[Congressional Record Volume 146, Number 17 (Wednesday, February 23, 2000)]
[Senate]
[Pages S741-S745]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WARNER (for himself, Mr. Lott, Mr. Levin, Mr. Daschle, Mr. 
        Hutchinson, Mr. Cleland, Mr. Thurmond, Mr. Kennedy, Mr. Inhofe, 
        Mr. Santorum, Ms. Snowe, Mr. Roberts, Mr. Allard, Mrs. 
        Hutchison, Mr. Lieberman, Ms. Landrieu, Mr. Reed, Mr. Crapo, 
        Mr. Inouye, Mrs. Lincoln, and Mr. Kerry):
  S. 2087. A bill to amend title 10, United States Code, to improve 
access to benefits under the TRICARE program; to extend and improve 
certain demonstration programs under the Defense Health Program; and 
for other purposes; to the Committee on Armed Services.


           the military health care improvements act of 2000

  Mr. WARNER. Mr. President, I am introducing this bill with the 
complete support and, indeed, the leadership of our distinguished 
majority leader, the Senator from Mississippi, Mr. Lott.
  The Senate will recall that Senator Lott was one of the principal 
persons who enabled the pay and other benefits bill that was passed by 
the Senate, and indeed adopted by the President, to be introduced last 
year. He has exhibited leadership on this subject throughout. He is a 
former member of our committee, a very valued member. He has kept quite 
active on matters relating to not only personnel but the whole aspect 
of our national defense. I pay a special tribute to him and also to the

[[Page S742]]

