Freshman lawmaker fights for broader Tricare coverage

Michigan Rep. Joe Schwarz may be new to Washington, but he’s already playing the lobbying game — in reverse. Usually, groups lobby lawmakers to get what they want, but on a key healthcare issue Schwarz is the one knocking on doors.
Michigan Rep. Joe Schwarz may be new to Washington, but he’s already playing the lobbying game — in reverse.

Usually, groups lobby lawmakers to get what they want, but on a key healthcare issue Schwarz is the one knocking on doors.
File photo

Rep. Joe Schwarz is pushing his fellow Michigan physicians to accept Tricare insurance.



The freshman Republican recently promised the Pentagon’s top leaders that he would press Michigan physicians to accept Tricare, the military’s medical plan. And the physician-turned-lawmaker also pledged to get other doctors in the House to do the same nationwide.

Low reimbursement rates and excess paperwork turn many doctors off to the Tricare program, available to all active-duty troops and their families, as well as retirees. Tricare reimbursements are tied to Medicare rates, which are typically lower than private healthcare plans and can cost physicians money in the end.

“I will try to get the other seven physicians in the House, at least as many who choose to sign, to write a letter to the American Medical Association and encourage them … [to] accept Tricare,” Schwarz told Defense Secretary Donald Rumsfeld during a March 10 House Armed Services Committee hearing. “And there’s absolutely no reason not to.”

Schwarz already has draft letters to the Michigan State Medical Society and the American Medical Association (AMA) sitting on his desk — and he hopes to rally support from fellow House physicians and send the letters out as early as this week, he later told The Hill.

The AMA, a membership organization, does not have the authority to mandate that its members accept Tricare. However, it can urge members to do so through newsletters, e-mails, and other communications.

“I think it is critical particularly in the case of Guardsmen and -women and reservists who are called to active duty that Tricare is accepted,” Schwarz said. “In my opinion, no questions asked, physicians should do this. It’s a patriotic duty.”

In return, David Chu, the Pentagon’s undersecretary for personnel and readiness, has promised the congressman he will look into any reimbursement problems to ensure that the healthcare administrator is “doing the job that they should do,” said Schwarz, an ear, nose and throat specialist.

The AMA is worried that Medicare rates are scheduled to be cut 31 percent by 2013 — which would directly affect most Tricare reimbursements. The only areas in which the Defense Department sets its own rates are for providers and procedures for which there are no corresponding Medicare codes, such as pediatricians and obstetricians.

“These cuts present a serious threat to patient access to care,” Dr. Nancy Nielsen, one of the association’s trustees, told a House Ways and Means Committee panel last month.

Compounding the Tricare problem is a long reputation for slow payments, with

reimbursements historically taking up to 120 days. The government has sped up the payment system in recent years but previous problems have left a bad taste in many physicians’ mouths, said Sydney Hickey, who sits on the board of directors for the National Military Family Association.

With more National Guardsmen and reservists around the country to have access to the healthcare plan in the next year, the problem of Tricare acceptance could become more widespread. The 2005 defense authorization bill expanded Tricare coverage for reservists and their families, giving them a year of coverage for every 90 days they serve on active duty.

“If you’re affected, it’s a big problem,” said Steve Strobridge, the director of government relations at the Military Officers’ Association of America. “I think in the majority of places in the country with some effort you can find a Tricare doctor. But there are some areas of the country where, for a variety of reasons, it can be a real problem.”

Traditional military outposts are far more likely to have local doctors who are familiar with — and accept — the Tricare program. But for Tricare members spread around the country, particularly the families of Guardsmen and reservists, it can be more difficult to find a doctor in the plan.

“Part of the problem for the Guard and Reserve is they not only not live in an area near a military installation but in areas where they do not have a lot of either active-duty families or retirees,” Hickey said. “They’re throwing Tricare out to a physician’s office who’s never heard the word before. It’s not Blue Cross Blue Shield.”

The 2004 defense authorization bill required the Defense Department to survey towns around the country to find out the percentage of providers in each area that accept new Tricare patients. The department is starting to compile that data, just as Tricare opens up to reservists on a cost-share basis.

For the past several years, groups representing Reserve and National Guard soldiers have fought hard to get reservists and their families access to the military’s Tricare benefit program. As it stands now, only activated reservists, and those immediately coming off of active duty, have access to Tricare.

Michele Traficante, who works in legislative affairs at the National Guard Association of the United States, said the organization’s few members currently on Tricare have not reported many problems with the plan. In fact, she said, the Tricare contractors have been readily available to the association, which represents more than 45,000 current and retired Army and Air National Guard members.

However, she said she expects “most definitely” to track any issues with physicians’ acceptance of the Tricare plan once more Guardsmen come onboard. Meanwhile, the organization continues to push to get all members of the Guard access to Tricare, regardless of their activation status, Traficante said.