[Congressional Record Volume 142, Number 48 (Tuesday, April 16, 1996)]
[House]
[Pages H3440-H3445]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                DOD MEDICAL AND DENTAL SUPPORT CONTRACTS

  The SPEAKER pro tempore (Mr. Coble). Under the Speaker's announced 
policy of May 12, 1995, the gentleman from North Carolina [Mr. Jones] 
is recognized for 60 minutes as the designee of the majority leader.
  Mr. JONES. Mr. Speaker, I rise this afternoon along with my colleague 
from the State of Georgia, Mr. Norwood, to talk about our military 
health care system, specifically to discuss TriCare and its 
implementation.
  I believe there are a number of important issues this body needs to 
address. The long-established ways of providing medical care for 
soldiers, military retirees, and family members are changing. As the 
bond with Korea's soldiers for lifetime medical care is being 
redefined, the historic promise of free lifetime medical care is coming 
face to face with the fiscal realities of the post-cold war.
  The most significant change in military health care is the 
introduction of TriCare, the Defense Department's regional managed care 
program. It is my understanding that TriCare is intended to provide 
high-quality, low-cost, successful care to dependent and retiree 
beneficiaries by partnering with civilian sector health care providers. 
The change has begun in selected areas of the United States and is 
scheduled to be fully operational in the continental United States and 
Hawaii by 1997.
  As we closely watch TriCare evolve, it seems that several outcomes 
appear apparent. Throughout the transition, Congress will examine 
TriCare closely, and alternatives to TriCare will be considered if 
problems of access and cost escalate and TriCare is unable to provide a 
uniform benefit.
  Mr. Speaker, at this time I would like to yield to the gentleman from 
Georgia [Mr. Norwood].
  Mr. NORWOOD. I thank my friend from North Carolina, and I am honored 
to share this time with you.
  Mr. Speaker, we are grateful for the opportunity to bring to you a 
very complex subject, and I hope that we can bring this down to a point 
where the people understand what we are talking about in terms of a 
national problem and by bringing it to you on a very local level.
  Now, I want to say up front I have the highest praise for the 
Department of Defense medical care system. In my district, the 
Eisenhower Army Medical Center is an outstanding example of how the 
Department of Defense provides the highest quality medical care to its 
military beneficiaries. However, with the military drawdown, this has 
forced many of our military families and our retirees out of the 
military hospitals and clinics. Under the new DOD medical management 
care system, now called TriCare that you referred to earlier, many of 
these beneficiaries are treated by civilian medical and dental care 
providers through the use of managed care contractors.
  Now, the intent, I believe, of the Department of Defense is to use 
these contracts to be sure that our military retirees and our active-
duty dependents have access to care, and quality of care, but at the 
same time manage the health care costs; in other words, try to bring 
that cost down.

  Now, if this is done well and properly, I believe these managed care 
contracts can successfully augment the outstanding care that is now 
being provided in our military hospitals and dental clinics all over 
the country; in

[[Page H3441]]

