By Tom Philpott
Older retirees such as Air Force Master Sgt. Floyd Sears, 81, stand shoulder to shoulder with younger generations of retirees in opposing proposed higher fees for TRICARE benefits.
But Sears also agrees with many retirees of his own generation that there's something especially wrong with the Obama administration's plan to impose a first-ever enrollment fee on 900,000 retirees age 65 and older and their surviving spouses.
The oldest among them entered service in World War II or during the Korean War. Some completed careers with tours in Vietnam. This older generation of retirees truly was promised free health care for life if they would serve at least 20-year careers.
"I was in Strategic Air Command and even heard (SAC Commander) Gen. Curtis E. LeMay say it. The words came right out of his mouth," Sears recalled from his apartment in the Armed Forces Retirement Home in Gulfport, Miss., where monthly fees for residents are based on income.
That promise of "free care" is why these retirees fought in federal court and in Congress, aggressively in the 1990s, to have the government acknowledge it and keep it. Even as the court fight was being lost, Congress by 2001 had approved TRICARE for Life (TFL), designed to be a cost-free insurance supplement to Medicare for older retirees if they agreed to pay -- or in most cases, to continue to pay -- their Medicare Part B premiums.
Sears and other elderly retirees were surprised to see a new TFL enrollment fee proposed in February as part of multi-prong initiative endorsed by military leaders to slow the growth of health costs.
The TLF fee, if Congress were to approve it, would be tiered based on level of retired pay. Retirees who draw less than $22,590 a year in military retired pay would pay $35 to enroll in TFL for the fiscal year beginning Oct. 1. The fee would climb annually to $150 by 2016. Thereafter, it would be adjusted yearly to keep pace with the rise in nationwide health care costs.
Tier 2 retirees, with retired pay from $22,590 to $45,178 a year, would see an initial fee of $75. That would rise incrementally to $300 by 2016. Tier 3 retirees, those with retired pay in excess of $45,178, would pay a $115 next October and $450 a year by 2016.
But last week Sen. James Webb, D-Va., chairman the Senate armed services subcommittee on military personnel, appeared most concerned about what TRICARE for Life users already pay in Medicare Part B premiums.
Webb presented a bar chart showing that a retiree and spouse age 65 and older can pay together almost $7,700 a year in Part B premiums.
Dr. Jonathan Woodson, assistant secretary of defense for health affairs, pointed out that Medicare Part B premiums are means tested, and only couples with combined incomes of at least $428,000 a year would have to pay the highest premiums on Webb's chart.
Most TFL beneficiaries, Woodson said, pay $1,200 a year each, $2400 per couple, for Part B. He also estimated that 90 percent of Medicare-eligible retirees would elect to pay for Medicare Part B coverage regardless of whether it was required to participate in TRICARE for Life.
Webb said he wanted his staff to look deeper into Woodson's argument that retirees contribute 27 percent of their total health care costs out-of-pocket when TRICARE began in 1996, and that their share has fallen to 10 percent today because TRICARE fees were frozen until Congress allowed a modest increase last October.
The fee increases proposed, Woodson added, would return retiree cost shares only to 14 percent of medical costs when fully implemented by 2017.
TRICARE officials later clarified that the 27 percent share of costs referred to average costs for a retiree under 65 with two dependents and receiving private sector care through TRICARE.
However Defense Comptroller Robert Hale, who testified with Woodson last week, made a separate argument for TFL fees. When the fees are fully phased in, Hale said, a Medicare-eligible retiree and spouse would pay an additional $300 a year if their retired pay fell under Tier 1, and $900 more a year for retired couples under Tier 3.
Hale urged Webb to "keep this in the context that we owe them not only good medical care but we've got to provide training and equipment" to the force, "a balanced package," in this era of tightening defense budgets.
"I totally agree with that," Webb said. "But what I am saying to you is you can't renegotiate the front end once the back end is done. This is an obligation that was made to people whose military careers are now done."