other members of our committee. Indeed, it is a bipartisan effort at 
this time in every respect to present to the Senate this piece of 
legislation.
  I see the distinguished chairman of the Personnel Subcommittee of the 
Senate Armed Services Committee who will follow me in addressing this 
issue.
  Mr. President, I will be chairing a committee meeting of the Armed 
Services Committee on the subjects of Kosovo and China, two very 
troublesome situations in the world today, so I am briefly going to 
make a few statements and then ask unanimous consent the remainder of 
my statement be printed in the Record.
  I rise to introduce a very critical piece of legislation entitled 
``The Military Medical Improvement Act of 2000.'' This legislation 
represents an important and much needed first step. I wish to carefully 
underline this is a first step. It is a beginning in addressing the 
many needed requirements to fulfill the commitments of the United 
States of America through the years--beginning in World War II--to the 
men and women who have proudly worn the uniform of our Armed Forces. It 
relates, of course, to the military medical care system, which serves 
not only those on active duty but their dependents and, indeed, those 
who have retired.
  I am particularly privileged to have had the opportunity to serve 
with, and to continue to work on behalf of, the men and women of the 
Armed Forces for over a half century. I was privileged to have brief 
tours of active duty in World War II and Korea. Indeed, I myself was a 
beneficiary of this care system. I did not remain in service long 
enough to get the entitlements that come with retirement, but 
nevertheless I know firsthand the value and superb medical treatment 
that is offered to the men and women of the Armed Forces.
  What we are trying to ensure is that the same treatment and care is 
spread throughout the system. A particular part of this legislation is 
to go beyond the President's request and includes laying a larger 
foundation, a larger beginning series of steps, for those in the 
retired community.
  All of us, when we proudly raised our hand and took the oath of 
office as military persons, were given certain assurances that we would 
be cared for not only while on active duty but for those who went on in 
a career--a career, I stress--type of situation, that they would get 
that care along with their families for the balance of their lives. 
That is the important thing that I address today.
  These men and women depend, at various times in our Nation's history, 
on the Congress. I repeat that--not necessarily criticism to the 
Commander in Chief, the President--it is not a political observation; 
it is simply a fact that the Congress, at various times in our history, 
has had to step forward on its own initiative to provide the 
fulfillment of the commitments that have been made to the men and women 
of the Armed Forces.
  This is one of those instances. The President put forth in his 
package those measures which he believed began to address this problem. 
Now we come along, as a coequal branch of this Government, and lay 
before first the Senate and, indeed, the House will soon take it up 
similarly, our own proposals as to how to add to the President's 
package so as to, in particular, have a bigger foundation, a greater 
beginning, to care for those men and women of the Armed Forces, 
particularly in their period of retirement.
  Mr. President, as I said, I rise today to introduce a very critical 
piece of legislation, the Military Medical Improvement Act of 2000. 
This legislation represents an important and much needed first step--a 
beginning--in addressing the many complaints and concerns with the 
military medical care system.
  I am particularly privileged to have had the opportunity to serve 
with, and to continue to work on behalf of, the men and women of the 
armed forces for over a half century. These men and women depend, at 
various times in our Nation's history, on the Congress to keep the 
commitments that were made when they took the oath of office to serve 
their nation. In most cases our nation committed to provide health 
care--for life--for military members, their families, and retirees and 
their families.
  Quality military health care has been a lifelong priority for me. I 
was dependent on the military health care system with brief tours as an 
active duty sailor and U.S. Marine, and later, responsible for its 
oversight as Secretary of the Navy. Today, I, along with the Majority 
Leader, Senator Lott, Senators Daschle, Levin, as well as others, 
propose legislation to meet our commitment to the brave men and women 
who have so honorably served their country, through a full career and 
those now serving, by taking initial steps to fulfill the obligation to 
provide them with quality health care.
  Last year, the Congress adopted significant enhancements to pay and 
benefits for our military members and their families. Already, we are 
seeing the positive impact of last year's legislative actions on 
recruiting and retention.
  We must not stop there. Health care remains to be addressed and is a 
significant component of our military benefit package, as well as a 
commitment our Nation made to our service members and their families.
  Meeting our health care promise to our service members and their 
families is not only a commitment and a moral obligation but it is also 
in our interest. Today it is a key factor in recruiting and retention. 
Delivery of quality health care and the assurance that the government 
meets its obligations are key factors in the morale and retention of 
our troops.
  I would like to acknowledge the efforts of Secretary Cohen, Chairman 
Shelton, and the Joint Chiefs in highlighting the many problems in 
meeting the health care commitment to our military retirees and 
implementing a user-friendly medical program for all. The legislation I 
am introducing today includes the initiatives for active duty family 
members included in the President's budget request for fiscal year 
2001. However, these initiatives do not go far enough. The President's 
request stops short in addressing any initiatives for our military 
retirees. Military retiree healthcare needs cannot wait longer.
  I am well aware of the promises of lifetime health care made to those 
service members with whom I served. There is ample evidence that when 
young men and women joined the Armed Forces, they were promised health 
care for themselves and their families, for the rest of their lives in 
return for career commitments. Often this was in writing. Now, upon 
reaching age 65, they are finding that this commitment is often not 
fulfilled.
  My desire is to return a sense of fairness to the military health 
care system by providing beneficiaries, including Medicare-eligible 
military retirees, access to health care. Under the current system, 
military retirees lose entitlement to military medical care at age 65 
and must rely on Medicare for their healthcare needs.
  In addition, base closure and realignment actions have had a 
significant impact on both active duty members and retirees by reducing 
the medical infrastructure of our Armed Forces. Our military's hospital 
network has decreased by approximately 30 percent since the mid-
eighties, while the military beneficiary population has grown and aged.
  Those who have so honorably served their country believed they could 
depend on health care provided by local base hospitals. The Department 
of Defense capacity has become limited. We must find other ways to meet 
our health care commitment.
  For our active duty members and their families, implementation of 
TRICARE, the Department of Defense's managed care program, has created 
its own set of challenges for the Department of Defense. As General 
Shelton stated before the Senate Armed Services Committee on February 
8, ``the program is not user friendly'' and ``we need to get it right 
and I know we will''.
  The first section of the bill I am introducing today provides for 
health care delivery to the over-65, Medicare eligible retired military 
population. Over the past 2 years, Congress directed implementation of 
several demonstration programs, for over-65 military retirees, 
including Medicare subvention, the Federal Employee Health Benefits 
Program, and a Medicare insurance supplement or ``medi-gap'' type 
policy.

[[Page S743]]

