A New Health Assistance Bill Proposal


There appeared to be serious consideration of a new proposal on the table: a national health plan similar to the Federal Employee Health Benefits Plan, which provides insurance to members of Congress and federal workers. It would be administered by the Office of Personnel Management, which oversees the federal plan, and all of the insurance options would be not-for-profit.

Devil in the detail as always, but this seems a viable way to run an Exchange. The Federal Employee Health Benefits Plans negotiate very well. Should also solve the Stupak Amendment problem. This is not a Public Option of course, but since the federal government could, in theory, negotiate the rates and benefits on par with what federal employees get, the expansion of health insurance to 30 million Americans can be done in a positive way. Of course this is not health care reform, but it could be acceptable health insurance assistance.

It's perfectly obvious that health care reform will not happen with this bill. But this could be an acceptable health insurance assistance bill. Let's see the details.

Speaking for me only

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    From Politico article linked (5.00 / 1) (#2)
    by MO Blue on Sun Dec 06, 2009 at 08:57:32 AM EST
    "It would be a national, not-for-profit," Brown said. "(The Office of Personnel Management) would administer it. It would be any number of national not-for-profits that would compete nationally and they would take the place - more conservative members hope - of the public option. They would be in states and be running a kind of lookalike to a public option.

    Existing insurance companies could participate as long as their plan is not-for-profit, he said.

    Somehow I can't envision a Blue Cross/Blue Shield not-for-profit doing anything that would put downward pressure on their for profit insurance plans.

    Now if Congress wants to roll their own plan into this option so that they receive the same great negotiated premiums as everyone else receives then maybe I would support this compromise of a compromise of a compromise. Since that seems highly unlikely, to me this just seems like another give away to the insurance industry.

    The plans for government employees (5.00 / 1) (#4)
    by inclusiveheart on Sun Dec 06, 2009 at 09:15:08 AM EST
    are all still administered by the private insurers.  It is a clever trick because the Federal Government subsdizes federal employees' premiums something on the order of 70%; and federal employees face many of the same challenges to their claims that most Americans are having problems with now.

    The reason why Senators, Congressmen and their staffs are so happy with their health plans is that they themselves are or are connected to politically powerful individuals.  The rest of the federal government employee unverse fares only slightly better through the labyrinth than the average American, and that's because they have protections as federal employees.  Protections that I don't imagine would extend to the greater universe of participants not directly employed by the federal goverment.

    This set up even in its current limited model for federal employees is a subsidy for the private insurers.  There really is no reason why federal employees shouldn't be covered by a government program too.  No reason other than to subsidize the private insurance companies that is.

    It isn't really reform per se.

    The problem, of course, is that (5.00 / 1) (#6)
    by andgarden on Sun Dec 06, 2009 at 10:13:41 AM EST
    the WH will insist on calling anything that's passed "reform."

    "Reform" is a fairly meaningless ... (5.00 / 1) (#31)
    by Robot Porter on Sun Dec 06, 2009 at 04:21:46 PM EST
    political buzzword.

    Well, it has meaning. (5.00 / 1) (#38)
    by inclusiveheart on Sun Dec 06, 2009 at 05:29:40 PM EST
    Just not here.

    Just so people are clear about what (5.00 / 1) (#8)
    by Anne on Sun Dec 06, 2009 at 10:28:46 AM EST
    FEHBP is and how it works, here is a pdf from PNHP that might prove helpful.

    From the pdf:

    What is FEHBP?

    • FEHBP is a private insurance program that the federal government offers to its employees, including the President and members of Congress.

    • An example of "managed competition," FEHBP is a system of over 100 competing private health plans offered by private insurance companies or employee associations such as labor unions. The majority of enrollment, however, is concentrated in just a few plans.

    • Like almost all private insurance plans today, the plans offered under FEHBP stipulate (i)which physicians you can see, (ii) which drugs your physician can prescribe, (iii) whether you can see a specialist, and (iv) whether and where you can be hospitalized. You can be turned down for treatment.

    • Like almost all private insurance plans today, the plans offered under FEHBP stipulate (i) which physicians you can see, (ii) which drugs your physician can prescribe, (iii) whether you can see a specialist, and (iv) whether and where you can be hospitalized.  You can be turned down for treatment.

    • Although FEHBP contracts only with health benefit carriers that offer a complete line of medical services, such as doctor's office visits, hospitalization, emergency care, prescription drug coverage, and treatment of mental conditions and substance abuse, there is no standard prescribed minimum benefit package and benefits vary from plan to plan.

    • The government pays a significant portion of each employee's insurance premium, covering either 72 percent of the average FEHBP plan premium, weighted by enrollment, or 75 percent of the premium for the plan chosen, whichever is less.  The enrollee pays the difference.  This is a better deal than many non-government employees get; in 2008, nearly half of employer-insured individuals paid more than 25 percent of the total premium for family coverage.

