13 May 2013 Legislative News Update 


Legislative News is AUSA Government Affairs Directorate's
weekly electronic newsletter, and is published
every Monday when Congress is in session.

In this issue:

  • AUSA on the Hill
  • Progress on the "Doc Fix"?



AUSA’s strong opposition to proposed TRICARE fee and copay increases was a topic at a recent meeting between Vice President for Education Lt. Gen. Guy Swan, USA, Ret.; Director of Government Affairs Bill Loper and professional staff members of the House Armed Services committee.  

In addition to the healthcare fee proposal, the group discussed the proposal to provide military personnel with a paltry one percent pay raise and the use of chained CPI to calculate cost of living increases for retired pay.  

If you recall, it was the House Armed Services Committee who essentially blocked the Pentagon's plan to drastically raise fees last year.  AUSA's meeting with the key staff members was very productive.  

Later, Swan and Loper met with the military legislative assistant to Rep. Joe Wilson, R-S.C.  Wilson, the Chairman of the House Armed Services Personnel Subcommittee, has repeatedly voiced his opposition to the fee increase proposal.  

In a recent editorial, he said, “The Department has asked Congress to increase TRICARE enrollment fees on military retirees as well as institute new enrollment fees on our over 65 military retirees who use TRICARE for Life.  In the fiscal year 2012 National Defense Authorization Act (NDAA), Congress authorized the Department to increase TRICARE enrollment fees equal to the Cost of Living Adjustments to retirement pay.  Since then, the Department has repeatedly asked for further increases, while at the same time requesting the authority to reprogram in excess of $1.3 billion from the Defense Health Program to other priorities outside of healthcare. The Department should honor the commitments that it has made to our military retirees and, as the Chairman of the Subcommittee on Military Personnel, it is not right to ask these retirees to shoulder any more of the burden.  The same holds true for our over 65 military retirees who use TRICARE for Life; they should not be subject to new enrollment fees while the Department continues to have excess funds within their healthcare programs.”

AUSA agrees.


We remain cautiously optimistic that Congress might finally be on track to solve the problem that is the “doc fix”.  

The “doc fix” refers to short-term funding Congress passes to keep the amount paid to physicians who treat Medicare/TRICARE beneficiaries stable.  

In 1997, Congress created the Sustainable Growth Rate or SGR, in order to control Medicare spending by tying it to the rest of the economy’s growth.  It worked fine for the first few years; however, as health care costs started outpacing the economy, it failed and left the entitlement with a multi-billion dollar shortfall.

Congress has two choices - they can either cut the already-too-low payments or they can find additional funding.  They fe(correctly) that physicians will opt out of treating Medicare/TRICARE beneficiaries making it even more difficult to find medical care especially in rural areas. 

At a House and Ways Committee hearing last week, Republican lawmakers unveiled a three-part system for replacing the SGR. The plan would repeal the flawed formula and then provide physicians with a period of stable payment updates.  After that, payment levels would be based on quality of care and value as measured by standards endorsed by physicians.  They would then have several new payment models to participate in and get payment adjustments.  

While the Democratic response to the GOP plan was positive overall, the committee’s Ranking Member Rep. Jim McDermott, D-Wash., said, “The chairman’s outlines are a good start, but without more detail, we can’t know if there is common ground.  Next we’ll be drafting.  I hope we can work together on the drafting.”

Committee Chairman Rep. Kevin Brady, R-Texas said, “I do look forward to working with my friends on the other side of the aisle when we start talking about how to pay for an SGR solution.  We will eventually have to go down that hard road, not only to pay for an SGR fix but also to address our spending problem.”

We know it won’t be easy, but at least there is an initial plan and serious discussion on how to fix the problem.