Top NCOs Get at the Table During TRICARE Conference

Senior enlisted leaders were among more than 3,000 attendees at the 2003 National TRICARE Conference, which was held at Washington's Marriott Wardman Park Hotel.

Emphasizing the importance of enlisted input in TRICARE decision-making, Sgt. Maj. Harry L. Robinson said, "We brought key issues from an enlisted perspective to the table. That's the way we should be doing business."

As the senior enlisted adviser to Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs and director of the TRICARE Management Activity, Robinson serves as a resource, liaison and advocate for enlisted members of the armed forces and their families. He represents their interests to the senior leadership of the military health system.

Robinson said some of the things that went wrong with TRICARE early on happened "because there wasn't any NCO perspective at the table." He praised TRICARE officials for "reaching out and bringing a senior enlisted adviser in and putting senior enlisted advisers in key positions within the organization in the lead agencies.

"Then they were able to get the perspective from the field through the sergeants major, chief master sergeants, master chief petty officers and master gunnery sergeants," said Robinson, who holds a bachelor's degree in occupational education with a specialization in health care administration and a master's degree in educational leadership. "The senior NCOs provided information to key people in the senior leadership within TRICARE that was used to fix a lot of those bumps."

Robinson's goal is to ensure that beneficiaries know what their TRICARE benefits are, with particular emphasis on reserve component personnel. "We haven't been there for them in some aspects of what we're doing," said the former artillery canon crewman and graduate of the Army's combat medic and practical nurse courses at Fort Sam Houston, Texas. "We want to ensure we're meeting and interacting with reservists and guardsmen and letting them help us make decisions that effects them."

TRICARE is streamlining, slicing the number of regions from 11 down to three and improving business practices. When that happens, Robinson said, he wants to ensure each region has senior enlisted advisers.

"There was some early discussion saying this is going to be a managed care piece just contractual things happening, therefore, we don't need to have an NCO," Robinson noted. But he said after discussions with the services' surgeons general, health affairs and other officials, "it appears we're going to have a senior enlisted advisor in those offices."

Calling health care an episodic event, he said many people don't check on their benefits until "'Oh, my foot hurts.' 'Oh, I have abdominal pain.' 'Oh, I have a headache.'"

Then there's the problem of a shortage of doctors in rural areas. Some doctors in those areas don't participate in TRICARE while others don't understand the program, Robinson said. "Medicare and Medicaid are experiencing some of the same things in some rural areas," he noted.

"Many family members were accustomed to getting care at military treatment facilities when their spouse was on active duty," the sergeant major pointed out. "But since the reduction in forces, some of the things we were doing in the direct care system are being farmed out. So they may have to seek a provider downtown.

"From a TRICARE perspective, we're trying to educate NCOs and enlisted folks who make up the bulk of the forces," he said. "The NCOs are the ones who are out doing training, educating, working and focusing on quality of life issues."

One of his breakout sessions was a panel discussion featuring the top NCOs of each service, including the Coast Guard, and the DoD Reserve Affairs senior enlisted adviser, Command Sgt. Maj. John Leonard Jr.

Master Chief Petty Officer of the Navy Terry D. Scott told the gathering that the military leadership has to care enough for the enlisted personnel to ensure they have the tools, training, challenge and the confidence to do whatever the nation asks them to do.

"If they're focused on problems at home -- inadequate medical care, substandard housing and the inability to make payments on their bills -- they're not going to be focused on the job," Scott said.

"Our families need to know that they're just as valuable to our overall combat capability as anyone," he emphasized. "Without their support, our sailors won't able to give it their heart."

However, Scott pointed out that TRICARE isn't the problem it used to be. "TRICARE questions used to dominate meetings with sailors and their families, but now, I rarely have a questions on TRICARE," he said. "It's not a question of receiving quality health care; it's the frustration of getting into the system and moving about in the system."

Emphasizing that quality of life tops his list of issues to concentrate on, Sgt. Maj. of the Marine Corps Alford L. McMichael said, "One of the most important things they (Marines) expect to have is good health care benefits. I'm not here to tell you that TRICARE is perfect, but there have been monumental improvements in what it has done."

He said his goal is to continue educating men and women in uniform about their health care benefits. "It really doesn't matter whether they wear a Marine uniform as long as they're representing the flag of the United States of America," he said. "I want them all to know what benefits they have in our health care system. Whether they're reservists, National Guardsmen, Individual Ready Reserve, or active duty it doesn't matter."

Chief Master Sgt. of the Air Force Gerald R. Murray told the audience that good health care is essential for readiness. "The Air Forces takes pride in taking care of our people, but more importantly, taking care of families and our retirees," he noted.

Noting improvements in TRICARE over the years, Murray retirees used to have to wait all day and sometimes had to return the next day for space-available entry into the "guaranteed medical system."

"The greatest thing we can do is to continue helping our members understand their benefits," Murray said.

Master Chief Petty Officer Richard Brown, who represented Master Chief Petty Officer of the Coast Guard Frank A. Welch, said TRICARE has made tremendous improvements over the years for his people. "TRICARE used to be the No. 1 people problem, now it's No. 14 or 15 on the master chief of the Coast Guard list of concerns," Brown noted.

Confusion often arises when Coast Guardsmen seek medical care, he said. "Some people are confused about our status, saying unless you're a part of the Navy during a time of war you're not armed services," Brown said. "We're an armed service, and I ask you to include that in your indocumentation package for all your new people coming on board. Make sure that they understand that we're a part of the armed services.

A few problems remain for members of the reserve components, but Command Sgt. Maj. John Leonard Jr. told the gathering TRICARE isn't a major item for him anymore.

But he pointed out that more than 75,000 of the 1.3 million reserve component personnel have been called to active duty, and a possible total of 250,000 will be activated if the country goes to war against Iraq.

"This will put an added responsibility on TRICARE," Leonard noted.

"When we used to do town hall meetings, that's was the touchiest subject," Leonard said. "Now it's just a few things that are brought up. The reserve components are more like the Coast Guard. We're stationed away from major bases for the most part, which means we don't have military facilities to go to for our medical care.

"On top of that, we're not eligible for TRICARE Prime Remote," Leonard said. The remote program was designed for active duty service members who live and work away from military installations and for their eligible family members who reside with them.

He said another problem occurs when reservists and guardsmen are activated. They sometimes have a problem with the Defense Enrollment Eligibility Reporting System, or DEERS, the computerized database that verifies eligibility for TRICARE benefits.

"When people go to mobilization stations they enter themselves and their families in DEERS and sometimes that information slips out," Leonard said.

"We've had soldiers who had to wait three or four weeks for medical care because they were told that they have to re- enter DEERS in Europe -- not correct," he noted. "But I haven't met anyone who wants to refuse medical care. They just don't understand the procedures."

In a brief statement, Sgt. Maj. of the Army Jack Tilley said, "Everything isn't perfect, but we need to continue to focus on medical care TRICARE and don't forget we're at war. And there are a lot more issues that are going to pop up with medical care."