Editor's note: This piece was co-authored by NCPA Executive Director Allen West and Veterans Coalition of North Central Texas President Nekima Horton.
In 2014, the four year old daughter of a serviceman stationed in Iraq nearly drowned in her family pool. She spent three and a half minutes under water before her mother found her and called an ambulance. After arriving at the hospital on the military post, the doctors realized the little girl needed to be air lifted to the nearest trauma center in Dallas, Texas, where she stayed for the next six weeks. A traumatic event for any family, but the distressed parents were in for another nasty shock – the trauma center didn’t take Tricare Prime, the managed care option of the military health insurance program run by the Department of Defense.
Formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), Tricare provides civilian health benefits for over 4.8 million Active Duty military personnel, military retirees, and their dependents, including some members of the Reserve Component. The program is plagued by many problems, including questionable quality of care, high costs, and a woeful lack of providers willing to take Tricare patients. According to a 2014 report on Tricare by the National Center for Policy Analysis, only 58 percent of civilian providers accepted new Tricare patients between 2008 and 2011.
Why is it so hard for those who protect and serve our nation to find quality health care providers willing to service them? Providers cite poor reimbursement, often lower than state Medicaid programs, as a key factor. Geographic areas with civilian provider networks that agreed to accept TRICARE reimbursement rates for their services, called Prime Service Areas (PSA), found that beneficiaries "experience problems finding a civilian primary care or specialty care provider compared to those in non-Prime Service Areas (non-PSA).” In these areas, providers may charge up to 15 percent more than the standard TRICARE reimbursement rate for their services.
Tricare reimbursement rates are often even lower than states’ Medicaid programs – and come with higher administrative costs. From July 2011 - June 2012, CHAMPUS reported that providers lost $3.6 million dollars on 6,060 patient cases, and it doesn’t look like those numbers have improved much over the last few years.
With providers refusing to accept military health insurance and fraud and waste plaguing both the Veterans Disability Program and the Veterans Benefits Administration – not to mention the horrific backlog at the VA – how can we ensure that our men and women in uniform and their families have access to the care they need and deserve?
Luckily for the family mentioned above, they were connected to the Veterans Coalition of North Central Texas VCNCT leadership, who were able to advocate for the family and ensure their little girl received the care she needed. While this story has a happy ending, no military family should be denied access to necessary, high quality health care. We must take steps to effectively address the serious flaws in our military health care system. In the meantime, the VCNCT has a few suggestions for our servicemen and vets.
First, get connected. Connecting to a legitimate and informative Veteran Service Organization in your area can make your dealings with system much smoother.
Next, educate yourself on the various types of Tricare insurance. Understanding which insurance you qualify for is the first step to knowing what services you don’t qualify for.
Third, put an emergency plan in place now. In an emergency situation, going to a clinic or hospital that doesn’t take Tricare could be an expensive mistake that could slow down the care process.
TRICARE truly is our nation's most challenging military quagmire. Who could possibly argue that the men and women who serve our nation don’t deserve the best? The current military health system fails to provide that.
There are those who advocate for universal, single payer healthcare in America. We hear political rhetoric promoting ideals such as “free healthcare.” Here we have examples of two government run healthcare systems that are failing, the Veterans Administration and TRICARE. If the government refuses to recognize its failure to provide quality health care to those and their families willing to make the last full measure of devotion to our Republic, why should we believe the government will be successful in caring for the personal health of all Americans?
Nekima Horton is the Founder, President and CEO of the Veterans Coalition of North Central Texas – and also the dependent of a WWII veteran.
A former member of Congress, Allen West is a retired Army Lieutenant Colonel who served as a battalion commander in Iraq and is the Executive Director of the National Center for Policy Analysis in Dallas