Action in Congress

Sept. 1, 2006

VA Case Backlog

Retired judges from the Court of Appeals for Veterans Claims should be reinstated to handle a worrisome backlog of claims cases, says the Senate Veterans’ Affairs Committee.

The case backlog at the appeals court, which Congress created in 1989 specifically to handle veterans’ cases, has doubled in two years, reaching an “unacceptable” level, said Sen. Larry E. Craig (R-Idaho), committee chairman.

“Veterans deserve it and Congress demands it” said Craig, calling for swifter decisions on appeals.

In 2004, the claims court had 2,700 cases pending, most involving disability compensation. Fewer than 200 new cases were arriving each month. Today, the backlog surpasses 5,800—with 300 new cases arriving monthly.

Chief Judge William P. Greene said in July that the court is weighing the possibility of recalling retired judges.

Greene said the court now has seven active judges, the most in six years, so he has “every expectation that we will continue an upward trend” in clearing cases.

Tricare Reserve Select

Any drilling Guard or Reserve member now can buy Tricare health coverage under a triple-tiered Tricare Reserve Select (TRS) program. Defense officials have announced details of the TRS enrollment process for the new Tiers 2 and 3.

Except for the premiums, the TRS benefit is similar to Tricare Standard. Enrollees pay annual deductibles and a 20 percent co-payment for inpatient and outpatient care. Drug co-pays in the Tricare network are $3 for generic and $9 for brand-name drugs. The ceiling on total out-of-pocket costs is set at $1,000.

Covered members and families can get care from any Tricare-authorized civilian provider, hospital, or pharmacy. They can access care in a military treatment facility on a space-available basis only.

An open season to enroll in Tiers 2 and 3 began in August and ends Nov. 25.

Tier 2 is available to drilling members who lack employer-sponsored health care including those self-employed. Premiums cover 50 percent of plan costs.

Tier 3 is for drilling members who have access to employer-sponsored health care but prefer TRS. Premiums cover 85 percent of program costs.

More information is at:

Medical Recruiting Incentives

With only the Air Force attracting enough prospective doctors to its Health Professions Scholarship Program to sustain the next generation of military doctors, Congress is considering increased medical bonuses and stipends.

An incentive package approved by the Senate would:

  • Double, to $30,000 a year, the stipend for HPSP scholarships.
  • Increase to $60,000, from $22,000, the maximum student loan repayment, to entice more medical and dental school graduates into service.
  • Increase to $45,000, from $15,000, the maximum annual grants for doctors who choose to complete residency training in the civilian sector before military service.
  • Increase to $25,000, from $10,000, the amount of special pay offered to selected reserve health professionals trained in critically short wartime specialties.
  • Enhance dental accession bonus authority. Dentists currently are offered an accession bonus of up to $30,000. That would be raised to $200,000—recognizing that dentists’ salaries in the private sector have increased.
  • Allow a new accession bonus of up to $400,000 for physicians and dentists in war-critical specialties. Enticed from civilian life, the doctors would promise to serve at least four years. Specialists who might qualify include maxillofacial surgeons, thoracic surgeons, and orthopedic surgeons.

The House version of the 2007 defense authorization bill had not endorsed most of these adjustments.

Preserving the Pipeline

The services recruit 70 percent of their physicians and 80 percent of dentists through HPSP. The program covers tuition in civilian medical schools plus books and fees and pays a monthly stipend of $1,289. In return, students agree that for every year of schooling provided, they will serve a year as a military physician or dentist.

Every service had been meeting HPSP goals until Fiscal 2005 when the Navy fell 44 percent short of the 291 medical students it had hoped to sign. Numbers for 2006 have not improved.

The Army in 2005 expected to award 307 scholarships. It fell 70 short.

Lt. Gen. Kevin C. Kiley, Army surgeon general, said this isn’t causing a shortage of doctors now because of the years-long training pipeline it takes to turn medical students into deployable doctors.

The Air Force is exceeding its HPSP goals. An official credited expeditionary rotations, which limit combat assignments for medical and dental officers to predictable four-month tours. Applicants also hear that the Air Force offers a higher quality of life.

Drug Rebate Battle

The Bush Administration is sending mixed signals about a push by Tricare officials to force pharmaceutical companies to provide deep discounts on drugs dispensed in the Tricare retail network.

High retail drug prices are adding about $260 million a year to Tricare budgets, according to Capitol Hill, Pentagon, and industry sources.

Lawyers for the Department of Veterans Affairs and DOD agreed in 2004 that the Veterans Health Care Act of 1992 directs drug manufacturers to grant discounts on all drugs supplied to DOD, VA, the Public Health Service, and the Coast Guard. The discounts already are provided on drugs dispensed through military pharmacies or the Tricare Mail Order Program. The discounts, which come in the form of rebates, lower drug costs by 30 to 40 percent.

Last year, defense officials told drug manufacturers that new Tricare contracts will assume that the rebates also apply to the retail network, and the department would budget accordingly. That announcement spurred the pharmaceutical companies to file a lawsuit against the department’s plan. A decision is pending.

William Winkenwerder Jr., assistant secretary of defense for health affairs, asked for legislative help in April. He said drugmakers already owed rebates to Tricare worth more than $450 million—and the tab is rising.

But Winkenwerder has stopped touting a supportive Senate provision. Asked to comment on it in June, he said, “The Administration does not have a position either in favor of or against that particular provision.’’

Protecting Vets’ Credit

The VA scrapped a $160 million program to provide free credit monitoring for 26.5 million veterans after authorities recovered a laptop computer and external hard drive containing veterans’ names and personal data.

In a letter to House Speaker J. Dennis Hastert, White House budget director Robert J. Portman said he was canceling the Administration’s special request to fund a year of free credit monitoring for veterans.

Portman said the FBI had a “high degree of confidence” that information stored on the stolen computer equipment had not been accessed since the theft.

The equipment had been stolen from the home of a VA analyst. (See “The Laptop Scandal,” p. 86.)

VA Secretary R. James Nicholson told the Senate Veterans’ Affairs Committee in July that the VA will hire a leading data analysis company to ensure the information is not being used to abuse veterans’ credit or steal their identities.

Payday Lenders Under Fire

The Senate’s defense authorization bill contains language to cap interest rates charged by “payday” lenders who profit from military families who are living paycheck-to-paycheck or spending beyond their means.

The amendment, from Sen. Bill Nelson (D-Fla.) and Sen. Jim Talent (R-Mo.), would strengthen protections for service personnel from abusive lending practices.

Critics of payday loans say annual interest rates as high as 800 percent create such debt for service members or their spouses that they lower morale and threaten unit readiness.

The Navy-Marine Corps Relief Society estimates that military families pay an estimated $80 million annually in payday loan fees. The Senate measure would block lenders from charging military personnel interest rates higher than an annual rate of 36 percent.

“We have to step in and stop these predatory lenders from making a quick buck at the expense of the livelihood and future of those defending our freedom,” Talent said.