On the campaign trail, every candidate seems to promise to “stand up for our military.” At the presidential level this year, you hear it from both Hillary Clinton and Donald Trump. Federal and state-level campaigns are no different. If elected officials simply kept their word, a serious healthcare issue facing our military men and women would not be a reality right now.
Congress recently allowed the prices derived from the Medicare bidding system for home medical equipment in major metro areas to be applied to rural America and other less densely populated areas previously excluded from the bid program. The resulting cuts for home medical equipment providers in these rural areas – up to 50-60 percent vs. the rates in effect in 2015 for many commonly used items – have been devastating for suppliers in these rural communities, who face significant extra costs in serving patients spread over a wider geographical area than their urban counterparts. As a result, Medicare beneficiaries across rural America are struggling to find suppliers who can meet their medical equipment needs, forcing many to pay out of pocket to get essential medical equipment.
I know what you’re thinking: “That sounds like a problem, but how does it impact our military or our veterans?”
The military healthcare plan covering active and reserve duty military personnel, their families, and military retirees is known as TRICARE, with plans administered on regional basis by major insurance companies. By law, TRICARE plans use Medicare rates as a baseline, and many discount reimbursement prices even further beyond those.
Since the Centers for Medicare and Medicaid Services (CMS) decided to apply the rates from these urban bidding areas to the entire country, the new baseline for TRICARE has also plummeted, with reimbursement less than half of what it was a few months ago.
These unrealistic reimbursement rates have been catastrophic for many home medical equipment providers who serve our military under the TRICARE program, and many of them are either reducing their product lines or opting out of TRICARE altogether. The resulting reduction in available care is only adding difficulty for individuals in the military and their families who need a wheelchair, home oxygen, a CPAP device, or other essential products. We all know that recuperating from significant health care challenges at home is preferred for many; but we should also keep in mind that being at home is almost always a less expensive treatment option than being forced over to an inpatient facility.
The competitive bidding system was designed for use in major metropolitan areas, where winning bid providers can receive the benefits of gaining market share as other companies are excluded in those areas. Also critically important: companies in those metro areas at least had some input in determining prices through their bids. What CMS fails to acknowledge in applying these rates universally is that many communities are different with varying patient needs and operating costs for a business. Whether they’re part of the military community, or if they reside in any one of thousands or rural communities nationwide, Americans deserve quality healthcare.
Despite repeated warnings from both home medical equipment suppliers and patient advocate groups nationwide, these significant cuts were allowed to move forward, with the latest round of reductions taking place on July 1 of this year. Congress has been working on legislation to roll back part of these cuts so policymakers can better study the potential impacts of these deep reductions before implementing them permanently. In fact, both the House and Senate have passed separate bills to accomplish this, but the two chambers have not been able to agree on important details. This reconciliation is critical not only for Medicare beneficiaries but for TRICARE and all other payors who look to Medicare to set their reimbursement rates.
At a time when partisan bickering and gridlock dominate Capitol Hill, this is one issue where Members of Congress from both parties can come together. In doing so, they can save local businesses, protect jobs, and – most importantly – ensure quality of care for our seniors and people with disabilities in rural communities, as well as military families. It would be the right thing to do and would prove to be good public policy.
If those are not reasons enough to motivate our elected officials on Capitol Hill, then they should simply do it because during their campaigns they promised to “stand up for our military.” The only question is, “Will they keep this promise?”
Brigham McCown is a retired federal senior executive and military officer and currently serves as a thought leader on public policy impact issues. You can follow him at here.
