By: Samuel Waltzer1
This note examines a gap in military health insurance availability for retired military reservists who have not yet attained age 60 ("gray area reservists") and proposes a solution to fix this problem. The solution essentially entails expanding the current health insurance program for actively drilling military reservists to cover gray area reservists. Actively drilling military reservists are eligible for military health insurance through the military health insurance program, TRICARE. Active duty military members enjoy a form of TRICARE coverage called TRICARE Prime,2 while drilling reservists who are not eligible for federal civilian health insurance are eligible to sign up for TRICARE Reserve Select (TRS).3 TRS, created in 2005,4 provides comprehensive health insurance coverage with a low catastrophic cap, at a highly affordable monthly premium.5 This rate is currently subsidized by the federal government so that reservists only have to pay monthly premiums in the amount of 28% of the value of the coverage,6 whereas with a civilian health insurance plan the reservist would pay the market rate of 100% of the value of the coverage.
The creation of the TRS program with its subsidized monthly premium rate stems from the extensive use of the military Reserve Component following the terrorist attacks of September 11, 2001.7 Members of the military reserves were called to active duty in large numbers for the first time since the Korean War.8 As they were undergoing medical processing, the military kept finding that many of these reservists were not medically fit for overseas deployment.9 A primary reason cited by such reservists for their lack of medical readiness was their lack of health insurance, and a primary reason for lack of health insurance was its high cost.10 In contrast, full time active duty members of the military were provided free TRICARE Prime coverage, and reservists mobilized for a period of active duty service were enrolled for free in TRICARE Prime while they served on active duty.11 The problem gap involved reservists not serving on active duty having no military health insurance option. This spurred Congress to create TRS, which for the first time provided a comprehensive and affordable military health insurance option to reservists who were not currently activated for military service.12
After TRS was created, a gap still existed for reservists who retired prior to reaching age 60. These retired reservists are called "gray area" reservists because, unlike their active duty counterparts who receive full retirement benefits immediately upon retirement, including continued eligibility in TRICARE Prime,13 retired reservists do not receive most full benefits, including TRICARE Prime coverage, until they attain age 60.14 Such a gap is troublesome because many gray area retired reservists are still eligible for recall to active duty in the event of a national military emergency.15 If in the future the military needs to activate large numbers of gray area retired reservists, it may face the same problems involving medical readiness it encountered when mobilizing large numbers of drilling reservists following the September 11th attacks. These medical readiness problems are largely preventable if gray area reservists have access to quality, affordable military health insurance. Additionally, healthy gray area reservists can contribute to military readiness in other ways, such as assisting their local Reserve Component units in logistical, training, and administrative requirements. This assistance would free currently drilling Reserve Component military personnel to focus on their mission essential tasks, rather than focusing on other functions that detract from training time for mission essential tasks.
Congress partially solved this problem when it created the TRICARE Retired Reserve (TRR) program in 2009, which authorizes gray area reservists to buy into TRICARE health insurance coverage.16 The main problem with TRR is that unlike with TRS, gray area retirees must pay 100% of the cost of the coverage in their monthly premiums.17 These monthly premiums are more than five times the premiums of the subsidized TRS premiums.18 Another significant problem is that the annual catastrophic cap is three times higher under TRR than under TRS.19 One possible solution is to simply eliminate TRR and to expand TRS to include gray area retired reservists. This solution has the benefit of simplicity because the TRS program already exists, with the accompanying regulations. In this author’s opinion this benefit is owed to retired reservists, who have spent at least twenty years of their lives ready to respond to national emergencies through service in some combination of the active duty military and military Reserve Component. Throughout the last decade many reservists have responded to mobilization calls, and extensive overseas military deployments continue into the present.20 In light of these facts, TRS eligibility should be considered a benefit owed to gray area retirees. Such eligibility would also have the practical benefit of helping to maintain a higher rate of medical readiness in gray area reservists in case of their needed deployment.
1Candidate for Juris Doctor, May 2012. The author serves in the Army National Guard.
