TRICARE may become available to reservists

Tom Philpott

o Critics say move too costly, won’t solve problems.

Dr. William Winkenwerder, the Defense Department’s top health official, has a task force working to implement healthcare gains for reserve and National Guard forces that Congress approved this month. That includes opening TRICARE, on a cost-share basis, to non-mobilized reservists who are unemployed or have no employer-provided health insurance.
But Winkenwerder is wary of how far Congress went this year in boosting reserve health benefits. The changes are costly, he said, and won’t solve the problem of some reservists being physically unfit when mobilized.
“I don’t think those two issues are related,” he said. “The issue that occurred at Fort Stewart and other mobilization sites (involved) command and medical accountability and responsibility. But they’re management issues that have solutions that don’t require benefit changes.”
Congress planned to boost reserve health benefits anyway this year but that took on added import in October after a wire service story reported hundreds of reservists and National Guard soldiers, sick or wounded from tours in Iraq or medically unfit for call up, were in “medical hold” at Fort Stewart, Ga., waiting weeks or months for care while living in rundown barracks. Some reservists reported their morale was sinking.
“There is no question that this was a significant and real problem,” said Winkenwerder.
Members of Congress demanded an investigation. The Army confirmed a shortage of medical staff and adequate housing. Stewart had processed 22,000 reservists for mobilization and 14,000 for demobilization since 9-11. Yet Army wide, they said, fewer than 4,000 of 200,000 soldiers mobilized were non-deployable and placed in medical hold.
The Army ordered extra medical staff to Stewart to relieve a backlog of care. Army wide, officials beefed up medical staff with contract personnel and sent more patients to other service hospitals or VA facilities. At Stewart, $3 million was found to buy air conditioners, improve lighting and spruce up recreation areas for medical hold soldiers.
David Chu, under secretary of defense for personnel and readiness, revised policy to improve treatment of persons in medical hold across the services. He ordered medical commanders to provide medical hold patients with specialty care within two weeks, half the TRICARE standard of 30 days. If care isn’t available on base, reservists are to be referred promptly to other military, VA or civilian physicians. Also, they are to be billeted in the same quality of housing as active duty members.
The 2004 defense authorization bill directs four other major improvements in reserve medical coverage. The one that most bothers Winkenwerder will open the TRICARE triple option — Prime, Standard and Extra — to about 170,000 inactive reservists, those who are unemployed or have no employer-provided health insurance.
Mobilized reservists deserve active duty benefits and are getting it, he said. But this change appears to ignore differences “in duty and in sacrifice” between non-mobilized reservists and active duty.
To enroll in TRICARE, the uninsured reservists will have to pay an extra premium on top of usual co-payments and deductibles. Per year, the premium will be about $420 for self coverage, $1440 for self and family.
Because of budget restraints, the TRICARE initiative is to expire Dec. 31, 2004, which might be before officials can launch it, given the time needed to issue rules and modify TRICARE support contracts. But lawmakers expect to make the program permanent before then, unless the Bush administration or congressional auditors make a strong case against it.
Service associations argued that Congress didn’t go far enough. They wanted TRICARE opened to all drilling reservists. They also wanted any reservist with civilian health insurance, when mobilized, to receive some reimbursement from the military to cover their monthly premiums.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111.