[Congressional Record Volume 145, Number 60 (Thursday, April 29, 1999)]
[Senate]
[Pages S4444-S4445]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAMM (for himself, Mrs. Hutchison, Mr. Mack, and Mr. 
        Coverdell):
  S. 915. A bill to amend title XVIII of the Social Security Act to 
expand and make permanent the Medicare subvention demonstration project 
for military retirees and dependents; to the Committee on Finance.


  Legislation expanding and making permanent the medicare subvention 
       demonstration project for military retirees and dependents

  Mr. GRAMM. Mr. President, along with Senators Kay Bailey Hutchison, 
Connie Mack, and Paul Coverdell, I am introducing legislation today 
which will expand the opportunities for military retirees to use their 
Medicare coverage to pay for treatment at military medical facilities. 
By giving our military retirees this option, we fulfill a health care 
promise that America has made to every man and woman who has retired 
from our armed forces after a career of exemplary service.
  Upon retirement after twenty or more years of military service, our 
nation promises to provide military health care to our retirees for the 
rest of their lives. This promise is one of the most important 
commitments our country makes to its military retirees. Unfortunately, 
for many military retirees age 65 and over, this promise is being 
broken. More and more of the 65 and over retirees have found themselves 
unable to receive care on a space-available basis at their local 
military medical facility. For these retirees, America's promise of 
health care for life is not being honored.
  Ironically, many of these military retirees are entitled to Medicare 
in addition to their military health care eligibility. An estimated 1.2 
million Americans fit into this ``dual-eligible'' category, with over 
300,000 of them regularly using military medical treatment facilities 
for their health care. The result is that the Department of Defense 
effectively subsidizes Medicare at the rate of approximately $1.4 
billion per year to treat these dual-eligible beneficiaries.
  As a first step toward fulfilling America's promise to military 
retirees 65 and over, Congress passed my proposal for a three-year 
demonstration project as part of the Balanced Budget Act of 1997. Under 
this demonstration project, known as Medicare Subvention, over 28,000 
dual-eligible military retirees are being treated in military 
facilities at selected test locations across the country. For these 
retirees, Medicare is reimbursing the Department of Defense up to 95% 
of the amount Medicare would pay Health Maintenance Organizations for 
similar care. Unfortunately, the limited scope of the demonstration 
project means that the majority of dual-eligible retirees are still 
unable to receive the treatment they have earned at the military 
facilities in their hometowns.
  The bill we introduce today will keep the health care promise America 
made to her military retirees 65 and over by expanding the 
demonstration project and by ultimately making Medicare Subvention 
permanent across the country. Specifically, this bill will expand the 
test locations for the demonstration project to 16 sites effective 
January 1, 2000. At these 16 sites, the demonstration project will 
become permanent. In addition, on October 1, 2002, the bill expands 
Medicare Subvention to any military medical treatment facility approved 
by the secretaries of Defense and Health and Human Services.
  This bill not only fulfills commitments America made in the past, it 
gives meaning and credibility to promises America is making to our 
military service members today. If America does not keep her word to 
those served during World War II, Korea, Vietnam, and the cold war, how 
can we expect America's best and brightest to dedicate their careers to 
serve this country in the future? We must act now to ensure that 
America's defense in the future will be as strong as it has been in the 
past. I ask my colleagues to support this important legislation. Mr. 
President, I ask unanimous consent that the text of a letter of support 
for the bill, signed by the Military Coalition, which is a consortium 
of military and veterans associations, be printed in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                       The Military Coalition,

                                   Alexandria, VA, April 27, 1999.
     Hon. Phil Gramm,
     U.S. Senate,
     Washington, DC.
       Dear Senator Gramm: The Military Coalition, a consortium of 
     military and veterans associations representing more than 
     five million current and former members of the uniformed 
     services, plus their families and survivors, is very grateful 
     for your leadership in developing legislation to expand and 
     make permanent TRICARE Senior Prime (the Medicare Subvention 
     demonstration project for Medicare-eligible uniformed 
     services beneficiaries). TRICARE Senior Prime has been 
     successfully implemented in all of the demonstration sites 
     and, by all accounts, has been very well received by eligible 
     beneficiaries at each site. The Department of Defense has 
     also expressed a strong desire to expand this program to 
     other sites across the country wherever feasible. Your 
     initiatives to expand TRICARE Senior Prime to ten additional 
     locations by January 1, 2001 and

