STATEMENT OF THE MILITARY COALITION (TMC)
on
IMPLEMENTATION OF TRICARE BENEFITS FOR MEDICARE-ELIGIBLE MILITARY RETIREES
Presented by
CDR Mike Lord, JAGC, USN (Ret.)
Commissioned Officers Association Of the US Public Health Service, Inc.
Co-Chair, TMC Health Care Committee
And
Susan
M. Schwartz, DBA, RN
The Retired Officers Association
Co-Chair, TMC Health Care Committee
MISTER CHAIRMAN AND DISTINGUISHED MEMBERS OF THE SUBCOMMITTEE. On behalf of The Military Coalition, a consortium of nationally-prominent uniformed services and veterans organizations, we are grateful to the Subcommittee for this opportunity to express our views concerning issues affecting the uniformed services community. This testimony provides the collective views of the following military and veterans organizations, which represent approximately 5.5 million current and former members of the seven uniformed services, plus their families and survivors.
. Air Force Association
. Air Force Sergeants Association
. Army Aviation Association of America
. Association of Military Surgeons of the United States
. Association of the United States Army
. Chief Warrant Officer and Warrant Officer Association, U.S. Coast Guard
. Commissioned Officers Association of the U.S. Public Health Service, Inc.
. Enlisted Association of the National Guard of the United States
. Fleet Reserve Association
. Gold Star Wives of America, Inc.
. Jewish War Veterans of the United States of America
. Marine Corps League
. Marine Corps Reserve Officers Association
. Military Chaplains Association of the United States of America
. Military Order of the Purple Heart
. National Guard Association of the United States
. National Military Family Association
. National Order of Battlefield Commissions
. Naval Enlisted Reserve Association
. Naval Reserve Association
. Navy League of the United States
. Non Commissioned Officers Association
. Reserve Officers Association
. The Retired Enlisted Association
. The Retired Officers Association
. The Society of Medical Consultants to the Armed Forces
. United Armed Forces Association
. United States Army Warrant Officers Association
. United States Coast Guard Chief Petty Officers Association
. Veterans of Foreign Wars
. Veterans' Widows International Network
The Military Coalition, Inc., does not receive any grants or contracts from the federal government.
INTRODUCTION
The Military Coalition (TMC) wishes to express its deepest appreciation to this Subcommittee for its extraordinary efforts to honor the lifetime health care commitment to uniformed services beneficiaries, particular those who are Medicare-eligible and have been increasingly locked out of military facilities over the last decade. The health care initiatives in the FY 2001 National Defense Authorization Act (NDAA), identified below, represent the most significant enhancements in benefits in more than half a century, if not ever.
· TRICARE For Life (TFL). This highly innovative initiative restores lifetime TRICARE coverage for all Medicare-eligible uniformed services retirees, their family members and survivors, effective October 1, 2001. TFL, if implemented as intended by Congress, effectively would fulfill the promise of "lifetime" health care made to servicemembers who dedicated their lives to careers in uniform.
· TRICARE Senior Pharmacy Program (TSRx). TSRx expands the Department of Defense pharmacy benefit to all Medicare-eligible uniformed services retirees, family members and survivors, effective April 1, 2001.
· DOD Military Medicare-eligible Retiree Health Care Fund. Effective October 1, 2002, the Health Care Fund will become responsible for funding TRICARE For Life. As a result, health care benefits for Medicare-eligible service beneficiaries will no longer have to compete with other priorities in the Department of Defense's budget.
· $3,000 TRICARE Catastrophic Cap. Reducing the TRICARE family catastrophic cap from $7,500 to $3,000 per year for all uniformed services retirees, effective October 1, 2000, relieves an extraordinary financial burden previously imposed on beneficiaries participating in TRICARE Standard.
The principal beneficiaries of these provisions in the FY 2001 NDAA will be the dedicated servicemembers who fought in World War I, World War II, Korea and Vietnam and brought the Cold War to a successful conclusion. They did not equivocate when called upon to endure the extraordinary hardships and sacrifices of careers in uniform; and join us in applauding your efforts to ensure that the government does not equivocate now in its determination to restore the health care they were promised and earned throughout their careers.