2TRICARE Prime, TRICARE.MIL, http://www.tricare.mil/mybenefit/home/overview/LearnAboutPlansAndCosts/T... (last modified Dec. 1, 2011).
3TRICARE Reserve Select, TRICARE.MIL, http://www.tricare.mil/mybenefit/home/overview/LearnAboutPlansAndCosts/T...? (last modified Nov. 15, 2011).
4Michael J. Jackonis et al, On the Cusp: Insight and Perspectives on Health Reform, 36 J.L. MED & ETHICS 677, 680 (Winter 2008).
5TRICARE: Summary of Beneficiary Costs, TRICARE.MIL, http://tricare.mil/mybenefit/Download/Forms/TRICARE_Summary_of_Beneficia..., at 4-5 (Nov. 2011).
610 U.S.C.A. § 1076d(d)(3) (West 2012).
7Reserve forces have made up as much as 40% of United States military forces in Iraq and Afghanistan. Lloyd de Vries, General: Fewer Reserves In Iraq Soon, CBS NEWS.COM (Feb. 7, 2006), http://www.cbsnews.com/stories/2006/02/07/politics/main1291742.shtml.
8Randy Pullen, The Army Reserve in the Korean War, KOREAN WAR 60TH ANNIVERSARY – HISTORY, http://koreanwar.defense.gov/factsheetarmyreserve.html (last visited Jan. 28, 2012); see also The Army National Guard in the Korean War, KOREAN WAR 60TH ANNIVERSARY – HISTORY, http://koreanwar.defense.gov/factsheetarmynationalguard.html (last visited Jan. 28, 2012).
9Andrew Waldman, Weak Pulse: NGAUS Fought for Years to Have TRICARE Health Coverage Extended to Every Guard Soldier and Airman. Why Are So Few Taking Advantage?, NAT'L GUARD MAG., Feb. 2011, at 30, available at http://www.nationalguardmagazine.com/publication/?i=60008.
10Id. at 29-30.
11TRICARE Prime, TRICARE.MIL, http://www.tricare.mil/mybenefit/home/overview/LearnAboutPlansAndCosts/T... (last modified Dec. 1, 2011).
12Issue Brief: Health Care Survey of DoD Beneficiaries (HCSDB), TRICARE, http://www.tricare.mil/survey/hcsurvey/issue-briefs/issuebriefQ2FY07.pdf (2007).
13TRICARE Prime Regular Army: Retired, MYARMYBENEFITS, http://myarmybenefits.us.army.mil/Home/Benefit_Library/Federal_Benefits_... (last reviewed Apr. 25, 2011).
14TRICARE Prime Army National Guard: Retired, MYARMYBENEFITS, http://myarmybenefits.us.army.mil/Home/Benefit_Library/Federal_Benefits_... (last reviewed Apr. 25, 2011). Both Active Component and Reserve Component retirees receive TRICARE For Life health insurance coverage upon attaining Medicare eligibility, which usually occurs at age 65. TRICARE For Life, TRICARE.MIL, http://www.tricare.mil/mybenefit/home/overview/LearnAboutPlansAndCosts/T... (last modified Nov. 22, 2011).
15Paul C. Taylor & Laura J. Taylor, Evaluating the Cost of an Involuntary Military Separation, 14-FEB J. LEGAL ECON. 1, 10 (Feb. 2007). See also 10 U.S.C.A. § 688(b)(2) (West 2012).
1632 C.F.R. § 199.25(a) (2012).
1732 C.F.R. §199.25(c) (2012).
18TRICARE: Summary of Beneficiary Costs, TRICARE.MIL, http://tricare.mil/mybenefit/Download/Forms/TRICARE_Summary_of_Beneficia..., at 4 (Nov. 2011).
19Id. at 5.
20Although the Iraq War ended when the last US troops exited Iraq on December 18, 2011, roughly 90,000 US troops remain in Afghanistan as of January 28, 2012. Troop Numbers and Contributions, AFGHANISTAN INTERNATIONAL SECURITY ASSISTANCE FORCE, http://www.isaf.nato.int/troop-numbers-and-contributions/united-states/i... (last visited Jan. 28, 2012).