Allowing America's uninsured access to the health plans offered Members of Congress--along with everyone else on the Federal payroll - may help those who can afford it although many would probably find the premiums beyond their reach, to say nothing of the subsequent deductible and copay requirements.
Campaign rhetoric notwithstanding, Members of Congress are in the same insurance program that covers other Federal workers, although they also have access to the Capitol Physician, who plays the role of school nurse in medical emergencies, including serious cases that may require hospitalization in a local military hospital like Walter Reed or the Bethesda Naval Hospital.
The Federal plans - including point-of-service, HMOs and consumer-driven options -- mirror those offered by large private employers via the usual insurers, reflecting a bargaining power that imposes some restraint on premium increases and an assurance that human resources personnel negotiating the contracts have included basic benefits. If a cancer is diagnosed, you don't have to worry that the disease - or appropriate chemotherapy - is excluded from coverage. And because the group is large, it is possible to immediately cover expensive pre-existing conditions.
Out of pocket expenses are capped in an effort to guarantee that a requirement to pay up to several thousand dollars in bills doesn't balloon into a situation that throws the insured into bankruptcy. The one unique thing about the government plans is that they're analyzed by Consumer Checkbook in a way that makes comparison shopping a real possibility.
Federal workers and retirees may select a plan at a cost ranging from just under $100 monthly for the cheapest individual plan to better than $500 for the most expensive family plan. In each case, the government pays a significantly larger amount, generally about 70 percent of the total premium . So allowing the uninsured to join these plans would cost the government a significant amount even if the premium for lower income Americans wasn't subsidized.
The Federal Employees Health Benefit Plans (FEHBP) are clearly part of the old, flawed system that reformers talk about changing. Premiums regularly rise at a rate double inflation. From an economic perspective, they are more problem than solution.
It is also worth remembering that this is now an employee benefit that makes working for the government more attractive. Some people take government jobs because of it. Were it to be offered to the general population, it would probably make the task of getting good help marginally more difficult - and perhaps expensive - for government agencies. Such a step would do little to reform the nation's healthcare system because the FEHBP differ little from insurance plans offered by other large employers.
Explanations of benefits or coverage are not always explicit and such plans are not particularly user friendly or structured for efficiency. Our insurer insisted on rejecting claims based on their incorrect assumption that we had Medicare Part B coverage. And while they delivered on their promises of a free mammogram annually for my wife, they insisted that the mandatory $25 computerized reading fee imposed by the preferred provider network selected was not covered. The way they read things, the mammogram was truly free. Of course, if you wanted someone to read it and tell you what they found, there was this slight extra charge.
My insurer finds it impossible to provide a current list of preferred providers, so it is necessary to check their status when an appointment is made, a sometimes confusing assignment because doctors are unaware that my insurer is affiliated with their network.
There's no help in selecting providers who rely on evidence-based medicine. Calls to their help line about an immediate problem inevitably result in a recommendation to report to the local emergency room. Assistance in navigating the system is limited. If a question is too complex for those at the call center to answer, there's no way to reach those higher up the food chain without writing a letter and patiently awaiting a response.
Granted these criticisms are minor complaints from the perspective of an uninsured consumer. Dealing with them is far superior to being unprotected and unable to afford needed care. Anyone offered access to these plans lacking coverage who can afford it shouldn't hesitate to sign up.