PROVIDE ADEQUATE FUNDING FOR THE DEFENSE HEALTH BUDGET
One of the Coalition's top priorities for FY 2002 is to work with Congress and DoD to ensure adequate funding of the Defense Health Budget: to meet readiness needs, to include full funding of TRICARE, and to provide access to the military health care system for ALL uniformed services beneficiaries, regardless of age, status or location. The Coalition believes that an adequately funded health care benefit is as critical to the retention of qualified uniformed services personnel and to readiness as are pay and other benefits. As the Commandant of the U. S. Marine Corps underscored at the annual TRICARE Conference on Jan. 22, 2001, "Medical care is a key component of military readiness..TRICARE influences the intangibles of military readiness, such as morale, the will to fight and dedication to duty..Our men and women perform their daily tasks better if they are not distracted by worries concerning their families."
The Military Health System (MHS) budget has been chronically under funded, resulting in execution shortfalls, lack of adequate equipment capitalization, failure to invest in infrastructure, and slow reimbursement to Managed Care Support Contractors. Each year, the MHS has had to rely upon Congress to supply emergency supplemental funding.
The stakes are even higher this year. As the Subcommittee is aware, TFL will be funded through a DoD Medicare-eligible Retiree Health Care Fund beginning October 1, 2002. However, because the statutory effective date for TFL is one year earlier - Oct. 1, 2001 - DoD will require an increase in appropriated funds over and above the current FY 2002 defense budget topline if TFL is to reach its full potential, without forcing DoD to absorb its costs "out-of-hide." FY 2002 is the landmark year for TFL and adequately funding the health care budget is the cornerstone for assuring the program is launched successfully. Doing so will eliminate any uncertainty and send a powerful signal to all service beneficiaries that Congress is resolved to make TFL a reality.
In years past, the funding problem was tied to some degree to the lack of a clearly defined benefit. Uncertain of the benefit, it was difficult to identify the level of funding necessary to fully support the Defense Health Program. With the introduction of TFL, the benefit is defined and funding requirements should now be understood.
The Military Coalition strongly recommends this Subcommittee authorize sufficient appropriations to fully fund the Defense Health Program, to include military medical readiness, TRICARE and the DoD peacetime health care mission, and full funding for TFL.
UNFINISHED BUSINESS
The Coalition is pleased to report that, thanks to this Subcommittee's focus on beneficiaries, TMC representatives have been participating in two OSD-sponsored TRICARE For Life (TFL) action groups. The first group is the TFL Steering Level Panel comprised of military association CEOs, the Acting Assistant Secretary of Defense for Health Affairs, members of his staff and members of the TRICARE Management Activity. The Steering Panel will address major policy decisions, consistent with the latitude provided by existing statutes. The second group, the TFL Working Group, has basically the same representation and meets bi-weekly, as a minimum, to discuss the "nuts and bolts" implementation plans and to identify issues that need to be referred to the steering panel. From our vantage point, the Defense Department is resolved to implement TFL consistent with Congressional intent and is working vigorously toward that end.
In the process of developing TFL implementation plans and how TFL will interact with Medicare under various scenarios, the Coalition has determined that there are certain statutory limitations that need revision to promote an equitable benefit for all beneficiaries, regardless of where they reside. The following discussion of the four TFL scenarios, defined by OSD, will help provide perspective on the Coalition's recommendations for making a superior program more equitable and even better.
These four scenarios illustrate how TFL works as second payer to Medicare:
Scenario 1: Procedures covered by both Medicare and TRICARE. In this situation, there would be no Medicare copayments or deductibles (TRICARE would cover these)
Scenario 2: Procedures covered by TRICARE but not Medicare. In these circumstances, the beneficiary will pay the TRICARE deductible ($150 individual/$300 family) and copayments:
(a) Prescription drugs. The most obvious example is prescription drugs under the TRICARE Senior Pharmacy Program (TSRx). This is a significant new benefit for Medicare-eligible military retirees that Medigap policyholders do not receive. TSRx copays are small, especially if the beneficiary uses the National Mail Order Pharmacy (NMOP) and accepts generic drugs. Generic drugs cost $3 for a 90-day supply through the NMOP and $3 for a 30-day supply in DoD's retail network pharmacies. Name brand drugs are only slightly more expensive -- $9 for a 90-day supply through the NMOP or a 30-day supply from a retail network pharmacy. There is no deductible for pharmacy benefits, except in non-network pharmacies. In that case, there is a $150 annual deductible ($300 family), and the copayment is 20 percent of the bill or $9, whichever is greater.