    It goes on to explain why FEHBP would not work as a national model for health coverage.

    insurance for gov't employee (none / 0) (#11)
    by Molly Pitcher on Sun Dec 06, 2009 at 10:59:35 AM EST
    AND retired gov't employees:  my brother-in-law and sister have had GEHA for years.  Theirs seems almost identical to the SC state medicare supplement plan I have.  The prescription benefit plan is also identical, except they diverge somewhat on which are the preferred drugs.  

    No cost controls, adverse selection (none / 0) (#32)
    by lambert on Sun Dec 06, 2009 at 04:41:03 PM EST
    From the same PDF:
    About half of personal bankruptcies are due in part to medical bills and two thirds of these bankrupted individuals had health insurance when they became ill. The private insurance plans in FEBHP expose patients to the same financial risks as private
    insurance plans available outside of FEBHP.

    If FEHBP were made more widely available, it could result in selection problems. People who could find affordable insurance in the commercial market would select those options, leaving the more expensive population to opt for FEHBP, thereby  making the program more expensive

    So, again,  buffing the t*rd of private health insurance.

    there is no compromise.. (5.00 / 2) (#9)
    by fly on Sun Dec 06, 2009 at 10:45:56 AM EST
    it is all a sell out.

    None of this is what so many of us worked so hard for, for many many years with the democratic party! This is not what we put our hard earned money into Democratic candidates for. And anyone that excepts this pile of manure is not a real Democrat in my book. This is  SELL OUT, there are no other words for it. Although it seems many today in the "NEW DEMOCRATIC PARTY"  seem so willing to except this sell out! Where are the principles and integrity that we all said we had????
    I know this for sure about myself..my integrity and principles are real, and are not about to accept a sell out! If this manure is so easily eceptable by people who "SAY" they are Democrats, I no longer have a party and will stay home from now on rather than waste my time voting and working for candidates, and no one will ever see another dime from me on the political spectrum!
    I have worked my entire adult life for the Democratic party, I have been elected as a Democrat, and I have given big big bucks to the Democratic party, that will all end if this "SELL OUT" is so easily excepted by those I thought professed to have the same principles and integrity and values, and actually have none of.
    I have seen to many in my lifetime go without health care, I have lived in Canada and seen many Americans go north of the border begging for health care. I have volunteered in an excellent Child hospital in Canada that has many many American children, because they could not get care in the richest nation in the world.
    This is dispicable, and to call it any different is a sell out in and of itself!
    Stop making excuses, there are none!

    Everyone (5.00 / 1) (#18)
    by Ga6thDem on Sun Dec 06, 2009 at 01:00:59 PM EST
    should accept that meaningful healthcare reform is dead. It's time to move on. Kill teh current bill that is in the senate and pass some assistance bills or something and call it a day.

    Yes, but it MUST pass (none / 0) (#46)
    by BrassTacks on Mon Dec 07, 2009 at 01:27:49 AM EST
    So that Obama can declare a victory.  He has to be able to say that he reformed health care.  

    Everyone willing to compromise to (5.00 / 2) (#39)
    by pluege on Sun Dec 06, 2009 at 05:31:38 PM EST
    get some obama/blue dog/LIEberrman piece crap ought to keep in mind: this is it for at least 20 years, if not longer.

    A federal government run exchange (none / 0) (#1)
    by Big Tent Democrat on Sun Dec 06, 2009 at 08:53:55 AM EST
    is an acceptable vehicle for delivering health insurance assistance IF the Exchange insists upon the same conditions and restrictions that are place on insurance plans offered to federal employees.

    Of course, the big question ... (5.00 / 1) (#3)
    by Robot Porter on Sun Dec 06, 2009 at 09:11:32 AM EST
    would be not how it's "similar to the Federal Employee Health Benefits Plan" but how it's different than such a plan.

    If this is such a great deal, why (5.00 / 4) (#5)
    by MO Blue on Sun Dec 06, 2009 at 09:27:59 AM EST
    have two separate entities? More negotiating power if there was just one entity where federal employees and average people could select from the plans offered. We already subsidize and collect premiums in the federal plans so that would not be the issue.

