WASHINGTON -- Tricare could be fixed rather than scrapped if the first House hearing Thursday on reforming the military health care system is any indication.
Troop advocacy groups and lawmakers who kicked off the reform effort said they were interested in major reforms in the system of military and private providers that cares for 9.5 million beneficiaries. But they veered away from recommendations earlier this year that Tricare be replaced with an array of private provider plans similar to what federal civilians are offered.
"We think it is important to preserve what is working and fix what is not working," said retired Vice Admiral Norb Ryan, the president and CEO of the Military Officers Association of America, the largest group of its kind in the country.
A congressionally appointed review panel said last winter that Tricare is in a "death spiral" and Congress is now rolling up its sleeves to solve the problems after spending most of the legislative year on an historic overhaul of the military's 20-year pension system. The hearings on Tricare reform are expected to stretch into 2016.
"From the 30,000-foot view, what is the primary purpose of the military health care system? ... Then [we] bring it down to the tactical level on how we provide that care," Rep. Joe Heck, R-Nev., said while explaining the aim of his armed services panel subcommittee hearing.
For beneficiaries, choice and access has been decreasing for two decades while costs are rising, the Military Retirement and Compensation Modernization Commission found in its landmark review released in January.
Tricare is now far behind other networks in its number of providers and ability to incorporate new types of medical care, according to the review. The commission's surveys of the military community found widespread difficulties in getting care and a lack of continuity in health care.
The commission recommended a new health insurance system similar to the Federal Employees Health Benefits Program with up to 250 alternative health care plans, including a minimum of 11 plans for rural areas and dozens for metropolitan areas.
Heck said he had not settled on any plans to fix Tricare. But he did question advocacy groups about a blended system that would direct more beneficiaries to base hospitals, rely more on clinics in places with smaller military populations, and offer guard and reserve troops insurance plans like ones offered to federal workers.
Congress and the White House passed an overhaul of military retirements before Thanksgiving that turned the 20-year pensions into a blended system that provides all members with 401(k)-style contributions in Thrift Savings Plan accounts. The new retirement options begin in 2018.
MOAA has favored keeping Tricare as calls for reform ratcheted up. Ryan said the group is open to increasing efficiency in base-treatment facilities -- military doctors see far fewer patients per day than private providers -- and to testing out a portfolio of private insurance plans on the National Guard and reserves to see how well it works.
The National Military Family Association told House lawmakers that it also supports major reforms because its members are frustrated by lack of access to health care as well as a patchwork of military rules that change between services and bases and often create barriers for families trying to get treatment.
In one instance, a military spouse who was 28 weeks pregnant moved to a new base with all of her medical records but was told she had to take a pregnancy test before being treated, said Joyce Raezer, the group's executive director.
Raezer said the woman was not able to get care until she was 36 weeks pregnant.
"It is time for a holistic review of Tricare and the military health care system, and not just tweaks around the edges," she said.