HEALTH CARE REFORM UPDATE: National health care reform — officially known as the Patient Protection and Affordable Care Act (ACA) — is the most ambitious piece of health care legislation since the establishment of Medicare and Medicaid in 1965. Passed in 2010, we’re only eight months away from many of the law’s major provisions coming online. The legislation aims to expand access to health care coverage to uninsured Americans through:

· An individual mandate requiring adults to have health insurance or pay a fine;

· An employer mandate requiring firms with 50 or more employees to offer coverage or pay a fine;

· A requirement that each state establish a health insurance exchange or accept a federally established exchange in which individuals and small businesses can buy coverage; and

· An expansion of Medicaid eligibility to cover greater numbers of lower-income people.

Another major goal of the ACA is to implement new health delivery reforms that would bend the health care cost curve down and reduce costs over time. Supporters believe realigning the delivery system to drive out inefficiencies in the health care system will reduce costs and improve quality of care. The five areas for system reform included in the law are

1) Payment reform

2) Primary and preventive care

3) Measuring and reporting quality

4) Administrative simplification

5) Health information technology

But how will these changes affect military and VA beneficiaries? By law, TRICARE (including TRICARE For Life) beneficiaries and veterans enrolled in the VA health care system are exempt from the direct impacts of the ACA. TRICARE and VA health care meet the minimum essential health care coverage requirements, and in general the ACA does not affect the administration, health care benefits, eligibility, or cost to beneficiaries of these two systems. However, the sweeping changes made by ACA could still impact TRICARE and VA beneficiaries in the future. Roughly 32 million uninsured Americans are expected to become insured as a result of the ACA. How will this influx of covered individuals impact access to health care? Especially in the absence of a permanent fix to the annual Medicare/TRICARE physician reimbursement rate cut — now estimated to be at 30 percent — which was critically left out of the ACA. Reforming an industry that accounts for more than 17 percent of our nation’s economy is bound to have unforeseen consequences. [Source: MOAA Leg Up 17 May 2013]

COMMISSION ON AMERICA AND ITS VETERANS: There are a number of ways for policy makers to sensibly address the glaring needs of post–September 11 veterans, who are suffering from a true crisis of posttraumatic stress disorder, unemployment and suicide. Congress can increase funding for the Department of

Veterans Affairs, extending job training and unemployment insurance that veterans’ receive, increasing tuition support, and so on. But there are deeper problems that are much more difficult to solve—the damaged mentality, perhaps, of a country that is essentially indifferent to the traumas of the thousands of citizens sent to fight and die over the past decade. To that end, Representatives Jim McDermott and Walter Jones have introduced H.R.1492 that would create one of the more fascinating Congressional commissions in recent history: the Commission on America and Its Veterans (CAV) .

They describe it as an effort to “heal the psychic wounds of war”—a kind of truth-and-reconciliation effort to bridge the gap between a battered combat force and the now-indifferent citizenry that ordered them to fight. “The United States has waged wars, but not all are involved in fighting those wars, and the United States needs to be more deeply and regularly connected with members and their experiences in war and returning from war,” the preamble to H.R.1492 reads. “The nation needs a whole-of-society approach to improving the veteran’s position in society.”

McDermott and Jones gathered in a small room on Capitol Hill last week to announce their proposal, to a small crowd that contained relatively few reporters—except the ones at the podium. Sebastian Junger, the documentarian behind Restrepo, which told the story of a platoon serving in Afghanistan, was on hand, along with Karl Marlantes, a Vietnam veteran who wrote the book What It Is Like to Go to War. Junger and Marlantes have been working with McDermott to help formulate the commission, and tried to describe what the group envisions during last week’s press conference.

“We’re going to try to change the consciousness of this country. It’s not about dollars, it’s not about whether the war was right or wrong, it’s about: does this nation actually share the burden of the killing?” Marlantes said. “The whole nation builds the rifle—pays the taxes, puts it together, and decides through its representative body how that rifle will be used. The veteran is the person who pulls the trigger,” he said. “But what happens is that when the veteran comes home, it’s like the veteran was the only one that did the killing. We’ve got to change that attitude.

They wonder why veterans feel alienated. If there’s an unconscious feeling on the part of the country that, ‘Well, you did it’—that’s going to go a long way to making that veteran’s healing way more difficult.” The commission would have a few general goals:

· First, it would hold meetings across the country to kick off a dialogue between post–September 11 veterans and their communities, where the vets would tell their stories and try to share their burden.

· It would also push for a national day of remembrance when the war in Afghanistan finally ends, for veterans of both that conflict and the war in Iraq. “We cannot end twelve years of war without marking it. It’s sort of like, well, is it business as usual to go to war?” Marlantes said. “No, it should not be business as usual. So when we’re done with it, we need to have a solemn way of marking it.”

· There would be eighteen members of the commission, appointed by leaders of both parties from the House and Senate.

The legislation says the members cannot be employees of the federal government—and Junger wants to think outside the box. “We think there should be a psychologist on the commission. There should be maybe a poet. Poets know how to turn life into words so that everyone can understand,” he said last week. “Maybe there should be an anthropologist. I mean, imagine, a formal cross-cultural study about how cultures throughout the world have dealt with combat trauma.” He also recommended that members of the clergy be part of the commission, including a Sioux shaman he knows. “We’re trying to be both effective and creative at the same time,” Junger said. “When people go to war, that means that you are going to kill other people. And right or wrong, it causes an enormous moral burden on anybody—on everybody. The community shares that burden in an organic culture. In this culture, it doesn’t.” Throughout the press conference last week, all parties involved stressed that it would be a nonpartisan commission that wouldn’t focus on whether the post–September 11 wars have been wrong or right.

That’s a stark contrast to what, for example, former Representative Dennis Kucinich repeatedly proposed : a truth-and-reconciliation effort of a different sort, wherein the political process that led to needless combat was thoroughly interrogated, and the political leaders behind it punished. But Junger—who opposed the Iraq War—stressed that he believed that for this particular effort to succeed in truly integrating recent veterans into society, it had to step outside politics. He related the story of a recent veteran he knew that was struggling with having accidentally killed innocent civilians during combat. The soldier told Junger he would try to work through his burden with friends, but that left-wing friends would respond with disgust: “You killed civilians, that’s on you.”

Right-wing friends would tell him to brush it off: “You did your job, you did your duty, thank you.” The soldier, according to Junger, was deeply frustrated by both responses. “Why won’t anyone have an adult conversation with me about what war is about? It’s their war,” he told Junger. “They asked us to fight it, and we did it as well as we could. Why are they pretending it’s our war? We were just there.” [Source: The Nation | George Zornick | 14 May 2013]