[[Page S4445]]

     then across the remaining TRICARE Prime catchment areas not 
     later than October 1, 2002 clearly meets a critical need for 
     our Medicare-eligible beneficiaries.
       The Military Coalition is particularly pleased that your 
     bill takes the additional step of making TRICARE Senior Prime 
     a permanent program. The Coalition has been concerned that 
     some older retirees have refrained from participating in 
     TRICARE Senior Prime because of their perception that the 
     temporary nature of the demonstration program could place 
     participants at financial risk. Beneficiaries need assurance 
     that this program will not disappear abruptly as so many of 
     their other health care benefits have, especially since 
     TRICARE Senior Prime is an integral part of fulfilling the 
     promise of health care for life for uniformed services 
     beneficiaries. Your bill takes a great step toward providing 
     retirees this assurance.
       The Military Coalition is also pleased that your 
     legislation would authorize non-enrollees to use TRICARE 
     Senior Prime services on a ``fee-for-service'' basis. The 
     Military Coalition believes this would be particularly useful 
     for the Department of Defense, as well as beneficiaries, 
     especially at some of the smaller facilities with little or 
     no inpatient capabilities where it might be difficult to 
     implement a Medicare HMO program.
       The Military Coalition wholeheartedly endorses your bill, 
     and will take whatever steps are necessary to encourage other 
     members of the Senate to co-sponsor this bill and have it 
     enacted as soon as the data from the existing test sites 
     validate that Medicare subvention is as valuable to DoD, 
     Medicare and the beneficiaries as we believe it is.
           Sincerely,
                                           The Military Coalition.
       (Signatures of Associations enclosed).
         Air Force Association, Air Force Sergeants Association, 
           Army Aviation Assn. of America, Assn. of Military 
           Surgeons of the United States, Assn. of the US Army, 
           Commissioned Officers Assn. of the US Public Health 
           Service, Inc., CWO & WO Assn., US Coast Guard, Enlisted 
           Association of the National Guard of the US, Fleet 
           Reserve Assn., Gold Star Wives of America, Inc., Jewish 
           War Veterans of the USA, Marine Corps Reserve Officers 
           Assn., National Guard Assn. of the US, National 
           Military Family Assn., National Order of Battlefield 
           Commissions, Naval Enlisted Reserve Assn., Naval 
           Reserve Assn., Navy League of the US, Reserve Officers 
           Assn., Society of Medical Consultants to the Armed 
           Forces, The Military Chaplains Assn. of the USA, The 
           Retired Enlisted Assn., The Retired Officers Assn., 
           United Armed Forces Assn., USCG Chief Petty Officers 
           Assn., US Army Warrant Officers Assn., Veterans of 
           Foreign Wars of the US, and Veterans' Widows 
           International Network, Inc.

  Mr. COVERDELL. Mr. President, today I am proud to join my esteemed 
colleagues in introducing a bill that will expand and make permanent 
the Medicare Subvention demonstration program passed as part of the 
1997 Balanced Budget Agreement. I worked with Senator Gramm to pass 
that measure then and I am pleased to join him again today to move this 
program to its next level.
  Military retirees have had an increasingly difficult time obtaining 
the lifetime health care they were promised in return for 20 years of 
service to their country. The problem, largely, has been access. The 
number of military hospitals has decreased dramatically since the end 
of the cold war and TRICARE/CHAMPUS, the health care plan created to 
assist military retirees, not only is not available to a military 
retiree who is Medicare eligible, but also when it is available its 
reimbursement rates are so low many private practitioners will not 
accept it, forcing military retirees back into military hospitals on a 
``space available'' basis. Mr. President, you can see the vicious cycle 
this creates. Simply, put, military retirees are being shut out of the 
military health care system.
  Congress, in turn, has been looking for solutions to this lack of 
access. Last year I cosponsored a commonsense measure with Senator 
Thurmond. Our simple proposal would have given military retirees the 
option to enroll in the Federal Employees Health Benefits Plan, the 
same plan in which you and I and our staffs are enrolled, Mr. 
President. Congress acted on this idea by creating an FEHBP 
demonstration program. While not a total solution, the program has 
moved us in the right direction.
  Another commonsense measure, Mr. President, is Medicare Subvention. 
Currently, Medicare does not reimburse the Defense Department for 
health care services. This makes little sense considering that Medicare 
would reimburse any other private physician or medical care provider. 
If a Medicare-eligible military retiree lives near a military hospital 
he cannot use his Medicare and he cannot use TRICARE. He must find 
another insurance provider to help pay for his medical care. This is 
why, Mr. President, we passed a test of the Medicare Subvention in the 
105th Congress.
  Now we hope to move this concept forward. It is my understanding that 
while the program is working, the connotation of the word ``test'' is 
deterring military retirees who might otherwise enroll in a program 
they know to be permanent. This bill would solve that problem. Our bill 
also provides a fee-for-service Medicare option at certain Military 
Treatment Facilities if this would be a more cost effective approach 
for those facilities.
  Mr. President, this bill enjoys widespread support. The Military 
Coalition strongly favors an expansion of the Medicare subvention test. 
My colleague from Texas, Senator Gramm introduced for the Record a 
letter from the Coalition supporting this bill. Further, Congressman 
Hefley's bill in the House has already garnered 69 cosponsors. I 
believe this is a proposal Congress should move forward.
  Congress must continue to increase access to health care for our 
nation's military retirees. Medicare subvention is a commonsense 
approach to achieving this end. Thus far, based on the demonstration 
program, the parties involved feel that Medicare Subvention has been a 
success. Now we must let our military retirees know that when they 
enter this program the Government will not leave them in the lurch. 
This bill will do exactly that.
                                 ______