  One of these programs is due to expire this year, some have just 
started, and other are due to start this spring. This legislation 
extends the demonstration programs to allow for continuity of care and 
assessment by the Department of Defense and the Congress to determine 
the most appropriate long term health care solutions for these 
beneficiaries.
  In addition, the bill allows for the expansion of the ``Medicare 
subvention'' or TRICARE Senior Prime Program to major medical centers 
throughout the country, where the Department of Defense is reimbursed 
for care provided to Medicare eligible beneficiaries through agreement 
between the Secretary of Defense and Health Care Financing 
Administration. This authority will permit TRICARE Senior Prime to grow 
in these areas in which the program appears to be more promising.
  Additionally, due to the low response to the Federal Employees Health 
Benefit Program demonstration so far, the Secretary of Defense will be 
authorized to expand the number of sites at which this option is 
offered. We want to allow a full and open evaluation of this program.
  The second section of this bill recognizes and meets a major 
healthcare need or our older military retirees by providing a pharmacy 
benefit, which Medicare does not provide. The legislation expands the 
Department of Defense's mail order program to allow participation by 
all beneficiaries, including the over 65 population. Military retirees 
over the age of 65 would be asked to pay a modest deductible of $150 
per year to participate in this new benefit. This responds to their 
urgent need for pharmaceuticals for our retirees--especially for those 
suffering from chronic long-term conditions such as diabetes and heart 
disease.
  This bill recognizes the need to quickly implement improvements to 
the Department of Defense's managed care program, TRICARE, especially 
for active duty personnel and their family members. Chairman Shelton, 
and the Service Chiefs, have been extremely vocal in his desire to 
create equity in the TRICARE program for active duty personnel and 
their families. The Department has recognized that improvements in this 
area are crucial to recruiting and retention and have included two 
provisions in the President's budget request.
  Those provisions which are incorporated in this bill, include 
expanding the TRICARE Prime Remote benefit to family members of those 
active duty personnel stationed in remote locations and elimination of 
co-pays for TRICARE Prime family member who use care outside of the 
military medical facilities.
  Defense Authorization Acts over the past several years have included 
various legislative direction pertaining to improving access, 
availability and scheduling of appointments, claims filing and payment, 
and a single nationwide enrollment program. This bill reinforces the 
previous actions of the Congress and requires the Secretary of Defense 
to accelerate implementation of these improvements to the TRICARE 
program by October 2001.
  In this time of decreasing resources, increasing costs and increasing 
demand for health care services, cooperation among the federal agencies 
is critical. The Department of Defense and the Department of Veterans 
Affairs have a long standing, cooperative, and productive relationship. 
This legislation authorizes additional initiatives between DOD and the 
VA in the area of patient safety, reducing medical errors and 
pharmaceutical safety.
  Finally, much discussion has taken place about how to finance the 
military health care program over the long term. Specifically, the 
Joint Chiefs have suggested the accrual financing of military retiree 
health care might be the most appropriate option. This legislation 
directs the Department of Defense to conduct two studies to assess the 
feasibility and desirability of financing the military health care 
program for military retirees on an accrual basis.
  Our men and women in uniform have answered the call of their country 
without hesitation or equivocation. Commitments were made to them in 
return for their service. We must fulfill those commitments. This 
legislation begins, I repeat begins, the process of satisfying the 
health care needs of all beneficiaries in a more comprehensive, uniform 
and fair manner. I urge my colleagues to support this legislation.
  The PRESIDING OFFICER. The Senator from Arkansas.
  Mr. HUTCHINSON. Mr. President, I commend Chairman Warner, the 
distinguished Senator from Virginia, for his outstanding leadership on 
this critically important issue. I am glad to join the majority leader, 
along with Chairman Warner, and Senators Levin and Cleland, in the 
introduction of this legislation.
  Mr. WARNER. Mr. President, I thank my colleague.
  I am confident we will have a majority of the Senate eventually as 
cosponsors on this legislation. Indeed, there are other Senators who 
may have ideas of their own, so we will work this piece of legislation. 
It may be passed as a freestanding bill. It may well be that this 
legislation will be incorporated in the annual authorization. That is a 
decision that the distinguished majority leader, myself, and others 
will make, together with the chairman of the Personnel Subcommittee in 
the course of the coming months.
  I thank the Senator.
  Mr. HUTCHINSON. It is, indeed, encouraging that this issue has been 
given such a high priority by the leadership of the Senate and that we 
have a bill--whether it passes freestanding or whether it is 
incorporated in the authorization bill--that is eminently doable this 
year. I think that is one of the hallmarks. There are others that have 
grander schemes of what can be done, but this is very achievable this 
year.
  Mr. WARNER. Mr. President, will the Senator yield?
  Mr. HUTCHINSON. Yes.
  Mr. WARNER. I am not certain that the Senator mentioned Senator 
Daschle as a cosponsor.
  Mr. HUTCHINSON. I think that underscores, once again, the bipartisan 
nature of this legislation. I appreciate the Senator pointing out that 
omission.
  Like the rest of our country's health care system, the military 
health care delivery system is in great need of reform. Over the years, 
I have met with and heard from countless veterans, military retirees, 
and their families, who have informed me of the many and varied 
problems of every aspect of the military medical care system--including 
access to proper care, dissatisfaction with the current TriCare 
program, loss of coverage at age 65 when they become eligible for 
Medicare, and, especially, availability of needed pharmaceutical drugs.
  Last month, in fact, I had the privilege of leading a congressional 
delegation overseas to visit U.S. service men and women serving in 
Japan and South Korea. The most common complaints I heard, aside from 
the high OPTEMPO that keeps families apart, were complaints about the 
military health care system and how it treats dependents. Too many had 
trouble scheduling appointments for dependents, and too many had 
trouble being reimbursed for the cost of care provided to their loved 
ones.
  This is unacceptable. The men and women who choose to wear America's 
uniform have too many other important things to worry about than 
dependable health care for themselves and their families. Millions of 
Americans made the sacrifice to defend our country with the 
understanding that health care would be available to them upon 
retirement if they served at least 20 years. Unfortunately, for too 
many military retirees this commitment has simply not been honored.
  Since the establishment of CHAMPUS, and its successor, TriCare, we 
have seen that the idea of space-available health care at military 
treatment facilities for military retirees is simply not adequate.
  With base closures, military downsizing, and reduced services at 
military treatment facilities, it is nearly impossible for military 
retirees to access quality health care without having to travel 
hundreds of miles.
  It should come as no surprise that problems with military medicine 
are often cited by troops as a key reason for leaving the force. In 
fact, a GAO study found that access to medical and dental care in 
retirement was the No. 5 career dissatisfier among active-duty officers 
in retention-critical specialties.

