Healthcare Coverage and Disability Evaluation for Reserve Component Personnel

Research for the 11th Quadrennial Review of Military Compensation

by Susan D. Hosek

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Research Questions

  1. What health insurance coverage does the military provide for reserve component members?
  2. What are the potential effects of health reform on participation by reserve component members in TRICARE Reserve Select?
  3. Do disability evaluations result in appropriate treatment for reserve component members?

Because Reserve Component (RC) members have been increasingly used in an operational capacity, among the policy issues being addressed by the 11th Quadrennial Review of Military Compensation (QRMC) is compensation and benefits for the National Guard and Reserve. As part of the review, RAND was asked to analyze healthcare coverage and disability benefits for RC members, including participation in the TRICARE Reserve Select (TRS) program, the potential effects of national health reform on coverage rates, and disability evaluation outcomes for RC members. This report summarizes the results of RAND's analysis. The author finds that 30 percent of RC members lack health insurance to cover care for non–service-related conditions. The TRS program offers the option of purchasing health insurance through the military on terms that are superior to typical employer benefits. Although program participation has increased, it remains low and TRS does not appear to be effectively targeting those most likely to be uninsured. TRS premiums are also lower than the premiums for the new options that will be available under health reform and the same as the penalty for not being insured. So health reform is likely to increase TRS enrollment. Finally, previously deployed RC members are referred to the Disability Evaluation System at a much lower rate than Active Component (AC) members, even for deployment-related conditions, but those who are referred receive dispositions (and thus benefits) similar to those for AC members. These findings suggest that the Department of Defense may want to consider ways to better coordinate TRS with other insurance options that will be available to RC members and that the identification of RC members who experience health consequences from deployment leading to disability merits further investigation.

Key Findings

DoD may want to consider ways to better coordinate TRICARE Reserve Select with other insurance options that will be available to RC members.

  • Nearly one-third of reserve component members lack health insurance.
  • TRICARE Reserve Select enrollment grew rapidly after changes were implemented and included 8 percent of the eligible population in June 2010.
  • TRICARE may become an attractive option for a number of uninsured reserve component members if an individual insurance mandate and associated penalties are implemented in 2014 in accordance with the Patient Protection and Affordable Care Act.
  • Reservists who have been deployed since 2001 are only one-half as likely as active component members to be referred to the Disability Evaluation System for post-traumatic stress disorder (PTSD) even though other research has shown the incidence of PTSD is at least as high in the RC.
  • More study is needed to determine the role of the line-of-duty requirement and other factors behind the major difference in disability evaluation referrals for reserve and active component members.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Healthcare Coverage

  • Chapter Three

    Disability Outcomes for Reserve Component Members

  • Chapter Four

    Conclusion

  • Appendix

    Variable Definitions, Descriptive Statistics, and Detailed Regression Results

The research described in this report was prepared for the Office of the Secretary of Defense (OSD). The research was conducted within the RAND National Defense Research Institute, a federally funded research and development center sponsored by OSD, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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