fact, the world. But if this is done poorly, the effects on the 
military beneficiaries could be devastating, and I think we are going 
to see some of that as we go through this today.
  These medical and dental contracts are worth billions of dollars to 
civilian managed health care companies. The financial advantage to 
these companies in securing a DOD contract is clearly very obvious, and 
we must insure that the value of the services that they provide is 
equally as obvious to our military beneficiaries as well as to the 
American taxpayers, and at this time the General Accounting Office and 
the Congressional Budget Office are not convinced that the TriCare 
program can do what it is supposed to do in its current form.
  Serious, serious questions have been raised in congressional hearings 
about questionable procurement procedures, uncertain budgetary 
projection, unresolved compliance violations by contractors. Last 
August, just last August, the GAO stated that the members of the DOD 
source selection evaluation board, and I will quote, ``have little or 
no experience with private sector managed care plans and thus have 
difficulty distinguishing among offenders who can perform effectively 
in the private sector and those who are less effective insuring quality 
care and controlling costs.''
  Now, that is what the GAO said. At a congressional hearing last month 
that Congressman Jones and I were both able to attend, the Assistant 
Secretary of Defense for health affairs was unable to list any 
substantial improvements in the way medical and dental managed care 
contracts are procured since that last GAO report. The GAO revealed 
unresolved concerns about the abilities of DOD to evaluate the 
effectiveness of TriCare programs and to measure the performance of the 
TriCare contractors.
  Now, this is going to be very important, I say to the gentleman, 
Congressman Jones, as we get into our story here to show how this is 
actually happening. An earlier Congressional Budget Office estimate 
suggested that TriCare will increase DOD's cost of health care 
delivery, says it will increase the cost of health care delivery 
despite the statutory requirement that TriCare not raise Government 
costs.
  In addition, CBO projects that DOD will not be able to meet its 
congressional mandate of offering beneficiaries a more uniform and 
stable benefit nationwide.
  Now, we are going to lead into all that when we talk about one little 
tiny town in this country.
  Despite these findings, an article in the December 27, 1995, 
Washington Post noted that the Foundation Health Corp., which is a 
TriCare contractor that manages 5 of the 12 TriCare regions now, pays 
its chairman and CEO an annual salary of $6.1 million. This is the 
highest paid or compensated health care executive in the United States.
  Within a few days of this, after last month's TriCare hearing, 
articles appeared in each of the Army, Navy, and Air Force Times which 
described access problems with the new contractor of the TriCare family 
member dental plan.
  Now, that is about to get into where we are going.
  This program provides comprehensive dental benefits to dependents of 
active-duty personnel and has historically been one of the Defense 
Department's most popular and successful health care programs.
  The problems reported in these articles certainly raise questions 
about whether DOD's confidence in the process it claims to have made in 
the area of procurement reforms is truly justified. These reports 
strongly suggest that the very problems GAO found with TriCare medical 
procurements may now extend as well to the dental contracts.
  Now, we want to try to discuss this afternoon a case where our fears 
about TriCare are real, happening to real Americans, and I am talking 
about a TriCare dental contract in Mr. Jones' district where patients, 
meaning military dependents and retirees as well as the dental 
providers, are living a pure nightmare.
  I would ask my colleagues if he wishes to tell us a little bit about 
what is happening in Jacksonville, NC.
  Mr. JONES. Well, I really appreciate having this opportunity, knowing 
of your background and your interest in providing for adequate medical, 
both health and dental, plans for our military and retirees. You and I 
share this same commitment to our retirees and to those serving on 
active duty and to their families to make sure that they get the very 
best medical care, both physical and dental.

  I will have to say, back in, I guess, January of this past year, I 
happened to be down in Jacksonville, which is the home of Camp Lejeune 
Marine Base, and we are very proud to have Camp Lejeune in eastern 
North Carolina, particularly in my district.
  Well, a group of dentists wanted to talk to me, and I will be very 
honest with you, I was very unfamiliar with the dental plan because it 
was something new. I think the Concordia is now the provider of this 
dental plan, and in the past, and I hope you are in touch with this in 
just a couple of minutes, Delta had been the provider.
  Well, according to these dentists that I met with, they had a 
tremendous concern about the fact that they were going to have to 
provide this dental care with a less fee, and they had it well broken 
down and documented as to the amount of money that it cost them to 
provide adequate medical care to the military family and the retirees, 
and the fact that Concordia was asking them to take a very, very 
significant decrease, and they were showing me with documentation how 
they could not afford to provide this dental care for the military at 
Camp Lejeune.
  Well, when I came back to Washington, I met with my military person, 
and we started looking into this matter, and in addition to what I 
heard when I was in Jacksonville, also these dentists were telling me, 
and, Charlie, they have been doing work with the military for years and 
years, and they were telling me that they were being threatened that if 
you do not buy into our contract, we will put our own dentists down 
here in Jacksonville to provide the dental service.
  So this is what really made me very upset because again my concern is 
for the dentists, but also my concern is for the military and the 
retirees, and what I was trying to do, and the reason you and I 
developed this relationship on this issue, is because you and I both 
share the concern with what the Department of Defense is doing. And I 
would appreciate if you would share with me and those that might be 
watching us this afternoon a little background on how DOD decided to go 
with Concordia, and my concern is that DOD is not, does not, have the 
proper oversight on the actions of Concordia as they are, in my 
opinion, intimidating many of the dentists in my district.
  Mr. NORWOOD. If the gentleman would yield, Congressman Jones, you 
have been hearing a lot, I know, from your constituents back home, and 
I have been hearing a lot from some of your constituents, too, because 
I practiced dentistry for 25 years, and I think they know and realize 
that I can understand what the problem is.
  Concordia is a managed care company. There are no health care 
providers there. They are managed care entrepreneurs, and as a 
Department of Defense put out bids to see who would manage the dental 
care for all of the Nation's retirees and so forth, Concordia bid on 
it. Now Delta dental plans had been running the same type of contract 
for something like 8 years; my understanding is all, if not most, of 
the dentists in Jacksonville were signed up with this particular 
managed care company, and it is a discounted fee, and everybody seemed 
to be pretty happy in that area with Delta dental plan, and I will have 
to tell you this thing with Concordia is not just in North Carolina, 
but it is nationwide. This is a $1.7 billion contract.
  Now that interests entrepreneurs. That is a lot of money. Yet 
Concordia, by most measures, would be considered a very small company, 
and they were interested in this contract for a couple of reasons: No. 
1, if they get it, then that would put them into a position to go 
nationwide, and in the long run we are talking about lots and lots of 
money.