In the unlikely event that out-of pocket expenses for prescription drugs become extraordinary even at this low cost, your work in the FY 2001 NDAA now assures that no TRICARE family will be required to absorb more than $3,000 in out-of-pocket medical/pharmacy expenses in any year. This lowered "catastrophic expense cap" is enormously important to the few who find themselves in dire circumstances, whether they are Medicare-eligible or not.
In addition to the above TSRx options, beneficiaries can still continue to use a military pharmacy at no cost.
The Office of the Secretary of Defense for Health Affairs and the TRICARE Management Activity should be commended for the alacrity with which they developed polices and procedures for implementing TSRx. It's obvious that the TRICARE Management Activity and Office of the Secretary of Defense expended considerable effort in sending two informational packets to all beneficiaries and establishing a TSRx toll free hot line. TMC also believes they should be commended for taking the initiative to develop standardize prescription drug rates, with emphasis on generic drugs, that will provide incentives to beneficiaries to use both prescription drug sources and drugs that are less costly to DoD. The obvious advantage is that money saved in this process could enable DoD to expand its base formulary to the beneficiaries' advantage as well.
(b) Inpatient hospitalization. In cases when the beneficiary's inpatient hospital stay exceeds the 150-day maximum Medicare-allowable hospital stay, TFL becomes first payer once Medicare benefits are exhausted. In this rare circumstance, the beneficiary would be liable for TRICARE copayments and deductibles (not to exceed $3,000 per family per year, regardless of how long the individual is hospitalized). Feedback from The Retired Officers Association (TROA) indicates only 5 out of 150,000 policyholders had hospital stays in excess of 150 days last year.
(c) Care in Skilled Nursing Facilities(SNF). If Skilled Nursing Facility stays exceed the Medicare maximum of 100 consecutive days, TFL becomes first-payer (pays 75% of the maximum allowable charge), with the beneficiary liable for TRICARE copayments and deductibles (capped at $3,000 per family per year, regardless of how long the individual is in a SNF). Based on TROA's records, only 31 out of 150,000 policyholders had SNF stays in excess of 100 days last year.
(d) SNF Care Not Approved by Medicare. In the extremely unlikely event a beneficiary were placed in a SNF without meeting Medicare's requirement for 3 days' hospitalization in order to qualify for SNF care, TRICARE would be first payer. The patient's liability would be limited to TRICARE's catastrophic cap of $3,000 per family per year.
(e) Residents in Foreign Countries. For individuals residing in foreign countries, who are enrolled in Medicare Part B, TRICARE would be first payer and the patient's liability would be $3,000 per family per year for charges that exceed 115% of the CHAMPUS Maximum Allowable Charge. This is an area that still requires more clarification from DoD. In addition, the Coalition believes it would be appropriate to exempt beneficiaries residing in foreign countries from the requirement to enroll in Medicare Part B, since Medicare does not function overseas.
Scenario 3: Procedures covered by Medicare but not TRICARE. The Coalition examined the relationship between Medicare and Tricare carefully and to date have identified only one Medicare-covered service - limited chiropractic care - which is not covered by TRICARE. Others may still be identified, but this appears to be a rare disconnect.
Scenario 4. Procedures not covered by Medicare or TRICARE. In such cases, the beneficiary is responsible for 100% of the cost. The primary example, offered by DoD, is an individual who enters into a "private contract" with a physician, normally a specialist, who does not accept Medicare patients. Under current law, this provider may not bill Medicare for services provided to a Medicare-eligible patient, nor may the beneficiary claim reimbursement from Medicare. The Coalition believes TRICARE should act provide partial payment in these situations, as FEHBP does.
Dental care, eyeglasses and hearing aids also fall in this category, but are outside the scope of TFL since Congress had no intent to modify the list of TRICARE-covered services when it enacted TFL.
The bottom line is that TFL generally provides a better benefit than any existing Medicare supplemental policy -- with no premium and only limited liability for copayments and deductibles. However, The Coalition has identified some potential inconsistencies in TFL that we would like to present for the Subcommittee's consideration. The Coalition believes the proposed changes will promote equity and can be resolved fairly inexpensively with some minor adjustments to the statute.
