CAUSEY: Tailoring is unlikely on health premiums

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There are at least three groups within the federal family that would like to see major “improvements” in the Federal Employees Health Benefits Program (FEHBP).

• Young, healthy workers don’t think they should have to pay the same premiums as older, less healthy workers and retirees.

They want group rate premiums but tailored benefits, and they want to be only in the group that will keep their premiums down. And they want the ability to move into a healthier risk pool even as they age and get sicker.

Typically, the over-55 crowd uses more health services (and drugs) compared with younger workers. Premiums in each plan, however, are same whether the couple are young, healthy and do endurance events on a regular basis, or whether both are bedridden in their 90s.

According to the Washington Consumers Checkbook, a married couple (no children) with an “average” medical year in 2010 will spend about $2,800 in premiums and to pay for out-of-pocket services. But if that couple are over 55, their likely costs for an “average” year will be $5,600 but could easily be double that amount if they are older.

So why, the younger feds ask, should they pay the same premiums as the so-called heavy users?

• Older workers and retirees make the same argument, but in reverse.

Most are out of the childbearing business, if they were ever in it. So why, they ask, should they pay for people who chose to have lots of children? Children, as we all know, often get sicker more often than adults. And they have the nasty habit of incurring injuries that require medical services and trips to the emergency room. Whose fault, they say, is that?

• DINKS (double-income, no kids) feds resent the fact that they can’t get a policy covering two people. Why, they ask, should the family premium in each health plan be the same whether the family is two people or 19 people?

The couple think their premiums would be a lot lower if they didn’t have to subsidize the equivalent of the little old woman who lived in a shoe — people with lots of children.

All of the above are correct, up to a point. But the point they miss is that they are in a group plan, as in everybody from the newest newborn to the oldest retired civil servant in the country.

That group, nearly 9 million people, from astronauts to postal clerks and members of Congress, comes in all shapes, sizes, ages and with varying degrees of wellness — or chronic illness caused by environmental conditions, occupation, genes and personal lifestyle choices.

Nobody in the federal family can be turned down, by any plan, for any reason, not because of age, health, habits, family history or occupation. People cannot be excluded or charged more because they may be obese, have risky lifestyles and dangerous hobbies or because of any pre-existing condition.

What feds are stuck with — in what is arguably the best health plan in the nation — is a group plan with a very large group.

Experts on the program, ranging from union staffers to officials who helped run the FEHBP, agree that the group plan is the worst idea around, except for all of the others.

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