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Monday, February 7, 2011

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. TRICARE coverage of children was extended to age 26 by the Ike Skelton National Defense Authorization Act for Fiscal Year 2011 (P.L. 111-383).

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 statute for CHAMPVA currently does not conform to this PPACA requirement. Furthermore, although the TRICARE authorizing statute has been amended to provide for coverage of children until age 26, the coverage provided by the new legislation differs from that required by PPACA in some important ways. To address the CHAMPVA situation, the CHAMPVA Children’s Protection Act of 2011 (H.R. 115) has been introduced in the 112
th Congress, although it has seen no action so far.

Date of Report: January 21, 2011
Number of Pages: 12
Order Number: R41198
Price: $29.95

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