                              {time}  1615

  Concordia came to the dentists in Jacksonville, NC, I think there 
were about 40 in a town of about 75,000 people, all of whom or most all 
of whom are connected with the military, either retired, one way or the 
other. These 40

[[Page H3442]]

dentists were already treating the people from LeJeune and in the area 
of North Carolina. They came to these guys and said, ``We won the bid. 
We would like for you to come work for us.''
  They said, ``We have been doing this for a long time with Delta 
Dental. What do you have?'' Concordia said, ``We want you to sort of do 
the same thing, but we are going to have to cut your fees by 20 
percent, 20 to 25 percent.''
  The problem with that that Concordia should have known is that most 
dentists practice with an overhead of about 70 cents. Another way to 
say that, for every dollar that comes in, the dentist gets to keep 30 
cents of that dollar. Then he pays 15 cents of that to the Federal 
Government. Concordia comes in and says, ``We are going to take 25 
cents out of that dollar,'' which means there is no way they could do 
that. They cannot make a living, they cannot stay in practice. It 
particularly affects a smaller town like this, because all of their 
patients are wrapped up and already involved in this.
  Concordia put this to the dentists and the dentists, as I understand 
it, simply said, ``Sorry, we can't do this. We can't make a living. We 
can't offer any kind of quality of care. We cannot do it.'' So none of 
them have signed up.
  I do not know if Concordia underbid Delta Dental to get the contract 
so they could grow nationwide. I do not know what they did in terms of 
their bid. But they have gone to the providers of health care and said, 
``We can't pay you enough for you to make a living,'' and the providers 
of health care in North Carolina said, ``Sorry, we can't be involved in 
that.'' Then comes the pressure. Your constituents are getting pressure 
from a big insurance company that is hired by the Department of 
Defense. That is how then we get involved.
  Mr. Speaker, it is not just the Jacksonville dentists. They are not 
alone in the rejection of this Concordia managed care company. The 
previous contractor, Delta Dental, had a provider network across the 
Nation of 113,000 dentists. Only 33,000 of that 113,000 agreed to sign 
up with Concordia. The Jacksonville dentists shared the opinion of the 
other 80,000 dentists across the country that will not sign up with 
Concordia because it is purely unacceptable. You cannot practice that 
way.
  Mr. JONES. Let me ask the gentleman, before he became a Member, since 
he was a dentist, is it not true that the dentists, and you explained 
this 30 cents out of a dollar, I believe you said, they work on a very 
tight margin, so many times these dentists, even though they might have 
been in business for 10 or 12 years, they still owe for equipment, they 
still owe moneys on the facility itself.
  So the concern that I had when I first heard about this was the fact 
that Concordia, if you will let me use this word, seemed to come in 
there in a very roughshod way to say, ``You either buy into our plan, 
or we are going to hurt your business by putting our own people in.''
  If you do not mind touching on that, I think you might have just a 
moment ago, but do you not see a problem with a company that has been 
OK'd, so to speak, or approved by the Department of Defense going into 
a community that has welcomed and loved the Marine base, it has been 
there for years and years, and then they come in and say, ``If you do 
not accept our fee structure, which is quite a reduction from what you 
had previously, if you do not follow our orders, then we are going to 
go in direct competition with you.'' Is that any way to build rapport 
in a town where you have a military facility as important as Camp 
LeJeune?
  And not only the providers or the patients, none are happy with a 
situation like that, but my understanding is they threatened to come 
into town, build a new clinic and import people from outside, in effect 
closing down 40 families, 40 offices in town who had been there doing 
the right things all these years.
  It is also my understanding, and it is a pretty clear understanding, 
that there is a real effort by Concordia to characterize the local 
dentists as selfish and uncooperative and unwilling to accept a 
discounted fee. But they have been doing that for the past 8 years with 
Delta Dental. The difference is that Delta Dental was paying them 
enough to make a living and they could still offer a good quality of 
care.
  The problem here, Walter, as I see it is that the Department of 
Defense, in fact CHAMPUS, selected this company, Concordia, Inc. This 
company has come under serious fire from patients and providers since 
it replaced Delta Dental earlier this year.

