Upload
congressional-budget-office
View
5.097
Download
2
Embed Size (px)
DESCRIPTION
Presentation by Carla Tighe Murray, CBO Analyst, at the Western Economic Association Conference
Citation preview
Congressional Budget Office
Approaches to Reduce Federal Spending on the Defense Health System
Presentation at the Western Economic Association Conference
July 1, 2013
Carla Tighe Murray
Senior Analyst, National Security Division
1 C O N G R E S S I O N A L B U D G E T O F F I C E
Actual and Projected Costs for Military Health Care as a Share of DoD’s Budget, 1990 to 2030
Percent
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 20300
2
4
6
8
10
12
14
16Actual Projected
TRICARE
Initiated
FYDP
Projection
TRICARE for Life
Initiated
CBO's ProjectionFYDP = DoD’s 2013 Future Years Defense Program
2 C O N G R E S S I O N A L B U D G E T O F F I C E
Funding for the Military Health Care System, by Category
(Billions of 2013 dollars)
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
10
20
30
40
50
60
Pharmaceuticals
Purchased Care and Contracts
Direct Care and Administration
TRICARE for Life Accrual Payments
Military Personnel
3 C O N G R E S S I O N A L B U D G E T O F F I C E
TRICARE Beneficiaries Pay Less Out-of-Pocket for Their Health Care
■ Share of health care costs for a military retiree family of working age (<65) has fallen
– 27 percent of the total cost of care in 1996, when TRICARE was first fully implemented
– 11 percent in 2012
■ In 2012, retiree families paid less than one-fifth as much for their care as civilian counterparts with employment-based insurance
4 C O N G R E S S I O N A L B U D G E T O F F I C E
Costs for Military Retiree Families Under TRICARE Plans and for Civilian Counterparts with Employment-Based Insurance, 2012
(Dollars)
Premium or Enrollment Fee
Deductibles and Copayments
Total Annual Out-of-Pocket Costs
TRICARE Prime 520 445 965
Civilian HMO 5,080 1,000 6,080
TRICARE as a Percentage of the Civilian Plan 16%
TRICARE Standard or Extra 0 1,035 1,035
Civilian PPO 4,270 1,295 5,565
TRICARE as a Percentage of the Civilian Plan 19%
5 C O N G R E S S I O N A L B U D G E T O F F I C E
Options for Slowing the Growth of Health Care Costs
■ Cost-sharing Options – Increase fees, copayments,
and deductibles for military retirees and families
– Prevent military retirees and families from enrolling in TRICARE Prime but allow access to Standard/Extra for an annual fee
– Introduce minimum out-of-pocket costs to Tricare for Life for Medicare-eligible retirees and families
■ Other Approaches – Expand disease management
programs
– Expand scholarships and close the Uniformed Services University of the Health Sciences (USUHS)
– Hire additional auditors to combat fraud
– Combine the military departments’ medical establishments
6 C O N G R E S S I O N A L B U D G E T O F F I C E
Estimated Budgetary Effects of TRICARE’s Cost-Sharing Options, 2014 to 2023
Approach Annual Savings
Increase Cost Sharing for TRICARE Users As much as several billion dollars
Other Approaches (Disease management, close USUHS, hire more auditors, or combine medical establishments) As much as roughly $100 million
7 C O N G R E S S I O N A L B U D G E T O F F I C E
Potential for Savings in the Other Approaches
■ Expand disease management programs – Studies of DoD’s existing program find small to nonexistent savings
■ Expand the use of scholarships and close USUHS – In 2012, USUHS funding was $190 million for operations and
maintenance and $35 million for military personnel
– Transferring functions means continuing some funding
■ Hire additional auditors – A cost to the government
■ Combine military medical establishments – DoD estimated that savings from implementing the Defense Health
Agency could equal $46.5 million per year
– GAO’s assessment was that savings would be lower