- The Washington Times - Tuesday, February 7, 2006

The average age of enrollees in Uncle Sam’s in-house health insurance program is 59 — to which most normal people would respond: “So what?”

Well, if you are one of the 9 million people in the Federal Employees Health Benefits Program (FEHBP), especially if you pay its premiums, it could end up being a very big deal.

For years, federal officials have watched the migration patterns among the FEHBP options for signs that one is getting top-heavy with costly seniors.

That is called “adverse selection.” If too many so-called heavy users move into a health plan, or the number of people paying premiums in that plan is too small, it can be reflected in premium increases.

Over the years, several health plans have bitten the dust. These include one limited to congressional employees — a favorite of Vice President Al Gore’s — and plans sponsored by unions or associations. Most either had costs that were too high and/or too few participants to stay in business.

Last month, the Office of Personnel Management pulled the plug on the Postmasters Benefit Plan for a number of reasons. Enrollees were moved into the Blue Cross and Blue Shield standard plan. They will have a chance next month to pick another plan if they like or stay with Blue Cross and Blue Shield.

Blue Cross and Blue Shield has the largest number of federal worker enrollees, and almost all the federal retirees.

Although most feds and virtually all retirees stay in the same health care plan year after year, each November-to-December open season brings a migration of workers from traditional fee-for-service plans to less-costly health maintenance organizations (HMOs).

In many cases, the HMO enrollees are younger, healthier and more interested in dental and child care benefits than in a long-term relationship with their very own family physician.

Officials also are monitoring the migration habits of FEHBP employees to so-called high-deductible health plans (HDHP). They are new and, the Bush administration hopes, the wave of the future. The idea is that people pay lower premiums but have higher deductibles. Once that is reached, they have good catastrophic coverage.

Backers of HDHP say such plans will force people to be more selective in seeking medical treatment because they will find out firsthand what it costs until they satisfy their deductible.

Opponents turn the argument around — we’re good at that in Washington — arguing that it will force people with less money to avoid going to the doctor when they are genuinely sick.

Both are probably correct.

A report by the Government Accountability Office finds that the average age of people in the high-deductible plans is 47 — much lower than the FEHBP average — and that they have much higher salary levels than feds in other plans.

An earlier study of the HDHP also revealed that its enrollees have higher levels of education. Some people would say that makes them smarter. And if they are better-paid, better-educated and younger, one could speculate that they are healthier, although maybe heavier, than their older colleagues.

But whether they are smarter or not, the changes could be important to premium payers down the road. Feds pay about 30 percent of their total health care premiums, and the government pays the rest.

The trend, if there is one, won’t be official and definitive for years. The best bet for feds, who have the best coverage in the country, is to stay tuned — and eat an apple every day.

Mike Causey, senior editor at Federal News Radio AM 1050, can be reached at 202/895-5132 or [email protected]

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