  We think, and we are looking into this, as you are, too, but we think 
there are certain deficiencies going on in the Concordia contract which 
I alluded to when I opened. The Congressional Budget Office alluded to 
it, too, that we basically do not have oversight of a situation like 
this.
  Concordia has not been able to establish an adequate provider 
network, meaning they do not have enough dentists working for them. 
Therefore, the patients, the military dependents and retirees, do not 
have as many choices. They do not have access to patients, which is one 
of the very first things the Department of Defense said they wanted to 
make sure that we had.
  Concordia has inadequate claims services, creating, really--that 
causes a serious financial crisis, not only for your patients, but also 
for the providers. They have been accused of making changes in the 
procedure codes during claim processing. Another way of saying that is 
that they go in, and if a provider puts a particular code down for a 
particular procedure that is supposed to pay x dollars, Concordia does 
not mind changing that code so it will pay fewer dollars. In other 
words, that is another way for them to make up for the fact that 
perhaps they underbid this contract.
  There have been unresponsive and most certainly uninformed service 
representatives causing delays in treatment and delays in claims 
processing. It has gotten to the point where there are just hostile 
relations down there between this managed care company--and again, that 
is not people who do any type of treatment, they are managed care, they 
are health care entrepreneurs--and the providers.
  Mr. JONES. When the gentleman has approached the Department of 
Defense, I know the gentleman mentioned in his earlier statement that 
we did have a hearing in one of our military committees and this 
subject did come up, but knowing that you have done an extensive amount 
of work, you and your staff along with my staff, will you tell me what 
your response has been from the Department of Defense when you say. 
``What in the heck is going on?''
  Mr. NORWOOD. Mr. Speaker, we have been assured that everything is 
wonderful, that everybody is doing exactly what they need to do, that 
patients will have all the access to care that they possibly want, and 
that there are really no problems.
  You know, I want to just point out a little small inconsistency in 
that. DOD says that the Concordia dental network is adequate, meaning 
there are enough dentists to provide the care that the patients need. 
Since the size of this network determines access, which you mentioned 
and I mentioned, which is so important, that beneficiaries have to 
dental care, how did the DOD determine what constituted an adequate 
network?
  The previous dental provider was Delta Dental. When they were first 
granted the contract from DOD, CHAMPUS determined that their existing 
national network, they had 90,000 dentists, and CHAMPUS said, ``That is 
too small.'' They required Delta Dental to go out and hire more people 
to work.
  Concordia stated that their goal for an adequate network was only 
40,000 dentists. To date, they have really been able to only sign up 
33,000 from the Delta Dental network plan of 113,000. Yet, Concordia 
claims, ``That is small enough to take care of all the patients.'' I am 
saying that somebody needs to oversee Concordia.
  Mr. JONES. Mr. Speaker, I want to touch on a couple of areas the 
gentleman has mentioned, but I want to share with him a letter that we 
received several months ago from a dentist, and I will not give his 
name. It says:

       My opinion is that the schedule of allowances known as fees 
     paid by United Concordia is too low to be profitable. My 
     income is solely derived from my fees. I get no subsidy from 
     the government. These United Concordia fees are 20 to 33 
     percent less than

[[Page H3443]]

     the fees paid by the old administrator, Delta. A reduction of 
     fees of this magnitude reduces my profit by 60 to 82 percent. 
     I cannot afford to see these patients at such a loss.

