ONE-HUNDRED PERCENT DISABLED CARE CONCERNS

Mr. MURTHA. Has anyone been notified of the change about the disabled we put into the Committee legislation and that the President signed last year?

Mrs. CHESCAVAGE. No. No one has been notified. I would like to make the point, if Andy Cox had been a mailman or a GS-4 clerk in the Department of Defense, he would not have lost his health care plan when he became disabled, and he would not lose it when he becomes 65 years old. Military people are the only Federal employees who lose their health care plan if they become disabled or turn 65.

CHAMPUS REFORM INITIATIVE

Mr. MURTHA. This has been one of the most frustrating experiences I have ever been involved in, trying to get the DOD to take care of people. I could not believe what this Committee has gone through with the unanimous support of this Committee time after time. We put more people in the budget, and they try to reprogram them out. They figure every way they can to change what we have suggested, and here we have a program which we think has improved health care substantially in a catchment area which is a microcosm of the entire United States. What do you have, 175,000 people enrolled now?

Mr. TOUGH. One hundred sixty-five thousand.

Mr. MURTHA. It works. People make one contact and they are sent on their way to the right place. It is impossible for me to believe what folks like Mrs. Cox have had to go through while the rest of the people are taken care of. I can't believe that the Defense Department is so insensitive. I know when I went down to Norfolk I was stunned by the insensitivity of some of the higher officials down there who paid no attention to the problem. People come to me and say that in the Washington, D.C. area, where we have the premier hospitals in the entire nation, you can't get access to them unless you fake a heart attack. That is absurd. I hope that we will convince the Defense Department that this project in California and Hawaii is a worthwhile project.

It is a model for national health care insurance. It has kept costs down, in addition to the fact that it has given service where 95 percent of the people are satisfied. So I just want to thank all of you for coming before the Committee.

We are going to pursue your problem, Mrs. Cox, and do everything we can to help. We thought we had taken care of the problem. Nobody has been more diligent in trying to help, not only you, but other people in the same category as Bill Young. We appreciate the help we have gotten from all of you.

The other thing that is depressing and disturbing is that we get all these comments from Associations that represent people and the Defense Department seems to ignore it. I can't believe what we go through, when people are satisfied with their health care. That is not something that just happens.

We argue with them all the time. We meet with them continually. Hopefully we can do what we suggested in the legislation, that we continue this initiative and in the rest of the country they try

their other programs, and if they work, fine, let them compete. But to disrupt the lives of 165,000 people is absurd. No question you can save more money; you just reduce the services. But when you have a record of only a two percent increase while the rest of the country has been at 16 or 17 percent, you have to say there is something right about the program, and admitting we had a lot of problems when we started out.

It would be the same thing with any new program. Mrs. Cox's problem is absolutely unacceptable, that is all there is to it. I would hope that this afternoon we talk to Dr. Mendez, the people that are in this category will finally be notified and we will be able to get them to address the situation as we have suggested here in the Congress.

Mr. McDade?

REMARKS OF MR. MC DADE

Mr. McDADE. Mr. Chairman, thank you. Before I say anything, Mrs. Cox, I want you to know that from my perspective as a Member who heard of this matter through the efforts of Congressman Young, I want to extend on behalf of the people of Pennsylvania whom I am privileged to represent an apology to you and your husband for the obscene treatment that you have received. Just as we thought we have remedied the problem, we will stay with it until we get the problem resolved. Nothing will ever compensate you and your husband for your travail, but at least we can try to balance the scale of justice and get to a point where your life will be reasonably normal.

Thank you for taking time from a difficult circumstance to enlighten the Committee about the circumstances you have faced and which may benefit other Americans who hear the problems you have faced.

I want to say to the panel, too, the Committee started out with the premise that we didn't need a lot of convincing on the efficacy of the program we had authorized and were fighting to see carried out and which is subsequently about to be overruled by somebody in the decisionmaking process within the DOD.

