As communities gather this Memorial Day to honor those who have served their country, some Connecticut veterans and their families are wondering if the nation will be able to honor its promise to provide a lifetime of low-cost, high-quality health care.

For retired chief petty officer Chad Colter of Norwich, plans to increase premiums for the Tricare health care system are unconscionable. "When I joined the Navy, the pay was so stinking low that one of the incentives for staying in the military was the promise of free medical care for life," said the 22-year veteran. "Now that promise is gone."

Traci Miller of New London is willing to pay more for Tricare because the cost is far below that of private insurance. She's more concerned about having access to physicians in a timely manner. "It's hard to find a doctor that accepts Tricare, especially when you need to see a specialist," said Miller, whose husband retired from the Navy after 20 years.

Colter and Miller are among the 50,992 Connecticut members of the armed forces, active National Guard and Reserve, retired military and their families who use Tricare - the military's main health care program. The program now faces a number of challenges, including possible higher annual premiums in 2012 and a growing list of physicians reluctant to accept Tricare because of inadequate reimbursement rates. In addition, a critical shortage of physicians in Connecticut makes it difficult for Tricare beneficiaries to access medical care, especially in rural areas.

Among the toughest specialists to find in the state are those with expertise in traumatic brain injury and post-traumatic stress - two of the signature injuries of the current wars.

Dr. John Foley, a physician with Cardiologists Associates in Norwich and vice president of the Connecticut State Medical Society (CSMS), thinks the federal government has reneged on its obligations to military personnel, retirees and their families.

"The government made a sacred pact: If you put your life on the line and leave your families to serve our country, then we will provide certain things, including health care," Foley said. "Asking them to pick up more of their health care costs as they leave active duty is wrong."

What Is Tricare?

Operated by the Department of Defense, Tricare provides health care coverage to more than 9.6 million people around the world. The Tricare system offers a variety of health plans, including the popular Tricare Prime and Tricare Standard. Health Net Federal Services has a contract with the federal government to administer Tricare in the North Region, which includes Connecticut. Health Net is one of three contractors across the nation working on behalf of the Department of Defense to administer Tricare.

The Tricare system involves three tiers of health care providers:

• Medical personnel at military treatment facilities, such as the Naval Branch Health Clinic at the U.S. Naval Submarine Base in Groton and the USCGA Medical Clinic at the U.S. Coast Guard Academy in New London.

• Civilian Tricare providers who have signed a contract with Health Net to accept a negotiated rate are known as network providers. Tricare Prime beneficiaries see a primary care manager who will provide care or make a referral to a network provider.

• Civilian Tricare providers who are not part of the Health Net network. Tricare Standard beneficiaries can see network and non-network providers, although their out-of-pocket costs are higher.

Finding civilian physicians and other health care providers to participate in Tricare is difficult not only in Connecticut but also across the country. "Making sure that we have enough doctors in the Tricare network is always a concern," said Austin Camacho, chief of public affairs for TRICARE Management Activity.

Molly Tuttle, director of communications for Health Net Federal Services, acknowledges that getting civilian providers to join its network can be difficult. Health Net has expanded its network of providers from 50,000 to 172,000 since 2004 in the North Region. Connecticut growth figures were unavailable. But recruiting providers in rural areas and specialists in traumatic brain injury and post-traumatic stress has been a challenge.

"It can be tough to incentivize providers to join the program," Tuttle said. "On the other hand, we get health care providers who immediately say, 'Sign me up. I want to help those who are coming back.' Our biggest challenge is ensuring we have plenty of choices for beneficiaries in the civilian network of providers in rural areas."

Health Net builds its network of providers by focusing on large populated areas, said Mark Pecotich, communications manager for Health Net Federal Services. "We establish networks in concentrated areas to best serve the customer at the lowest cost to the government," he said.

But the need to tap Tricare providers in other parts of Connecticut has grown with the active deployment of the National Guard and Reserve in recent years. "Today's reserves are routinely deployed to active duty," said Dr. Michael Deren, a thoracic surgeon in New London and chairman of the CSMS Council.

"These individuals live all over the state and may not have a military treatment facility or a Tricare provider nearby."

Economics vs. civic responsibilities

Concerns about the Tricare network of providers are expected to worsen as physicians in Connecticut debate whether it's economically feasible to see patients in government-subsidized health care programs that do not cover the costs of providing quality care.

"Physicians made a commitment to the military and their families because it's the right thing to do. It's our civic responsibility," Foley said. "But it's becoming increasingly difficult for physicians to meet this commitment. Some physicians may be forced to opt out of Tricare, and that would be terrible for patients."

Seventy-eight percent of doctors who responded to a Connecticut State Medical Society survey said they would limit the number of Tricare/Medicare patients they accept or stop participating in these programs altogether if Congress does not find a permanent solution to the flawed system that reimburses physicians who provide care.

Physician shortages

Compounding the problem is a critical shortage of physicians in Connecticut, leaving patients with limited access to high-quality medical care.

Deren, who has provided care to military families and retirees for 30 years, has seen the number of doctors in the New London area decrease and those willing to care for Tricare patients dwindle.

"There are barely enough providers in the New London/Groton area and even fewer elsewhere throughout the state," he said. His Tricare patients have traveled from all parts of Connecticut and surrounding states because for many years he was the only thoracic surgeon in the area who accepted Tricare, he said.

This story was reported by the Connecticut Health Investigative Team (www.c-hit.org), under an agreement with The Day.