  In addition to the fact that dentists should not be expected to stay 
in business if they cannot make a profit, no one can in America, the 
problem that I have is that, again, not only are our dentists, in my 
opinion, being treated unfairly, but the fact that we do not have the 
network to service those at the base and their families and the 
retirees. We have a real serious problem, Charlie, and I am delighted 
that you are so involved in this issue. We have a serious problem, and 
that is giving adequate care to our men and women in the military.
  Mr. NORWOOD. If the gentleman will yield, Mr. Speaker, the gentleman 
is totally right. When we do not pay enough to let people make a 
living, then we may be assured access will be affected, and so will 
quality of care. Those are the three things that the Department of 
Defense says it is interested in. I hope that they have not gone out 
and accepted a bid just based on who is cheapest. There is more to it 
than that.
  They say so, too. They say access of care is very important, and they 
say quality of care is very important, but they want it for less money, 
and the problem in this particular area is they want it for so much 
less people cannot make a living, so nobody will join the program. 
Therefore, there are no providers.
  Mr. Speaker, I want to remind the gentleman from North Carolina, we 
are talking about a $1.7 billion, with a B, billion, contract to 
provide dental care to military families. With this contract in 
billions of taxpayers' dollars, Concordia, which is a small, regional, 
managed care company, is going to transform itself into a major 
national player in the emerging dental care managed care industry. The 
potential for rapid corporate growth and huge future profits for 
Concordia is staggering. The question remains: What will the American 
taxpayer and our military beneficiaries receive in exchange for a very 
lucrative contract?
  Mr. JONES. Along these lines, Mr. Speaker, I want to read a newspaper 
article, just a couple of quotes from this article, one being from a 
dentist in New Bern, NC, which is Craven County, adjacent to Onslow 
County.
  It says: Dr. Jim Congleton has not signed with United Concordia. He 
said that he wished the company had been more honest and open in 
developing the dental plan which they are offering to military 
dependents.
  In addition to that, let me share a comment by a dependent. 
``Military dependents are not happy with this situation. Our costs are 
going to go way up,'' said Jeannette Coulsey, a military spouse. ``UCCI 
says if no dentist in the area signs up, or we see a dentist who is not 
in the plan, United Concordia will pay the dentist 10 to 12 percent 
less than one of their participating dentists.''
  So your point about our concern should be for the dentists, and also 
it certainly should be for those in the military and their families, 
and again, this is why I really appreciate you joining me this 
afternoon, because this is a very serious problem in my opinion, and 
one that, thank goodness for people like you, and I want to say my 
staff, the fact that we are willing to look into a firm that could 
receive $1.7 billion, and that is with a B, billion dollars, $1.7 
billion, and yet we have so many unhappy, dissatisfied people.
  Mr. NORWOOD. If the gentleman will continue to yield further, Mr. 
Speaker, one of the questions I think we have to ask ourselves is how 
did Concordia wrestle away this $1.7 billion contract from a managed 
care plan that had been in business for the last 8 years? Did they bid 
less? Did they bid so low that they cannot pay the providers enough to 
sign up, so they can at least make a living? I am not sure. We need to 
understand these problems.
  Concordia assures us that patients are satisfied with their program. 
That is what they said at the hearings. Health affairs has no formal 
plan for determining patient satisfaction or assessing contractor 
compliance. That is very, very important. who is going to oversee this? 
The only method being used at this point is to perform periodic spot 
checks using the participating provider list, using trend analysis, or 
to evaluate complaints by beneficiaries.
  I want to remind Members, this is a $1.7 billion contract. I will 
tell the Members something I do not understand at all.

                              {time}  1630

  Prior to having TriCare, the health care of our military, the dental 
care of our military was left up to the commanders at local military 
hospitals.
  Why does Health Affairs not allow local dental commanders and 
regional dental service support area commanders to have oversight 
authority over Concordia? I do not understand that. Once CHAMPUS 
selects a contractor, Mr. Speaker, the contractor is responsible only 
to CHAMPUS and DOD Health Affairs.
  Currently dental commanders do not have the official oversight 
authority over Concordia. That is not true in the medical side of the 
house, where the medical commanders, they are called lead agents, they 
have oversight authority over TriCare contractors, and they are 
responsible for ensuring that the contractor is complying with the 
terms of the contract.
  Who is responsible here to be sure that your constituents in 
Jacksonville, NC, have a good deal?
  Mr. JONES. That is why I sincerely appreciate your joining me in this 
effort to find out what we can do to help correct a very bad situation. 
I am like you. I do not know why we do not have oversight over 
situations like this, because we are talking about the taxpayers' 
money. We are talking about providing good health plans for our 
military and our retirees, and we all know that we are talking about 
the taxpayers' money, and you said again, I keep using this, $1.7 
billion contract.
  Let me share this also with the gentleman from Georgia [Mr. Norwood] 
and also those that might be watching. This is a quote from, again, a 
news article. I want you to know that I give credit to the news 
article, because these are not my words but the words of someone else. 
This has to do with a statement by a gentleman named Jeff Album, 
spokesman for Delta Dental. I would like to share this with you.
  ``But Onslow County is not alone. There are other counties across the 
country around military bases without dentists signed up with UCCI,'' 
which again is United Concordia, said Jeff Album, spokesman for Delta 
Dental.
  Then I go further with his quote. ``We believe the criteria specified 
for selection of a winner in the request for proposal did not match the 
criteria that seems to have been used in the selection of UCCI,'' Album 
said. And I further quote: ``It appears DOD opted for the least 
expensive bid rather than best value.''
  Let me read that again, and I want you to comment, if you will. ``We 
believe the criteria specified for selection of a winner in the request 
for proposal did not match the criteria that seems to have been used in 
the selection of UCCI,'' Album said. ``It appears DOD opted for the 
least expensive bid rather than best value.''
  Since you have looked into this matter in detail, can you comment on 
that? Do you think that the bid process was equal to what Delta had 
been asked to bid on before?
  Mr. NORWOOD. No. And, more importantly, maybe I do not believe it has 
been, but neither has GAO or the Congressional Budget Office. I talked 
about that when we first started.
  In their hearings before us, they had made more than a few comments 
about the fact that they were not sure we had this together enough yet, 
and what we are doing is we are making sure now, because we have rushed 
into this and perhaps did not take the best contract. We have got our 
military retirees, our active duty dependents that do not have access 
to care. Their care is going up. I cannot speak to the quality, but one 
has got to question it when you start reducing the dollars in it.
  We have got these, and then we have got other citizens, small 
business people who have a small office. They are being attacked by 
this giant insurance company saying,

