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Cutting doctor's fees cause for concern


Lawmakers took steps this past week to put military people at ease over how TRICARE benefits will be protected and, for older children, how coverage likely will be expanded as the Obama administration implements the new national health care reform law.

But Congress continued to take only clumsy temporary steps to relieve another source of anxiety for Medicare and TRICARE users — a scheduled 21.2 percent reduction in reimbursements to participating doctors. If such a cut were allowed to take effect, it could severely crimp access to care.

First, two pieces of good news.

EXPANDED CHILD COVERAGE: A key feature of national health care reform is a requirement that commercial health insurance firm allow family plans to cover children until age 26. Gathering steam now, separately, is a similar expansion of TRICARE to older military children.

Sen. Mark Udall (D-Colo.) was joined by three Democratic colleagues Wednesday in introducing a bill to allow TRICARE coverage to children until age 26 for what Udall called a “reasonable premium.” The premium, still to be determined, would be set high enough to cover any extra cost of care.

TRICARE now covers children until age 21 or, if they are full-time college students, until age 23. Udall’s bill is identical to the TRICARE Dependent Coverage Extension Act (HR 4923) introduced in the House last month by Rep. Martin Heinrich, D-N.M.

Both Udall and Heinrich serve on the armed services committees, which are expected to embrace the bill and make it part of the fiscal 2011 defense authorization act to be passed later this year.

TRICARE PROTECTION AFFIRMED: The Senate Monday passed and sent to the president the TRICARE Affirmation Act which explicitly states what Democrats say they did not doubt: that TRICARE meets minimum requirements for individual health insurance under the health reform law.

House Republicans, in opposing national health reform, had argued that many TRICARE beneficiaries were exposed to an annual penalty to be levied on citizens who lack minimum health coverage. It was a silly notion, Democrats countered, considering the value of TRICARE coverage.

Yet to reassure all TRICARE users that national health reform wouldn’t harm them financially, the House had passed the TRICARE Affirmation Act unanimously March 20, just a day before it passed national health reform. Sen. Jim Webb, D-Va., introduced identical legislation in the Senate, which was approved by unanimous consent April 12.

MEDICARE/TRICARE REIMBURSEMENTS: A Medicare fee formula Congress adopted more than a decade ago has been mandating cuts in doctor fees for years.

Lacking political will either to impose the cuts or to replace the formula with one more realistic, lawmakers voted year after year to suspend temporarily the formula’s effect.

The formula, if allowed to take effect this year, would drop Medicare fees for doctors by 21.2 percent. Congress passed temporary measures to delay its effective date from Jan. 1 this year to March 1, then to April 1. But the Senate left for Easter recess without approving the last delay, leaving the rate cuts to take effect in mid-April unless retroactive relief could be passed.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:

[email protected]


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