TRICARE and VA Health Care: Impact of the Patient Protection and Affordable Care Act (PPACA)

Sidath Viranga Panangala
Specialist in Veterans Policy

Don J. Jansen
Analyst in Defense Health Care Policy

The 111th Congress passed, and the President signed into law, the Patient Protection and Affordable Care Act (P.L. 111-148; PPACA), as amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152; HCERA), and hereafter referred to as PPACA. In general, PPACA did not make any significant changes to the Department of Defense (DOD) TRICARE program or to the Department of Veterans Affairs (VA) health care system. However, many have sought clarification as to whether certain provisions in PPACA, such as a mandate for most individuals to have health insurance, or extending dependant coverage up to age 26, would apply to TRICARE and VA health care beneficiaries.

To address some of these concerns, Congress has introduced and/or enacted legislation. The TRICARE Affirmation Act (H.R. 4887; P.L. 111-159), signed into law on April 26, 2010, affirms that TRICARE satisfies the minimum acceptable coverage requirement in PPACA. Similarly, P.L. 111-173, signed into law on May 27, 2010, clarifies that the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Spina Bifida Health Care Program, and the Children of Women Vietnam Veterans Health Care Program meet the “minimum essential coverage” requirement under PPACA.

PPACA requires that if a health insurance plan provides for dependent coverage of children, the plan must continue to make such coverage available for an adult child until age 26. This requirement relating to coverage of adult children will take effect for the plan years beginning on or after September 23, 2010. Under PPACA, both married and unmarried children will qualify for this coverage. The authorizing statutes for TRICARE and CHAMPVA currently do not conform to this PPACA requirement. Several measures have been considered by Congress to extend coverage under these programs. The House-passed version of the National Defense Authorization Act (NDAA) for FY2011 bill (H.R. 5136, H.Rept. 111-491) includes a provision (section 702) that would provide for a premium-based extension of dependent coverage under TRICARE and a non-premium-based provision (section 600) that would also extend CHAMPVA coverage until age 26. The Senate Armed Services Committee-reported version of the FY2011 NDAA (S. 3454, S.Rept. 111-201) included a similar provision for TRICARE but not CHAMPVA. Several standalone measures have been introduced to extend CHAMPVA coverage to eligible dependent children up to age 26: H.R. 5185, H.R. 5206, S. 3356, and S. 3801. Stand-alone bills to extend coverage under TRICARE to age 26 include H.R. 4923, H.R. 5185, and S. 3201. There has been no legislative action on these measures.

This report addresses key questions concerning how PPACA affects TRICARE and VA health care.


Date of Report: September 30, 2010
Number of Pages: 12
Order Number: R41198
Price: $29.95

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