[[Page S744]]

  One of the critical challenges now is how best to reconfigure 
military health care delivery systems so that it might continue to meet 
its military readiness and peacetime obligations at a time when our 
base and force structure is continually changing.
  Let me briefly give a summary of legislative provisions in the bill 
that we are introducing.
  Section A deals with our over-65 retirees. It extends the 
demonstration programs that have been in place. It allows expansion of 
``Medicare subvention,'' which is critically important as a funding 
stream for military retiree health care. It allows expansion of the 
Federal Employee Health Benefits Program Demonstration--a program that 
I believe will still work, though there have been too few enrolled in 
it. We need to adequately publicize it, adequately promote it, and 
allow it to be expanded. This bill does that.
  It expands the National Mail Order Pharmacy Program to all 
beneficiaries, including Medicare-eligible beneficiaries, with only a 
$150 deductible. Addressing of the needs of retirees for 
pharmaceuticals is probably the most critical part of the entire bill 
and will provide great relief for our military retirees in the area of 
prescription drugs.
  It directs modification to DOD's implementation of a legislatively 
directed pharmacy pilot program by reducing participation fees and 
alternative payment methods.
  Section C deals with TriCare Prime. It makes improvements to the 
TriCare program, especially for active duty and their family members. 
It requires expansion of TriCare Prime Remote for active-duty family 
members of those members in remote locations. We hear many complaints 
from those who are serving in remote locations, and who are not near 
military hospitals, and this would allow expansion of that Prime Remote 
for those important service members.
  It eliminates copays for TriCare Prime for active-duty family 
members, a very important provision. It directs improvement in business 
practices used in administering provision of health care services 
through the TriCare program to include access, availability, and 
scheduling of appointments; claims filing, processing, and payment; and 
national enrollment. It continues and caps previous provisions related 
to custodial care.
  Section D provides for further collaboration between the DOD and the 
VA in the cooperative programs that exist in the areas of patient 
safety and pharmaceutical safety. All of these are critically important 
provisions, and there are other provisions that are going to help our 
military health care situation.
  As we know, retirees especially have had problems with access to 
health care. These over-65 retirees and their families are seeing a 
critical problem develop. These beneficiaries believe--and rightly so--
that a lifetime commitment was made and that lifetime commitment is not 
being honored. Service members thought they were assured free lifetime 
health care. This was promised by recruiters in recruiting materials as 
late as the 1990s. We must honor that promise to our retirees.
  Our active-duty service men and women find that access to care is 
very often difficult. Young families find it especially difficult to 
navigate the often cumbersome process of getting their young children 
to the care they need. Implementation of the managed care program 
appears inconsistent across the country. Families don't know what to 
expect when they move to different regions of the country because 
administration of the program appears to be handled differently at 
different locations.
  We must show these active-duty service men and women that we care. We 
can do that by the passage of this bill. I look forward to working with 
my colleagues on both sides of the aisle to see this legislation 
enacted. This is a very doable, very achievable first step in improving 
our military health care provision for our service men and women.
  I thank the Chair for his willingness to serve a little extra today 
so I could make my comments regarding what I think is very important 
legislation.
  I yield the floor.
  Mr. CLELAND. Mr. President, I am pleased to introduce this military 
health care initiative--the Military Health Care Improvements Act of 
2000.
  I am here today because the military health care system saved my 
life.
  Many distinguished members have preceded me in attempting to address 
this issue of ensuring that our military members and their families are 
properly cared for.
  As I have stated many times--and devoted untold hours of thought, 
