Lawmakers Propose Self Plus One Option for Federal Health Program

This December 2, 2013 photo shows a woman reading the HealthCare.gov insurance marketplace internet site in Washington, D.C.
National Journal
Kellie Lunney, Government Executive
Kellie Lunney, Government Executive
Dec. 11, 2013, 10:50 a.m.

The bi­par­tis­an budget pro­pos­al an­nounced Tues­day would pave the way for a “self plus one” cov­er­age op­tion un­der the fed­er­al em­ploy­ee health in­sur­ance pro­gram.

A pro­vi­sion in the $85 bil­lion deal un­veiled by Rep. Paul Ry­an, R-Wis., and Sen. Patty Mur­ray, D-Wash., would al­low the Of­fice of Per­son­nel Man­age­ment to “mod­ern­ize” the Fed­er­al Em­ploy­ees Health Be­ne­fits Pro­gram by ex­pand­ing the menu of en­roll­ment op­tions. FE­HBP cur­rently of­fers self-only and fam­ily cov­er­age; en­rollees with spouses and no de­pend­ents must choose the fam­ily plan to re­ceive cov­er­age for their spouse. The Fed­er­al Em­ploy­ees Dent­al and Vis­ion In­sur­ance Pro­gram, or FED­VIP, has had a self plus one op­tion since 2004.

The ad­di­tion of self plus one cov­er­age “would align the FE­HB pro­gram with the com­mer­cial mar­ket and serve to spread costs across dif­fer­ent en­roll­ment types,” a sec­tion-by-sec­tion ana­lys­is of the budget pro­pos­al stated. FE­HBP provides health care be­ne­fits to 8.2 mil­lion fed­er­al em­ploy­ees, re­tir­ees and their de­pend­ents.

The House could vote on the le­gis­la­tion, which par­tially re­peals the se­quester for two years, be­fore it ad­journs on Dec. 13. The bill also would re­quire new ci­vil­ian fed­er­al work­ers and work­ing-age mil­it­ary re­tir­ees to con­trib­ute more to their pen­sions.

Fed­er­al em­ploy­ees and their ad­voc­ates long have com­plained about the lack of a self plus one op­tion in FE­HBP. Em­ploy­ees with spouses and no de­pend­ents have balked at hav­ing to pay more for a fam­ily plan when they don’t have any chil­dren. But it’s not clear a self plus one op­tion would be any cheap­er for en­rollees since that demo­graph­ic — em­ploy­ees with a spouse and no de­pend­ents — tends to be older and more ex­pens­ive to in­sure than a young couple with chil­dren, ac­cord­ing to OPM’s ana­lys­is. The agency has long stud­ied the costs and be­ne­fits of of­fer­ing self plus one.

“The self plus one premi­um would be based on the health cost of this group,” states OPM in its on­line Fre­quently Asked Ques­tions sec­tion. “For this reas­on, it is not clear that adding ad­di­tion­al en­roll­ment op­tions to the FE­HB Pro­gram would res­ult in any sig­ni­fic­ant be­ne­fit to those who ask for the change. In fact, they might be worse off.” The budget le­gis­la­tion would re­quire OPM to do an ac­tu­ar­ial ana­lys­is of the cost to self plus one be­ne­fi­ciar­ies for the first year of en­roll­ment.

Ex­pand­ing the health cov­er­age op­tions for fed­er­al work­ers has many sup­port­ers, in­clud­ing some em­ploy­ee and re­tir­ee ad­voc­ates and White House of­fi­cials. Pres­id­ent Obama in­cluded a pro­vi­sion to of­fer self plus one in FE­HBP in his fisc­al 2014 budget pro­pos­al. The Na­tion­al Act­ive and Re­tired Fed­er­al Em­ploy­ees As­so­ci­ation and the Fed­er­al Man­agers As­so­ci­ation praised the self plus one pro­vi­sion in the Ry­an-Mur­ray budget pro­pos­al.

“We be­lieve firmly in the prin­ciple of of­fer­ing an equit­able and af­ford­able fed­er­al be­ne­fits pack­age that will best meet the needs of all fed­er­al em­ploy­ees,” said Greg Stan­ford, dir­ect­or of gov­ern­ment and pub­lic af­fairs at the Fed­er­al Man­agers As­so­ci­ation. “Es­tab­lish­ing a self plus one op­tion with­in FE­HBP has been on FMA’s le­gis­lat­ive agenda for sev­er­al years, so we are ap­pre­ci­at­ive that it is in­cluded as part of the budget deal.”

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