Military Update: Romney plan could hike costs

Republican presidential nominee Mitt Romney has proposed opening military TRICARE networks of civilian health care providers to veterans who can't get timely mental health care from the Department of Veterans Affairs.

TRICARE networks currently exist to provide health care to military personnel and retirees, their families and survivors.

Two days after Romney's pledge, President Obama signed an executive order with several new initiatives to improve access to mental health care services for veterans, service members and their families.

One directs VA and the Department of Health and Human Services to establish at least 15 pilot programs involving community-based health providers to expand mental health services in areas not well served by VA. Another establishes an interagency task force on military and veterans' mental health co-chaired by VA, DoD and HHS.

Not mentioned is an initiative to allow VA to refer veterans in need of immediate mental health care to TRICARE network.

But Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, said the Romney idea has real merit. The former Massachusetts governor unveiled it in a speech last month to the American Legion conference in Indianapolis.

Miller suggested Romney's notion is a reasonable step on a path Miller wants to travel — giving veterans more access to private sector health care, at VA expense, rather than forcing them to commute long distances to a VA facility or to endure long delays to get a VA appointment.

Romney's idea, Miller said, would swiftly address VA's shortage of mental health care providers — to treat post-traumatic stress and traumatic brain injury and the epidemic of suicides among veterans — by immediately doubling the number of available mental health care providers.

VA in April announced plans to hire 1,600 more mental health care providers and 300 support staff. But Miller is skeptical that VA can do so in a timely way, given that it already had 1,500 vacancies for mental health providers when it announced the new hiring effort.

"If you can't fill those 1,500," Miller said, "it's hard to imagine that VA would be able to double that number and be able to hire them any quicker. Their hiring process is more than cumbersome. It takes a tremendous amount of time ... and in many cases, (applicants) are being lost to the private sector because they just can't wait for VA to make a decision."

VA already has authority to refer patients to civilian providers when they can't get timely care inside the VA. But it has used this authority sparingly to hold down costs.

Some veterans' service organizations worry that forcing VA to spend a larger share of its budget on care delivered by private sector physicians will drive up costs and, over time, leave VA without enough operating dollars or patients to sustain a full service, high quality health system.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:

[email protected]