[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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