If we were to vote this second, you could be sure that we would vote to continue directing the Department to continue in the states that we have instituted the model program, that it be continued. I can't imagine any comparable program that shows a decline in the cost of delivery in the service and an increase in the effectiveness of that delivery. That is a win-win situation, and why we have to try to find a reason to tamper with it, I don't know.

It reflects perhaps a model for the country on the national program and indeed for the veterans population throughout the country. Everybody also has to reinvent the wheel. Sometimes the wheel proves to be a good instrument that works. Thank you for taking the time. It is very important that you be here, because this is a tough town to get attention, to have people understand the kinds of problems that our veterans population face.

Your being here will reinforce that effort and help us see that the people who serve their country well are taken care of. Mr. MURTHA. Mr. Sabo?

CHAMPUS REFORM INITIATIVE

Mr. SABO. I am sorry I missed most of the testimony. I understand most folks who testified indicated that they like the CHAMPUS Reform Initiative.

Mr. MURTHA. What we have here is a panel made up mainly of people who use the program and, of course, the contractor who has operated the program. If you remember over four or five years the program has developed and now we have 165,000 people in Hawaii and California using it—and 95 percent satisfaction rate. The RAND Corporation gives it high marks with their independent study and they have only had a 2 percent increase in costs while the rest of the country had a 16 percent, meaning the rest of the military establishment.

Mr. SABO. They are trying to change it?

Mr. MURTHA. Not only trying to change it; they put an RFP out that makes it impossible for them to continue to operate with a program that takes care of people.

Mr. SABO. If I understand, we have an experiment that beneficiaries like better and it is costing us less?

Mr. MURTHA. That is exactly it, costs us and the government less. So the Defense Department can't figure that out, so they are going to change it and mess it up.

Mr. SABO. Thank you.

Mr. MURTHA. Mr. Young?

CHAMPUS PROGRAM

Mr. YOUNG. Mr. Chairman, I want to also thank all the panelists for being here to help us point out some problem areas in the Department of Defense medical program. I want to qualify that by saying that the DOD of the United States is probably the best in the world. There are some bureaucratic problems that develop and we are facing one now.

Any criticism that I might present to the CHAMPUS program is certainly no reflection on the fact that the United States Department of Defense and its predecessors have kept this a free nation for well over 200 years, and I have to applaud them for that.

I remind the Chairman that during the height of operation Desert Storm, some of the doctors in Florida who were dealing with CHAMPUS patients offered to allow the family members of active duty soldier's who were in Operation Desert Storm to waive payment of the doctors' 20 percent copayment. And they were notified by CHAMPUS that if they continued that practice, that they were going to be thrown out of the program, that they could no longer participate in CHAMPUS.

We called that to the attention of this Committee, and it was not long before the Department recognized they had made a great error and they reversed the decision, and the doctors in Florida were permitted to go ahead and not charge the dependents of the soldiers fighting in Operation Desert Storm, so there are some bureaucratic problems which we have solved.

You heard the Chairman's and Mr. McDade's commitments that we are going to continue our efforts to make sure that this does not happen. I think the consideration of the CRI program is extremely important to us.

Mr. Tough, I recognize that you can't change the CHAMPUS laws; only the Congress can do that. Had the CRI program been in Florida like it has been in California and Hawaii, how would you have approached Terry and Andy Cox and their problem?

Mr. TOUGH. Recognize I am not totally familiar with the Cox situation, so I can't speak fully grounded on all the circumstances. In the normal course of the CHAMPUS Reform Initiative program in California, we have a program designed to accommodate the medically fragile. We have a case management program where we assign individuals in a situation where they are extremely ill or where they have an ongoing condition to a nurse who is the coordinator of that individual's case.

The point is to interact where they enter the institution, hospitalization or general care. Since we see all the claims information going through the system, we can identify individuals who fall in that category. Once that assignment occurs, we then work with that patient and his or her needs, trying to move them from the institutional critical care environment to the intermediate, to the lower levels, eventually to the home environment, to try to accommodate their needs, even to the extent where some of our nursing personnel have coordinated with community services not linked to CHAMPUS, trying to link them to other agencies in town.