       You better come to work for me because I put out a $1.7 
     billion bid and I can't fix teeth. I've got to have dentists 
     to do that. You guys come to work for me, or we're going to 
     spread your name around town as being unselfish or unwilling 
     to cooperate.

  That is hard to take for a small business, and that is what a little 
dental

[[Page H3444]]

office is. They are being picked on by this giant conglomerate of 
insurance companies, where they are trying to force them to come to 
work and not be able to make a living. Then they have done worse than 
that. We will get into that in just a minute, too.
  Mr. JONES. It is our responsibility to oversee the spending of the 
taxpayer dollar, you and I and other Members of the House. It is our 
responsibility to be sure whether it is DOD or another agency that they 
are getting their money's worth. Certainly the taxpayer needs to get 
his or her money's worth and certainly our military needs to be treated 
fairly with the best plan possible for the money. What I have gathered 
from the last 20 or 25 minutes that we have been talking from your 
comments as well as mine, that we feel that they are not getting their 
dollar's worth and you just said about the dentists, and this probably 
appalled me as much as anything. When I had dentists and, I want people 
to remember, these are taxpayers of America.

  Mr. NORWOOD. That is right.
  Mr. JONES. These are taxpayers. Yet they have a company that comes 
down and threatens their livelihood and says, ``If you don't join our 
group, we're going to take your money, because you're a taxpayer, we're 
going to spend your money and put you out of business.''
  Mr. NORWOOD. Some of your constituents who are dentists have been 
writing me and I am going to take just a minute, Mr. Jones. I want to 
read two paragraphs, but it says so much. This is a 10-page letter that 
lays out lots of the problems. Just two paragraphs.
  He says:

       You may correctly assume that I have much better things to 
     do with my time than to argue with and complain about a 
     government contractor that is not performing as specified. My 
     full attention should be given to my patients and their 
     families, my staff, my practice and my family and friends. 
     The amount of effort I have given to this issue never should 
     have been necessary but I will do whatever it takes to 
     protect my patients and my practice and to make sure everyone 
     gets a fair deal. I do not believe that the United States 
     government is getting what it contracted for, optimum dental 
     health for military families through a fee-for-service dental 
     plan. Indications are that we are entering into an ordeal 
     with Concordia where only Concordia is benefitting.

  I will jump off the letter for a minute to remind you that they are 
going to get their 25 percent of that $1.7 billion. I bet it works for 
the company.
  He goes on to say:

       Because of situations like this, those of us in the 
     trenches work ourselves to the bone and then have to scramble 
     to meet our overhead. Consider the fact that some of my 
     regular monthly expenses are around, say, $50,000 for 
     payroll, without the provider, close to $19,000 for mortgages 
     of office, $5,000 for utilities, $12,000 for dental and 
     office supplies, and because of a massive need of supplies, I 
     have not taken a salary since last September. I have 
     virtually exhausted my savings and may shortly be forced to 
     sell or borrow against assets. Surely this was not the intent 
     of the Department of Defense. I know this is also happening 
     to numerous other colleagues in the Jacksonville area.