Legislative Adjustments to TFL
Medicare Part B Penalty. Currently, about six percent of the Medicare-eligible beneficiaries residing in the United States would be subject to a Medicare Part B penalty if they desire to participate in TFL. The penalty, which increases by 10 percent per year, could be particularly onerous for more senior retirees (principally the veterans of World War I and World War II), lower grade retirees and survivors. Under these rules, a 75-year old would have to pay double Part B premiums for life. An 85-year old would incur triple Part B premiums for life. Although we would prefer to see this penalty waived, TMC recognizes that jurisdiction over any aspect of the Medicare program is outside the scope of the Armed Services Committees and obtaining a waiver of the Part B late enrollment penalty could be a difficult hurdle to overcome before TFL is implemented next October. TMC proposes an alternative, under the jurisdiction of the Subcommittee, which parallels the treatment of Medicare Part B for participants in TSRx. Specifically, beneficiaries who are 65 prior to April 1, 2001, are not required to enroll in Medicare Part B to participate in the TSRx program. Those who become 65 after that date must enroll in Part B. TMC believes the same groundrules should be extended to TFL. Beneficiaries who become 65 before April 1, 2001, should be provided the option of declining enrollment in Part B. Under these circumstances, TRICARE would be the primary payer for services normally covered by Medicare Part B and the beneficiaries would be subject to applicable deductibles and copayments for those services. (The individuals in question are entitled to Medicare Part A).
The Military Coalition recommends that individuals who become age 65 prior to April 1, 2001, who would otherwise be subject to a Medicare Part B penalty, should have the option to decline enrollment in Medicare Part B, with TRICARE assuming first-payer responsibilities, as applicable, for such beneficiaries.
Inpatient Hospitalization and Skilled Nursing facility (SNF) Care. Based on the experience of The Retired Officers Association (TROA), regarding hospital stays beyond the Medicare maximum, DoD would save only about $150,000 per year by requiring the beneficiaries to pay the $3,000 TRICARE catastrophic cap, before TRICARE assumes 100% of the cost. [This estimate was derived by extrapolating the experience of TROA (where 5 of 150,000 insured beneficiaries exceeded the150 day Medicare limit in one year) to the entire 1.4 million Medicare-eligible service beneficiary population.] Similarly, DoD would save only about $930,000 per year by requiring beneficiaries to pay the $3,000 catastrophic cap before TRICARE assumes 100% of the cost of SNF care. [This estimate was also derived by extrapolating the TROA experience (31 of 150,000 beneficiaries exceeded the Medicare 100-day limit) to 1.4 million potential TFL participants.] These relatively rare experiences are highlighted by TFL skeptics as examples of how TFL falls short of Standard Medicare Supplemental Plan F coverage. The Coalition believes strongly that extending full TFL coverage, when hospital and SNF stays exceed the Medicare maximums, offers administrative and public relations benefits that far exceed the tiny dollar savings that would be foregone.
The Military Coalition recommends that TFL assume 100% of the costs for service beneficiaries who incur hospital stays that exceed the Medicare maximum (90 days plus 60-day lifetime reserve) and SNF stays that exceed the 100-day Medicare maximum.
Beneficiaries Residing Overseas. Under TFL, approximately 11,000 Medicare-eligible beneficiaries, who reside in foreign countries, are required to participate in Medicare Part B, even though Medicare does not function overseas. This is a particularly onerous burden for elderly retirees who have resided outside of the United States for years and, for obvious reasons, did not enroll in the non-existent Medicare program at 65. For example, an 80-year old retiree overseas would have to pay 250% of the normal Part B premium for the rest of his life to gain TFL coverage even though Medicare would not pay a cent pay for his care. The Coalition believes this situation is highly inequitable.
The Military Coalition recommends that this Subcommittee eliminate the requirement to enroll in Medicare Part B for beneficiaries who reside in foreign countries.
Private contracts. In some areas of the country, particularly rural areas that are medically underserved, beneficiaries are unable to locate providers who accept Medicare for certain specialized services and may have to enter into "private contracts. " There are also instances where a beneficiary may be forced to enter into a private contract because some medical practices have exceeded capacity and are unable to see additional Medicare patients. Under current policy, beneficiaries in these situations are liable for 100% of the costs. Conversely, in these circumstances, individuals enrolled in the Federal Employees Health Benefits Program (FEHBP) do not encounter the same degree of out-of-pocket costs, because FEHBP pays the copayments it would have paid if Medicare were first payer.
