince Congress to agree with them. But remember these are just the Administration’s proposals. They are not law. We have successfully pushed back these sort of ideas in the past. This is not the time to give up. It is crucial that military retirees do not remain silent. TREA (along with other VSOs and MSOs) are telling Congress that this is not fair, wise or just. This proposed budget must be changed. But for that to happen members of the House and Senate must hear from YOU. Their constituents! Please contact your members of Congress today.

2) Administration Rolls Out FY 2013 VA Budget Request

Over the next five years more than 1 million active-duty personnel are scheduled to join America’s 22 million Veterans. To pay for the healthcare and benefits that they have earned, President Obama has proposed a $140.3 billion budget for the Department of Veterans Affairs for the fiscal year beginning Oct. 1. That is an increase of $13.4 billion dollars, or nearly 11%, over last year’s funding levels.
Secretary of the Department of Veterans’ Affairs Eric K. Shinseki said the budget proposal, which must be approved by Congress, would fund services for newly discharged Veterans, continue the drive to end homelessness among Veterans, improve access to benefits and services, reduce the disability claims backlog, improve the Department’s collaboration with the Defense Department and strengthen its information-technology program that is vital for delivering services to Veterans.
The budget request includes $64 billion in discretionary funds, mostly for medical care, and $76 billion for mandatory funds, mostly for disability compensation and pensions. According to VA Deputy Secretary W. Scott Gould, the increase in discretionary funds is permissible under the law because it is an increase to existing, rather than new, programs. If the programs were new they would be subject to “Pay as you go” or mandatory offset rules.
If approved by Congress, the new spending levels would support a health care system with 8.8 million enrollees and growing benefits programs serving nearly 12 million Servicemembers, Veterans, family members and survivors, including the eighth largest life insurance program in the nation; education benefits for more than 1 million Americans; home loan guarantees for more than 1.5 million Veterans and survivors; plus the largest national cemetery system in the country.

Medical Care:

The President’s proposed budget seeks $52.7 billion for medical care, a 4.1 percent increase over the $50.6 billion approved by Congress for the current fiscal year, and a net increase of $165 million above the advance appropriations level already enacted for FY 2013.

What isn’t currently known is whether VA healthcare funding will be subject to across the board cuts known as sequestration (as called for in the Budget Control Act of 2011). House VA Committee Chairman Jeff Miller (R-FL) has said the Administration is leaving veterans “twisting in the wind” regarding their healthcare funding. Strangely, last year Chairman Miller, along with Senate VA Committee Chairwoman Patty Murray (D-WA) offered up VA funding as part of the sequestration process in order to lessen the impact of budget cuts on the Department of Defense. TREA will keep you informed about what happens.

For the next fiscal year, VA estimates 6.33 million patients will use VA for health care. About 610,000 of those patients will be Veterans of the conflicts in Iraq and Afghanistan. The budget request also would provide:

•       $403 million for the gender-specific health care needs of women Veterans, improving their access to services and treatment facilities;
•       $6.2 billion for mental health, a 5.3 percent increase in funding over the current level, making possible increased outreach and screenings, expansion of innovative technologies for self-assessment and symptom management of post-traumatic stress disorder, and enhancements to programs that reduce the stigmas of mental health;
•       $7.2 billion for long-term care, meeting VA’s commitment to provide long-term care in the least restrictive and most clinically appropriate settings, such as non-institutional programs that serve a daily population of about 120,000 people;
•       $583 million in direct appropriations for medical research, which receives another $1.3 billion from other sources, with emphasis on research for traumatic brain injury, suicide prevention, PTSD and genomic medicine;
•       $792 million to support the activation of health care facilities, including new hospitals in New Orleans, Las Vegas, Denver and Orlando, Fla.

Funding in VA’s major construction account of $396.6 million is provided to continue construction of new medical facilities at Seattle, Dallas, St. Louis and Palo Alto, Calif.
Since enactment of the Veterans Health Care Budget Reform and Transparency Act in 2009, VA includes an advance appropriations request for medical care in the Budget submission. Included in today’s spending request is $54.5 billion for FY 2014, which begins Oct. 1, 2013. This request for advance appropriations will support nearly 6.38 million unique patients. The Administration will review the initial advance appropriations request in the FY 2014 budget cycle.

Veterans Job Corps

The 2013 budget proposes $1 billion over five years for a Veterans Job Corps, a new effort to leverage skills Veterans developed in military service for a range of jobs protecting and rebuilding America’s public lands. The initiative would put up to 20,000 Veterans to work on projects to restore America’s lands and resources.
It is important to note that since this is a new program, Congress must approve it and there must be offsets found elsewhere in the federal budget, so it remains to be seen whether this will ever actually take place. TREA will keep you informed.