Mr. YOUNG. Would it be accurate to say that the Terry Cox/ Andy Cox situation, at least under CRI, would not have fallen through the cracks and been basically ignored until such time as the Congress of the United States learned about it and got into the act?

Mr. TOUGH. From a speculation standpoint, I think we would have picked it up and begun to manage the case and informed the individual where they sat with respect to benefits and various alternatives on the course of treatment they were on.

Mr. YOUNG. My question has two purposes, one to assure us that Terry's problem wouldn't have been as severe, but also to get you on the record as to your intent, so when CRI becomes a fact in more places than it is, we are going to hold you to that.

Thank you, Mr. Chairman.

COX LEGAL PROBLEMS

Mr. MURTHA. We ordered the Defense Department, because of their own mistakes, to forgive $79 million in pay that people would receive during Operation Desert Storm. On April 20, DOD is taking the Coxes to court and trying to recover $200,000, is that right? Mrs. Cox. That is right.

Mr. MURTHA. The lawyers' fees will cost more. I cannot imagine our Defense Department, which we think so much of, is going to take a family who is bankrupt to court for $200,000. That is absolutely outrageous. The court costs will cost more than the $200,000. That is not something that should happen, and you know, you don't like to interfere in judicial processes, but I can't imagine the United States Government being involved in something like that. Mr. Miller?

59-855 O 92-9

RESERVE CALLUP DURING OPERATION DESERT STORM

Mr. MILLER. Thank you, Mr. Chairman. Colonel Johnson, in your statement you have told about the problems, but one particular remark that I see, says that, during Operation Desert Shield, medical units from all of the services were deployed to the Persian Gulf area, leaving many military installations with limited health care providers to attend the family member still resident on and around these installations.

We understand, at least I understand, and with talking to the people who are involved in this, that they were taking care of the residents at home. They were bringing in the Reserves, and were giving service to the people at home. Could you elaborate a little on this and tell us a little more about that?

As the Chairman stated, we will be having the military in this afternoon, and I would like to have something more than just that one statement in order to discuss this with the people who are providing and essentially have the responsibility for providing health

care.

Colonel JOHNSON. I will be happy to. You are absolutely correct that there was a call-up of Reserves, but you will also recall that the call-up was not right away. There was a delay, and so the rapid rate of deployment did leave Military Treatment Facilities understaffed.

When we talked to the contractor, CRI contractor, he brought this up and mentioned the fact that they were able to backfill, and do it very, very promptly. So that is why I included it in my statement.

Mr. MILLER. At Bethesda Naval Hospital, they had empty beds, and they had staff available. Of course we see that; that is close to Washington. But you were seeing it from a different point.

Colonel JOHNSON. At the installation level, sir.

Mr. MILLER. Are we saying that one-half of the family members did not receive treatment?

Colonel JOHNSON. No, I didn't say that, sir.

Mr. MILLER. How deep is the problem?

Colonel JOHNSON. I don't know how deep. We know that it happened and that they were understaffed. We got calls, from Fort Bragg and Fort Campbell. They were concerned.

Mr. MURTHA. If the gentleman would yield-one of the things we did was to insist that the Defense Department call up the Reserve doctors to replace the ones that were sent overseas early on, because we knew the people would just go on CHAMPUS.

Secretary Atwood agreed to this, so this helped alleviate the problem substantially, but there was some time when people were deployed initially-I am sure Fort Bragg was one of the places-we pressed the issue to call up the Reserves. That is what the Reserves are for, to replace the people on active duty.

Mr. MILLER. Thank you, Mr. Chairman.

Mr. MURTHA. Mr. Livingston?

CHAMPUS REFORM INITIATIVE IN NEW ORLEANS

Mr. LIVINGSTON. Thank you, Mr. Chairman. I want to thank you for your help in bringing us to this point to provide alternative