The Military Coalition recommends that this Subcommittee authorize TFL to make partial payments for individuals who enter into private contracts with non-Medicare providers, on the same basis that FEHBP does.
Other TFL Considerations
TRICARE Prime Feature of TFL. The Coalition supports DOD's decision to implement only the Medicare supplemental feature of TFL - TRICARE as second payer to Medicare - in the first year of the program rather than to delay TFL pending implementation of the TRICARE Prim option . The Coalition is also pleased to note that OSD is examining several alternatives to provide Medicare-eligible service beneficiaries the opportunity to enroll in TRICARE Prime in a military treatment facility (MTF), a civilian provider network or a combination of the two. According to feedback from the TFL Working Group, the preferred alternatives will be operational by October 1, 2002.
By way of background for new members of this Subcommittee, the Budget Reconciliation Act of 1997 provided for a demonstration to test the concept of Medicare subvention, now called TRICARE Senior Prime. Under this test, Medicare-eligible uniformed services beneficiaries in six demonstration areas (10 sites) were given the opportunity to enroll in DOD's health maintenance organization (HMO) - type plan, similar to TRICARE Prime, with some of the costs of care being reimbursed to DoD by Medicare. Under current law, the program is due to expire on December 31, 2001.
With this expiration date only a few months away, the Coalition was concerned about the status of the 30,000 beneficiaries currently in TRICARE Senior Prime, pending implementation of the TRICARE Prime feature of TFL in October 2002. However, at a recent TFL Steering Panel meeting, we were informed that OSD intends to allow the current TRICARE Senior Prime enrollees to remain in the TRICARE Prime system indefinitely and to allow current TRICARE Prime beneficiaries under age 65 to continue in the Prime program when they become Medicare-eligible. By doing so, DOD is powerfully reinforcing the principle that servicemembers' interests come first.
Claims Processing. The Coalition urges DoD to implement automated TFL claims processing to expedite payment and eliminate beneficiary claim-filing requirements. Since Medicare, not TRICARE, will be adjudicating these claims, TRICARE supplemental payments to Medicare providers should be automatic. Failure of TFL claims processing to meet the expectations of beneficiaries, who are used to the current Medigap system, will result in a lack of confidence on the part of beneficiaries, provide a disincentive for physicians to treat TFL beneficiaries, and cause undue financial hardships on beneficiaries. The Coalition is very concerned that past experiences of beneficiaries and providers with a cumbersome TRICARE claims' processing program will make both beneficiaries and providers skeptical of TFL. Again, giving credit where credit is due, TMC is pleased to report that OSD expressed its intent to automate the TFL claims processing system and to make the process invisible to the beneficiary by deeming most Medicare providers as TRICARE providers. TMC will closely monitor this development. Should problems arise that pose a stumbling block to provider participation, the Coalition may seek the Subcommittee's support to amend the statute to deem Medicare-approved providers as TRICARE-approved providers.
The Coalition plans to remain vigilant in its efforts to identify gaps in coverage between Medicare and TRICARE benefits to make TRICARE for Life the true "wrap around coverage" as intended by Congress. It's extremely important that beneficiaries are confident they will no longer require Medicare supplemental insurance policies and are willing to rely wholly on TFL. Unintentional gaps in coverage, such as those identified above, will result in financial hardships for beneficiaries, undermine confidence in the program and once again fuel the demand for the Federal Employees Health Benefits Program (FEHBP).
FEHBP-65 Demonstration
By way of background for new Subcommittee members, the Coalition wishes to update the Subcommittee about the provision in the FY1999 Defense Authorization Act that directed the Defense Department to allow up to 66,000 Medicare-eligible uniformed service beneficiaries to enroll in the Federal Employees Health Benefit Program (FEHBP-65) at six to ten sites around the country. The FEHBP-65 demonstration was programmed to run from Jan. 1, 2000, through December 31, 2002.
During the first enrollment period, only about 2,500 beneficiaries enrolled, and at the Coalition's request, this Subcommittee supported an effort to expand the demonstration to two additional sites with beneficiary populations of 25,000 or more. During the second open enrollment period last November, enrollments tripled from the year before and more than 7,500 Medicare-eligible service beneficiaries are now enrolled in FEHBP-65. The Coalition believes this is a direct result of DoD's much improved marketing and educational program.
