Health care recommendations by the Military Compensation and Retirement Modernization Commission would improve health services for military families and actually save lives, commission members told lawmakers in separate hearings on Tuesday and Wednesday.

One key recommendation — to align the Veterans Affairs Department's pharmacy formulary with that of the Defense Department— would "get at" the heart of the veterans' suicide problem by ensuring continuity of care for troops leaving the military, commission member and retired Army Gen. Peter Chiarelli told the Senate Armed Services Committee.

According to the Government Accountability Office, just 43 percent of the medications in DoD's formulary also are in VA's system, excluding many pain medications, anti-depressants and antipsychotics taken by injured service members for physical pain and mental health conditions.

The gap leaves troops vulnerable, Chiarelli said.

"If we have found a medication that works, it should be available wherever [the veteran] goes. … If it's not the VA formulary, someone should hand the veteran a card so he or she can go to a [retail] pharmacy and get it," Chiarelli said.

A version of a bill passed Tuesday in the Senate includes a provision requiring VA and DoD to furnish a report on the challenges of combining the two formularies.

The bill's namesake, Clay Hunt, killed himself almost four years ago after moving to Texas and finding — among other challenges of obtaining a mental health appointment at the VA medical center there — that his much-needed prescription was not available at the hospital's pharmacy because the the facility didn't stock that particular brand-name drug.

"We should not put our service men and women in this situation," Chiarelli said.

The commission recommended other significant changes to the military health system in its comprehensive report, to include creating a health care program for families and retirees that uses commercial insurance plans, changing the medical command structure and improving services to troops with special needs children.

Under the recommendations on Tricare, active-duty members and mobilized reservists would continue to receive medical care from U.S. military personnel and have easier access to specialty care in the civilian sector if they need it.

Their family members, retirees under 65 and their family members, however, would receive health care through commercial insurers, similar to the plans run under the Federal Employee Health Benefits Program.

Under Tricare Choice, as the commission dubs it, active-duty families would receive a new allowance to cover the cost of their insurance premiums, called the Basic Allowance for Health Care.

Retirees too young to qualify for Medicare would pay their premiums out of pocket, although at a lower cost than under civilian plans as "recognition" of their service.

Commission members said their proposal would improve health services for military families and retirees across-the-board.

Stephen Buyer, a former chairman of the House Veterans' Affairs Committee and retired Army Reserve colonel, said the current system fails to attract quality providers because the reimbursement rates are low.

That limits the number of available physicians and raises concerns about quality care, panel members said. "Choice, value and access are the things we heard from time and time again" as issues concerning military families, said commission chairman Alphonso Maldon Jr.

Buyer said that although the commission plan would increase out-of-pocket costs for working-age retirees -- to eventually reach roughly 20 percent of their overall healthcare costs -- it would, ultimately, be a better system that they would want to pay for.

"I am sure you will hear that with rates going up, you're breaking a promise. But they are tangled right now in a subpar health system" that is not sustainable, Buyer said.

Addressing concerns among some senators over preserving military medical readiness, commission members also said their proposal would preserve lessons learned from the past 14 years of war and would improve quality of care at military hospitals and clinics by offering incentives for patients with complex cases to be seen at military hospitals, providing needed training for military doctors.

Under the current system, many military providers see a relatively healthy, young population or retirees with chronic conditions related to aging — neither of which provides adequate training for battlefield medicine.

Under the system, according to Chiarelli, "military treatment facilities are in a death spiral. They just don't have the cases they need that provide training."

Committee members expressed concern about the effects of the proposals across the ranks and whether commercial insurers could meet the unique needs of the military population.

Sen. John McCain, R-Ariz., chairman of the armed services committee, thanked commission members for their thorough work and said some aspects of the decades-old military compensation system may not be suitable for today's force.

"We have a nearly 70-year-old military retirement system, and Tricare was implemented in the mid-1990s. Both the retirement system and Tricare were appropriate for their time, but clearly times have changed," McCain said.

Sen. Jack Reed, D-R.I., said the value of the commission's recommendation lies in modernizing the system to preserve the country's all-volunteer force.

"The goal of this commission is not to save money. ... It is to ensure that service members and their families enjoy a quality of life, and a quality of service, that will enable the services to recruit and retain the very best men and women for military service needed to meet national defense objectives," Reed said.

While some lawmakers expressed concerns over the potential cost of a Tricare Choice program, at least one -- Rep. Tulsi Gabbard, D-Hawaii -- wanted to know how quickly it could be enacted if the commission recommendations are approved.

According to Gabbard, her constituents who do not live on Oahu cannot find physicians who take Tricare and fly to Oahu for medical care.

"Opening that up to provide more options is something that is very interesting and necessary in some places where access is an issue," Gabbard said

Buyer told the lawmaker if the Pentagon can wind down the current contracts, it could take :"two to three years."

"I ask because the Tricare contract that has made this change will be up in about a year, so my concern is that we would get locked into something that would continue this," Gabbard said.

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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