Federal health plan offered as model for all

January 27, 1994|By Gilbert A. Lewthwaite | Gilbert A. Lewthwaite,Washington Bureau

WASHINGTON -- President Clinton didn't mince words when he told the dignitaries attending his State of the Union address Tuesday that they enjoyed the sort of health coverage that all Americans should have.

"The American people provide those of us in government service with terrific health care benefits at reasonable costs," Mr. Clinton said. "We have health care that's always there. I think we need to give every hard-working, taxpaying American the same health care security they have already given to us."

He was referring to the Federal Employees' Health Benefit Program, which some experts consider a model for health reform. It is the basic program offered to every member of the civil service as well as members of Congress, the Cabinet and the Supreme Court, who were among those assembled before Mr. Clinton when he outlined his 1994 agenda on Capitol Hill.

The federal health plan offers 9 million federal employees, retirees and their dependents a choice of more than 300 insurance programs, ranging from Blue Cross Blue Shield to local health maintenance organizations.

Federal workers like the program and hope to save it from extinction under the Clinton administration's health care reform plan, which would require most Americans -- government employees included -- to obtain insurance coverage through new regional "health alliances."

Under the plan, the government pays an average 72 percent of the premiums, and the employee contributes an average 28 percent. By law, the government's contribution is restricted to between 60 percent and 75 percent of the premium, which varies from plan to plan.

Under the Blue Cross Blue Shield option, family coverage now costs $404 monthly, of which the government pays $303 and the employee $101. For an individual, the monthly premium is $181, of which the government pays $136.

The plan, introduced in 1960, has been successful in holding down costs -- one of the goals of the Clinton reforms -- because its size enables it to drive a hard bargain in annual premium negotiations conducted by the Office of Personnel Management with the insurers. The average premium increase under the federal health program last year was 3 percent, about one-fourth the average in the outside market.

Coverage usually involves a deductible for hospitalization, doctor visits and prescription drugs. The federal program covers mental illness but not long-term care.

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