meetings, and considerations to--military health care is the issue for 
those who have served and for those who are serving, and especially 
those who will serve in the military.
  From my first day in the Senate, I have considered no issue more 
important in the maintenance of our military forces than the military 
health care system. I have addressed this issue in prior legislation.
  As I arrived in Washington, the Tricare system of military health 
care was taking hold in my State with poor performance I might add. Of 
course, much has been improved because of this body and the Congress as 
a whole responding to our constituents, and ensuring we live up to our 
obligations to our military members.
  In any scholar's opinion, our Nation's rise as a national power has 
been dependent on our military power--military power is the enabler to 
economic power and well being of any country.
  The underpinning to our military power has always been and always 
will be our military service members. In fact, Time magazine recently 
voted the American GI as the Person of the 20th Century.
  We have obligations to these brave souls and their families who serve 
selflessly and proudly.
  I believe that among many other quality of issues, the most important 
of these obligations is quality military health care. Service members 
serve with distinction, in places unknown, without question to orders, 
and without expectations. It is up to this Congress to act on 
legislation, and to provide the most comprehensive health care for 
those members--past, present, and future.
  I urge my colleagues to support this bill with conviction. Why? 
Because it is more than the right thing to do--it must be done, if we 
are to fill the ranks of our services, and if we are to live up to the 
obligations of all those brave soldiers, sailors, marines, and airmen 
that have given their lives for this country so that we could enjoy 
this country's bounty.
  Our legislation would cover several main health care issues for 
military personnel, their families, and military retirees, such as: 
expanding health care coverage for Medicare Eligible Retirees by 
extending the demonstration projects already underway to 2005, 
expanding the Tricare Senior Prime demonstration, and expanding the 
Federal Employees Health Care Benefits Program (FEHP), demonstration 
for Medicare eligibles, that is also currently underway; expanding the 
military pharmacy programs by expanding the national mail order 
pharmacy program to Medicare-eligible beneficiaries, reducing 
enrollment fees for the pharmacy pilot program and implementing 
deductibles and quarterly/monthly payment schedules; eliminating copays 
for Tricare Prime and expanding the Tricare remote program and improve 
Tricare business practices; and grandfather those participating the 
Department of Defense home health care demonstration program; and 
additionally, encourage the Department of Defense and Veterans 
Administration Cooperative Programs already underway to address patient 
safety and pharmaceutical safety, two key issues in health care today. 
Several other legislative initiatives have been introduced this year to 
address health care for the military--active duty and retirees.
  In the coming weeks, the Personnel Subcommittee of the Senate Armed 
Services Committee, which Senator Hutchinson heads and of which I am 
pleased to be the ranking Democrat, will address each bill that comes 
to us on the subject of military health care reform in the hopes of 
finding the right combination of each of these bills to formulate the 
best final product for the committee's markup. I look forward to 
receiving testimony on each measure, and I look forward to working with 
Senator Hutchinson on these important health care initiatives. Since 
his appointment to the Senate Armed

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Services Committee, I have truly enjoyed a wonderful working 
relationship with him, and I am sure that will continue. I appreciate 
his support and his interest in the issue of service men and women and 
their health care.
  I have also been encouraged by the bipartisan support our measure has 
received, and I am happy to be working with the chairman of the Armed 
Services Committee, Chairman Warner, Ranking Member Levin, Majority 
Leader Lott, and Minority Leader Daschle on addressing this critical 
issue. This legislation continues our work on addressing health care 
for retirees and the active components. I am excited at the possibility 
of passage of this comprehensive legislation.
                                 ______