Disability Pay, Pensions

In the next fiscal year, VA projects it will receive about 1,250,000 claims for Veterans disability benefits. This is a 4 percent increase from the 1.2 million projected for this fiscal year.

Shinseki noted that today’s claims from Veterans who served in Iraq and Afghanistan, on average, total 8.5 disabilities per Veteran, a rate nearly double that for claims by Veterans of earlier eras and a substantial increase in the workload for VA employees who administer the benefits system.

By 2013, the budget projects no more than 40 percent of compensation and pension claims will be more than 125 days old, a significant cut from the 60 percent of claims exceeding that mark this year. Other improvements funded by the new budget include:

•       A new case-management operating model that moves less complicated claims more quickly through the system;
•       Additional eBenefits self-service features that allow registered Servicemembers, Veterans and their families to apply for benefits and manage certain aspects of their benefits accounts online;
•       Publicly available electronic medical questionnaires that allow private physicians to provide VA with exactly the information needed for Veterans claims for disability compensation; and
•       National implementation of a system for processing disability claims that will have all of VA’s regional offices, working in a digital, near-paperless environment by the end of 2013.

Veterans Homelessness

The proposed VA budget for fiscal year 2013 contains nearly $1.4 billion for programs that prevent or treat homelessness among Veterans. This is an increase of 33 percent, or $333 million, over the 2012 level. The VA has a goal of ending Veteran homelessness by 2015.

In the past year, the number of Veterans homeless on a given night has declined from 76,300 in 2010 to about 67,500 in 2011. By emphasizing rescue and prevention, the budget request envisions driving down the numbers to 35,000 by the end of fiscal year 2013. Some specific efforts funded in the new budget are:

•       $21 million to provide 200 coordinators who will help homeless Veterans with disability claims, housing problems, job and vocational opportunities, and problems with the courts;
•       $300 million to provide grants and technical assistance to community non-profits to maintain Veterans and their families in their current housing or to get them rapidly into housing;
•       Provide grants and per diem payments to community-based organizations offering transitional housing to 32,000 homeless Veterans; and
•       Build upon the recent success of a VA hiring fair in Washington, D.C., which drew about 4,000 Veterans and has led to about 500 hiring offers to date.

Education Program

The Post-9/11 GI Bill will help pay the educational expenses of more than 606,000 Servicemembers, Veterans, family members and survivors during the next fiscal year. Over the past two years, VA has successfully deployed a new IT system to support processing of Post-9/11 GI Bill education claims, and has seen a dramatic improvement in the timeliness and accuracy of its processing program during the same period.
TREA remains concerned about the gap in funding during the time veterans are not in school; we do not understand how veterans are expected to pay for their room and board in an economy where people who want to work full-time cannot find jobs, let alone people who employers know are returning to school in one or two months. We feel that this gap in funding seriously erodes the benefit and impedes veterans who want to increase their skill level to compete in a 21st-century economy, and we will monitor this benefit to make sure that nothing else is taken away.

A separate funding increase of nearly $9 million would expand the “VetSuccess on Campus” program from 28 campuses to 80, serving approximately 80,000 Veterans. The program provides outreach and supportive services during their transition from the military to college.

Vocational Rehabilitation and Employment

The budget request for 2013 would provide $233 million, a 14 percent increase over 2012, to administer VA’s vocational rehabilitation and employment program. The increase is focused on expanding services to wounded, ill and injured Servicemembers to ease their transition to the civilian sector. Program participants are expected to increase from 108,000 in 2011 to 130,000 next fiscal year.

National Cemeteries

Fiscal year 2013 will see $258 million for operation and maintenance of VA’s system of 131 national cemeteries if the budget proposal is accepted. The budget supports the initial implementation of a new policy to establish a national cemetery presence in eight rural areas.

Funding in VA’s Minor Construction budget request would finance $58 million for land acquisition, gravesite expansion and columbaria projects. Also included in the budget request is funding for online mapping of gravesite locations from the IT account.

With a funding request of $46 million, VA will continue its partnership with the states by funding the construction, expansion and improvement of state Veterans cemeteries, while continuing its support to Veterans cemeteries on tribal lands.

Information Technology

The 2013 budget proposal includes $3.3 billion for information technology, a $216 million increase over the current budget. VA operates one of the largest consolidated IT organizations in the world, supporting over 300,000 VA employees and about 10 million Veterans and family members who use VA programs. About 80 percent of the IT budget supports the direct delivery of health care and benefits to Veterans and their families.
The Department will build upon its success rate of 89 percent on-time delivery of IT milestones by continued improvements in support of access to health care, ending Veterans homelessness and improved benefits delivery. VA will implement the integrated Electronic Health Record with Department of Defense, easing the transition from active status to the VA health care system by upgrading electronic health records for all Veterans to a single, common platform.

