Military Families Are Getting Shafted By Public Health Insurance

It is no secret that America's veterans are getting the shaft. We have seen these troubling headlines: A fatal wait: Veterans languish and die on a VA hospital's secret list Veteran dies after setting himself on fire outside New Jersey VA clinic

America has not lived up to its promise

The stories behind these and similar headlines reveal that America has not lived up to its promise to "care for him who shall have borne the battle and for his widow and orphan." In fact, military families, specifically the children of military families, face similar obstacles in receiving appropriate and needed care. According to the Chicago Tribune: in Kansas, an Army spouse says she frequently has trouble getting urgent-care appointments for her young children. She recently spent the night in the emergency room because that was her only option when her 4-year-old's temperature spiked to 105 degrees. She declined to give her name because she was concerned her husband's career would be affected, but she voices a common complaint: It's hard to get appointments for acute-care needs such as high fevers, strep and urinary-tract infections. "I frequently call, and I'm not able to get the kids in," she said. "The other day I called; there were 28 callers ahead of me. It was about a 35-minute wait to try and get an appointment, which we couldn't get." So she waits, she said. She waits on the phone. She waits in the emergency room. She waits to see pediatricians because they can address only one issue per visit -- if a child has a sprained ankle and a fever, that means scheduling two visits.

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Let that "logic" sink in. Karen Ruedisueli, of the National Military Family Association in Alexandria, Va, tells the story of the military spouse who was 34-weeks pregnant when her family was transferred to a new location: "Before she could see an obstetrician, she had to go to her newly assigned primary-care provider and take a pregnancy test." Seriously? These frustrating and logically challenged stories are only a few of many, but when it comes to the healthcare of military families, specifically their children, there are 17 million reasons why Rep. Adam Smith has introduced an amendment to address this sobering statistic: An estimated 28 percent of military children are not up to date on their vaccines.

TriCare Doesn't Seem to Care

Eleven states (AK, CT, HI, ID, IN, ME, NH, NM, RI, VT, WA) have Universal Vaccine Programs (UVPs), in which they purchase vaccines in bulk from the Center for Disease Control (CDC) to provide to all children, regardless of whether they have health insurance coverage. UVP states purchase and stockpile their immunizations. When a claim arises, the insurance companies then reimburse the states for the costs rather than the individual doctors (because the states are the physical purchaser, not doctors/pharmacies). Since UVP states purchase in bulk, they receive a significant discount off private market prices. The military's health care program, known as TRICARE, provides health coverage to nearly 10 million active duty personnel, retirees, reservists and their families. Currently, retirees and their dependents outnumber active duty members and their families -- 5.5 million to 3.3 million. Yet, the only health benefit payer in the U.S. that has refused to pay UVP states the assessed cost of vaccines administered to their children is TRICARE.

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UVP's Tricare's recalcitrance threatens military children's access to public health

This public insurance company claims that it does not have statutory authority to pay UVP assessments because the UVPs are not registered TRICARE providers and do not assess payers on a per-claim basis. As a result of the company's recalcitrance, states are forced to either cover TRICARE's costs with state tax dollars or apportion TRICARE's costs among the other private payers. Over the period of six years, TRICARE's unpaid assessments total more than $17 million. By refusing to reimburse UVP's Tricare's recalcitrance threatens military children's access to public health. Their position on vaccine reimbursement reflects a disturbing attitude toward military families by healthcare providers. As a PUBLIC healthcare organization, the federal government is indirectly discriminating against military families. Military families should not have to drive all the way to a military base to get vaccinated or to receive care. This is not only a hardship, but is discrimination against military families, and as TRICARE is a public healthcare organization, the U.S. federal government is indirectly discriminating against military families. This is simply unacceptable. Thankfully, Rep. Adam Smith (D-WA) has introduced an amendment to the National Defense Authorization Act (H.R. 4909) which would mandate that TRICARE participate in the UVP. Congress can and should pass Rep. Adam Smith's amendment to the National Defense Authorization Act and TRICARE should admit wrongdoing and pay past due amounts to the UVP states. This amendment would be one step of the many needed to reform the healthcare system for military families.