As we anticipated two years ago, participation is considerably less that the 70 percent rate predicted by the Congressional Budget Office (CBO) - in fact, the 6.3% participation rate is several orders of magnitude less. This is a plus in several significant respects.
· More than 120,000 beneficiaries were given the opportunity to switch to FEHBP and thus avail themselves of the same health care plan available to Members of Congress and virtually all federal civilians. Thus, denial of the opportunity to venture to "greener FEHBP" pastures should become a non-issue for that group.
· The cost of the demonstration is only about 11 percent of what was anticipated - a considerable savings.
· Both the Defense Department (DoD) and Office of Personnel Management (OPM) have learned from this experience that thrusting the uninitiated into the different world of FEHBP requires different marketing techniques than are employed for retiring Federal civilians already familiar with FEHBP.
· It would be relatively inexpensive, particularly if TRICARE For Life (TFL) cost offsets are considered, to keep this demonstration functioning at the current sites, until such time as a thorough evaluation of TFL is conducted to determine the degree to which TFL is complying with Congressional intent for all categories of beneficiaries under the scenarios mentioned earlier. Doing so has the added advantage of having a joint DoD-OPM venture available for expansion if Congress determines the option to enroll in FEHBP is preferable to filling in some of the gaps in TFL that TMC believes should be addressed.
Regardless of how successful TFL is - and the Coalition believes it will be highly successful - we believe the current FEHBP-65 demonstration should be extended until Dec. 31, 2003. This would enable current enrollees to plan for a smooth transition to TFL without having to make an irrevocable enrollment decision this fall, while TFL is still getting off the ground.
The Military Coalition recommends that the current FEHBP-65 demonstration be extended to Dec. 31, 2003.
Dual Eligible DoD-VA Beneficiaries
The Coalition was disappointed to learn that the President's budget envisions seeking legislation to force DoD beneficiaries, who are also eligible for Veterans Administration (VA) medical care, to enroll with only one of these agencies as their sole source of health care. It is the Coalition's view that this policy change will be viewed as a serious breach of faith.
The VA health system delivers specialized care and services for members with significant disabilities (e.g., prosthetics and treatment of spinal injuries) that are difficult if not impossible to duplicate in military facilities. But their needs for such specialized care for service-connected disabilities should not be turned to their disadvantage - either to compel them to get all their care from the VA, or to deny them specialized VA care if they choose routine care for themselves and their families through TRICARE.
We acknowledge that a critical, but not insurmountable, challenge for Congress, DoD, and VA will be to implement a suitable policy framework under which these beneficiaries will be able to access the health care they have earned. Retired veterans with VA-rated disabilities (68 percent of enrolled retired veterans are in Priority Groups 1-3), or with other factors codified in law (Priority Groups 3-6), are entitled to VA health care and, as a matter of principle, should not be required to choose between VA health care and TFL. These service-connected disabled veterans have earned the right to military health care in return for their careers of service in uniform. They also have earned access to specialized VA care for the (often severe) disabilities that their service has imposed on them.
On the other hand, Priority 7 enrolled retirees - those with no service-connected disabilities or non-compensated service-connected disabilities who meet the "means test" - who choose to use VA health care facilities are subject to an annual means test and are required to make copayments under law. It would not be unreasonable to require these nondisabled retired veterans to make an election between the VA health care system and TFL.
The Coalition strongly recommends that the Subcommittee work with its counterparts on the Veterans Affairs Committee to ensure that disabled military retirees eligible for VA care under Priority Categories 1-6, should not be forced to make an election between VA and DoD health care.
CONCLUSION
The Military Coalition would like to reiterate its profound gratitude for the extraordinary work this Subcommittee has done to provide health care equity for all uniformed services beneficiaries, particularly those who are Medicare-eligible. The Subcommittee's efforts to authorize the implementation of TFL and TSRx are giant steps toward honoring the lifetime health care commitment. And, as the Coalition discussed earlier in its testimony, with a few minor refinements TFL will provide a comprehensive and equitable health care benefit for all Medicare-eligible beneficiaries.
Mr. Chairman and Distinguished Members of the Subcommittee, in closing, we wish to express our deepest appreciation to you for the opportunity to present the Coalition's views on these critically important topics.
2120 Rayburn House Office Building
Washington, D.C. 20515
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