IT funding will enable VBA’s transformation to a digital and near paperless environment using the Veterans Benefits Management System, decreasing claims processing times by 50 percent, while VA’s telehealth programs will take advantage of new IT technologies, increasing VA’s ability to provide health care to Veterans in remote locations.

TREA will keep you posted on any updates or criticisms of specific funding proposals as they become available.

3) TREA Supports Guard-Reserve Gathering on Capitol Hill

Yesterday, February 16, the House of Representatives Guard-Reserve Caucus held its annual caucus breakfast. TREA was a sponsor of the event and President Art Cooper, Legislative Director Larry Madison and Deputy Legislative Director Mike Saunders represented TREA at the event.

The main speaker was David L. McGinnis who currently serves as the acting Assistant Secretary of Defense for Reserve Affairs. In addition, the service chiefs of all the Reserve Components spoke about the needs of their respective branches.

In his remarks, Secretary McGinnis stated that as of today there are 73,951 Guardsmen and Reservists on active duty representing all seven of the Reserve Components serving in various capacities around the world. He also pointed out that all members of the Reserve Components have either enlisted or re-enlisted since September 11, 2001, so they understand what is expected of them with regard to being mobilized and deployed. This is important, according to Mr. McGinnis, because the new strategic guidance issued by the President and the Secretary of Defense places an increased reliance on the Reserve Components.

One of the missions that directly supports the new strategic defense guidance is the National Guard State Partnership Program. Currently there are 63 countries partnered with State National Guards under this program, the purpose of which is to promote national objectives, stability, partner capacity, trust and understanding that will be useful to those countries in the future. “Many of these partnerships have resulted in collaborative working relationships through police and military operational mentoring and liaison teams with our new NATO partners who are part of the effort in Afghanistan,” McGinnis stated.

All of the service chiefs emphasized that trained and ready-to-deploy personnel are the key to a force that is ready and quipped to go whenever and wherever they are called.
TREA is proud to have sponsored this event and we will continue to fight in Washington on behalf of all Reserve Component personnel, as well as active duty, retired personnel and veterans.

4) VA Introduces Text Messaging to Expand Efforts to Prevent Suicide

Below please find a Press Release from the VA outlining its latest improvement in its Suicide Prevention Line:

Veterans Crisis Line Provides Confidential Help to Veterans and Families

WASHINGTON (Feb. 15, 2012) – The Department of Veterans Affairs is expanding its efforts to prevent suicide through several new initiatives that increase the availability of services for Veterans, Servicemembers and their families.

The new initiatives include a new, free, confidential text-messaging service in the existing Veterans Crisis Line, introduction of toll-free access from Europe, and collaboration with Vets Prevail and Vets4Warriors, two groups providing crisis help to Veterans, Servicemembers and their families.

“Offering text messaging services will help VA reach more Veterans and their friends and families,” said Dr. Janet Kemp, VA’s national mental health director for suicide prevention. “We are working to meet their needs by communicating through multiple channels -- over the phone, through online chat, and now via text, which provides quick, easy access to support. VA wants all Veterans to know that confidential support is only a text message away.”

Since its founding July 2007, VA’s Veterans Crisis Line and the later Chat Service have received 500,000 calls and engaged in 31,000 chats resulting in over 18,000 rescues of Veterans in immediate crisis.

Now, in addition to the Veterans Crisis Line (1-800-273-8255 and Press 1) and online chat (www.VeteransCrisisLine.net), Veterans and Servicemembers in crisis—and their friends and families—may text free of charge to 83-8255 to receive confidential, personal and immediate support. The text service is available, like the Veterans Crisis Line and online chat, 24 hours a day, seven days a week, 365 days a year and connects a user with a specially trained VA professional -- many who are Veterans themselves.
As a part of the effort to extend VA’s reach, Veterans and members of the military community in Europe may now receive free, confidential support from the European Military Crisis Line, a new initiative recently launched by VA. Callers in Europe may dial 0800-1273-8255 or DSN 118 to receive confidential support from responders at the Veterans Crisis Line in the U.S.

VA’s Veterans Crisis Line continues to add external resources to provide Veterans with additional support. Two of these organizations include Vets Prevail (www.VetsPrevail.org) and Vets4Warriors (www.Vets4Warriors.com).

In December, Vets Prevail launched a chat service that connects Veterans to caring responders who provide information on a wide variety of resources. If the Veteran is in crisis or needs mental health support, the conversation is then seamlessly transferred to a VA Veterans Crisis Line responder.

Vets4Warriors has helped thousands of their peers connect with confidential assistance through a free hotline (1-855-838-8255/1-855-VET-TALK) and online chat (www.Vets4Warriors.com). If a Veteran is in need of professional crisis or mental health support, Vets4Warriors’ responders will transfer the Veteran to a responder at the Veterans Crisis Line.

For more information about VA’s suicide prevention program, visit: http://www.mentalhealth.va.gov/suicide_prevention/

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