- The Washington Times - Monday, December 7, 2009

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.

In public meetings and private conversations, they say essentially the same thing: Don’t Balkanize the program.

It would be great to have a health plan that rewarded the young and healthy with lower premiums. However, as they point out, the young and healthy won’t always be either one. As they age, most will be glad they are in a big group that includes people like themselves when they were 20 and 30.

Congress next year will take a serious look at requiring the FEHBP to provide health benefits to same-sex couples. Some want to extend it only to married couples while others say a deep commitment would suffice.

In addition to objections from some religious groups, the same-sex situation will require some major changes. The devil is always in the details.

But insiders say that same-sex benefits will come long before there is any serious effort to break the FEHBP down into groups based on age, health or family size.

2 percent pay raise

President Obama surprised and angered federal unions with his decision to limit the 2010 federal pay raise to a flat 2 percent. His decision not to authorize locality pay means that feds in cities such as Washington, New York and Boston will get smaller raises than they would have had local private sector pay gains been taken into account.

In holding the federal pay raise well below levels called for in the complex, complicated and controversial federal pay law (FEPCA), Mr. Obama follows in the footsteps of President Clinton and George W. Bush.

The difference this time:When Mr. Clinton and Mr. Bush proposed pay raises, Congress nearly always voted to override them and give feds a little more.

Given the makeup of this Congress, a legislative end run around the White House just isn’t going to happen.

Mike Causey’s Federal Report runs Mondays. Contact him at [email protected] or 202/895-5132.

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