  Mr. JONES. Mr. Speaker, I think it is worth restating. Would the 
gentleman from Georgia [Mr. Norwood] tell me again how many dentists 
were in the network when Delta had the plan versus Concordia today?
  Mr. NORWOOD. Delta Dental had 113,000 dentists in their network 
nationwide. Concordia has said, ``Well, we can do it with 40,000.'' 
That means less access. They have only been able to sign up 33,000. 
Eighty thousand not willing to sign up and work for nothing.
  I want to present to the Speaker some corrections that I think that 
DOD Health Affairs really has to bring out and deal with, because this 
is just the beginning. They have not even awarded the contracts all 
across the country yet. This is just the beginning. So if I could, Mr. 
Jones, I would like to list a few things for the record because we are 
going to bring it back to them in other ways as time goes on.
  First of all, DOD must establish a full-time oversight board to 
monitor complaints of the Concordia contract, which are numerous. They 
must authorize local dental commanders and regional dental service 
support area commanders. That means the colonels and the majors and the 
captains and so forth that are working in the different armed services 
clinics around the world, we need to let them exercise some oversight 
over this Concordia program. In the same manner, by the way, as the 
TriCare lead agents and medical facility treatment commanders have over 
TriCare contractors.
  Third, we need to establish a methodology for measuring the 
effectiveness of the Concordia program to provide access, choice, and 
quality of care, not just how much cheaper is it. Establish an 
effective means to receive comprehensive input from beneficiaries on 
patient satisfaction. In other words, how do the patients feel about 
this. That is who this is all about and that is who this is for.
  We need to issue a, quote, cure notice to Concordia, require 
correction of contractual deficiencies within a specified time. And 
after an appropriate transition period, give them some time to get it 
right, if Concordia does not live up to its contractual agreements, 
Health Affairs should issue a cancellation by default order and allow 
another more capable contractor to assume the program.
  Those are things we are going to have to deal with if, No. 1, we are 
going to deal with the patients and your constituents, and, No. 2, the 
providers of health care.
  Mr. JONES. I like those four or five points the gentleman from 
Georgia [Mr. Norwood] made because as you said in your comments a few 
minutes ago, there is no oversight. Once the bid process is finished 
and a company gets the contract, then this has become very helter-
skelter. We have dentists that have not been treated fairly in my 
opinion, we have patients who have not been treated fairly in my 
opinion, and I am delighted to hear these four or five points, because 
if there is anything I want those that might be watching to fully 
understand in fact that this new majority, we understand making 
Government more efficient. Here we have got a dental system that in my 
opinion is not efficient and is not serving the people it was intended 
to serve. When you think about our military, these are men and women 
that were willing to sacrifice their life, and they should not be 
denied dental care. Yet we have our dentists as we have said, I am 
being a little repetitious but I want to repeat it again, they are 
taxpayers, American citizens, and here we have got the Government 
through this Concordia group working against the taxpayer who is paying 
for this $1.7 billion plan.
  So I am delighted to join you, and I am sure you will have many 
others as you go forward with these four or five points that you think 
would help with oversight as it relates to dental care for our 
military.
  Mr. NORWOOD. If the gentleman from North Carolina [Mr. Jones] would 
yield further, as we are headed toward conclusion, I want to point out 
another thing that has happened in this contract that drives me crazy. 
It is one of the reasons why the American people lose faith in their 
Government. It is one of the things that I think make people dislike a 
strong Federal Government.
  We have talked about this great big insurance company spreading bad 
information around this small community of 70,000 people about the 
providers because the providers won't come to work for them for 
nothing. Then we are talking about this large company that then says to 
the providers, the dental care providers, ``Well, if you don't come to 
work for us, we're going to close you, we're going to build this big 
office in town and import people from out of town to take care of it.''
  But the icing on the cake to me is now Concordia, this big insurance 
company, has called in the Federal Government, has called in the 
Federal Trade Commission, and it said, ``Come get 'em, they're bad 
guys, they've actually been talking about what this costs.''
  Now, it is perfectly legal for Concordia to set the price of the cost 
of dental care across the Nation. But if two dentists in Jacksonville, 
NC, sit down to talk about what this does to their practice and how it 
affects them, we get the Federal Trade Commission lawyers running in at 
the behest of Concordia.

                              {time}  1645

  All they got to do is make an allegation. It does not--you are 
guilty. If they make an allegation to the Federal Trade Commission, you 
are guilty until you can prove yourself innocent. What does that do to 
people? Well, it is like

[[Page H3445]]

the IRS running in. The first thing you know is no matter who wins, I 
lose.
  There is no way to win that, because you get involved in a lawsuit to 
defend yourself against the Federal Trade Commission. What does it do? 
It costs you a ton of money to defend yourself. It costs time. You 
spend hours and hours and hours answering all the questions that you 
must answer because the Federal Trade Commission has come rushing in. 
No matter there is no point to it. If they are called, they are glad to 
run in. I presume that maybe they do not have anything else to do, but 
they are going to go down there and they are going to pick on these 
guys in Jacksonville, NC.
  And this is a managed care company using the Federal Government as a 
big club to make people, small family businesses, come to work for them 
at absolutely no way to make a living.
  I do not know what we should do about this, but I have been involved 
in this thing once before in my life. Some years ago when I was 
President of the Georgia Dental Association, the dentists of 
Pennsylvania told Blue Cross and Blue Shield, no, thanks, we are not 
coming to work for you because you will not pay us enough. By the way, 
that is the parent company of Concordia. Now, this happened. I was 
involved in this. They said we are not coming to work for you because 
you will not pay us enough to make a living.
  So what do the Blues do? They run straight down here to Washington, 
get the Federal Trade Commission in on it. The Federal Trade 
Commission, the entire Pennsylvania Dental Association. By the way, all 
of the North Carolina Dental Association is being sued now by the 
Federal Trade Commission.
  This goes on for months and months and months. We raised money around 
the country to help this one little dental association defend itself 
against the Federal Trade Commission. They got all through and found 
nothing was wrong, and it cost $2 million.
  These are not rich people that you can just go throw around $2 
million. This is not Ford Motor Co. These are small family businesses, 
very small businesses, and we cannot continue to allow the Federal 
Government to be used as a club to beat on your folks in your district.
  Mr. JONES. Let me tell you. Mr. Norwood, I know we are closing down 
in another 5 or 6 minutes and will be ready to yield back the balance 
of our time, but I could not agree more. We have gotten to a point in 
this country where too many times those people, and you are right about 
the dentists in eastern North Carolina. Most of the dentists in North 
Carolina, but particularly eastern North Carolina, these are hard 
working, family people. they are not muntimillionaires, they are not 
millionaires; they are just people working hard to provide a very 
valuable service, trying to take care of the people in their community. 
Yet, as you said, too many times the Federal Government, whether it bve 
DOD or another agency that you were just talking about, comes down with 
a heavy hand or club, as you said, and as long as there are people like 
you and I and many on both sides of the aisle up here in Congress, we 
are going to fight for that man, that woman, in our district that we 
feel has not been treated fairly.
  If I can before closing, I would like to read, because this is a 
letter sent to me by an Air Force captain on April 1, 1996. I am just 
going to read a couple of sentences to you. It says, ``Dear Mr. Jones: 
As a member of the USAF stationed at Seymour Johnson in your 
Congressional District, I am writing to you about the new military 
dental plan. I attempted to follow my chain of command and in doing so 
determined this is a Congressional issue.''

  ``According to Champus,'' and this is a quote, `` `there would be no 
change in coverage' under the new plan.''
  I am just skipping around in this letter.
  ``My payments have almost doubled. Personally, I would rather pay the 
extra $308 per month'' for the service that I had prior to this new 
company. ``I am certain that I am not the only military member. With 
this problem with Concordia's limits being so low, I can hardly blame 
dentists for not accepting the new plan.''
  Let me repeat that again. ``I am certain I am not the only military 
member with this problem. With Concordia's limits being so low, I can 
hardly blame dentists for not accepting the new plan.''
  ``In all honesty, it gets old having your health packages changed, 
being told that `coverage is the same', and discovering that twice as 
much money is coming out of your pockets.''
  I want to get that in for the Record, Mr. Norwood, because again, 
with all of this 30 or 40 minutes we have had, what we are talking 
about is American citizens, taxpayers and military. I am going to 
continue to work with you and your staff to see if we cannot correct 
this problem. I think it is a problem that has gone too far, to the 
detriment of taxpayers in my district and some of your friends 
elsewhere. I am going to work with you and your staff as you work with 
me and my staff to see if we cannot correct this situation.
  Mr. NORWOOD. If the gentleman would yield, I will conclude by saying 
this, Mr. Jones: I think the people in your district are very fortunate 
to have you up here. In many cases there is no other advocate for those 
people. You have military retirees, you have dependents of active duty 
military people, who are not winning under this program. In fact, they 
are losing. You are up here defending them. Who else will?
  I mean, we do not have any oversight from the DOD. I am glad you are. 
We have your constituents who provide dental care in your district, my 
colleagues. You know, who is going to help them? They have got a large 
manage care company coming after them with all the resources in the 
world. Now they have the Federal Government coming after them through 
the Federal Trade Commission. Who is going to be on their side in this?
  Well, they are your constituents, but they are my colleagues, and I 
am not going to ever let this go until we give them some protection 
down there from that big heavy arm of the Federal Government.
  Mr. JONES. Charlie Norwood, I want to thank you for joining me today. 
I look forward to joining you on this issue. We are going to right a 
wrong before it is over. I promise you that.

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