    Only reason for two separate entities is that the differences would jeopardize the ENTITLEMENTS of Congress.


    agree (none / 0) (#44)
    by jedimom on Sun Dec 06, 2009 at 06:52:36 PM EST
    actually this IS what HRC and Obama originally proposed, opening up the Fed Emplyee plan to all Americans

    I know the Mail Handlers Plan verry well it is EXCELLENT

    it is in fact a Cadillac plan, lol

    administered by third part CAC here in AZ

    I would be quite happy with it and they cna negotiate great rates

    it would be a heck of a lot closer to an actual reform bill than the other things proposed


    I used to joke this summer... (none / 0) (#19)
    by christinep on Sun Dec 06, 2009 at 01:36:08 PM EST
    that everyone should be so lucky as to have federal benefits. Funny after all the career years of being told how superior the "private sector" was...fortunate, as it turns out, that as a federal retiree I have FEHB (federal exchange.) Last year, my high option plan for family amounted to less than $300 per month. That includes dental. And, the details of the plans during the annual open season are published quite openly should anyone want to have a freebie change during that period. As it happens, my family and I have been quite satisfied with Kaiser for years.  This is not to brag; rather, my telling you about my longtime federal employees health plan is to underscore that the plan works well with lowered cost and quality care. (It works so well, btw, that many retirees opt to stay in the plan--a retired federal employee prerogative--rather than switch to Medicare. So, something is being done right.) Other than my own experience with FEHB, I wonder now if there wouldn't be a way to increase the OPM overview authority in such a way as to extend this potential type of "option" to a larger segment of the populace than would be covered in the current public option proposal??? The structure for such an approach already exists, obviously; and, adding on a much larger version would only be a matter of scope and not approach. That should mean that the applicable implementation date could be significantly advanced. It could be a possible resolution--especially if  OPM (or similar agent) had the authority not only to expand the exchange, but also authority to enforce its mechanisms.

    Just out of curiosity, could you (5.00 / 1) (#21)
    by Anne on Sun Dec 06, 2009 at 02:36:07 PM EST
    afford the plan without the subsidies?  As I figure it, if you were paying the full cost of the plan, your monthly premium would be more like $1,000/month; that's just out of reach for most people.

    Wikipedia has an entry (5.00 / 1) (#25)
    by Dan the Man on Sun Dec 06, 2009 at 03:59:51 PM EST
    pointing out the fundamental flaw of FEHBR.

    "A chief criticism of this program's legislation and management is that the purchasing power of the Federal Government is not utilized to draw down premiums and expand coverage."

    "In the FEHBP, the Federal Government sets standards that, if met by an insurance company, allows them to participate in the program. The result is numerous competing insurance plans that are available to Federal Employees, but which vary only marginally in price and coverage"

    Also, for this year, "FEHBP would be rising by an average of 8.8% in 2010."

    So in reality, FEHBR is suffering the same problems all other businessses are - high premiums.  FEHBR is in reality a proof of the failure of the federal government in addressing insurance at a low price.  If FEHBR wants to save money without raising premiums, the only way is to make it into a model of single payer (just like Medicare) and have the insurance program run by the government.  This would save money and make it possible for it to provide adequate insurance for the employees.


    Agree (none / 0) (#36)
    by christinep on Sun Dec 06, 2009 at 05:08:57 PM EST
    I agree with your comments, in general, that the shortcoming of FEHB is the limitation on using the full power of government.  In fact, after reading your comment, I re-checked the 2010 Kaiser High Option Self & Family (incl dental)to calculate the monthly increase for next year. Yes--it is at the 9% level (from $288 to $315.) Interestingly enough, two years ago, the monthly premium was more than 2009 by about 6 or 7 percent--reflecting the executive methinks. My inner support has always been for single-payer. At this point, tho, it appears that the real political parameters are more confined. So...I choose to react in terms of the given parameters now because of the importance of realizing some advancement now. The last time, we waited since 1994. Many families cannot live with that kind of a wait. To me, the greatest service is to advance the cause of on-the-ground improvements in the medical care & delivery system to more people in our country.  (BTW: I'm not asserting that FEHB is THE answer here--only that it has been a good system for the active & retired feds. And, maybe, there are some aspects of it that could fit into the overall legislation.)

    Subsidies (5.00 / 1) (#27)
    by christinep on Sun Dec 06, 2009 at 04:10:51 PM EST
    Anne: Subsidies certainly would be the key. A friend (another retired fed) & I were talking about bargaining for lower costs in an expanded setting...and, how ploughing in the subsidies both to lower cost and to directly subsidize those still in need would be key. We both assumed that "not having to reinvent the wheel" by using the FEHB model would have some built-in savings in terms of $ and time. For example: Possibly creating a new division of bargaining agents rather than a whole new agency(?) is a lot less complicated. We also guess that economies-of-scale would enter into the implementation as well. Tho, I know very little about offsetting budget projections--only guessing that if the system takes the subsidies already planned for and uses most of those $ for jawboning down premium costs via subsidization and the remainder $ for dirct subsidization based on annual earnings, the money might stretch more than setting up a whole new process because it is being fashioned on an extant system. ???

    Kool-Aid, and whatnot. (none / 0) (#26)
    by ChiTownDenny on Sun Dec 06, 2009 at 04:09:12 PM EST
    You just wasted your time.  "I'm fabulous and I LOVE Kool-Aid."  'nuff said by me on the commenter to whom you replied (not that I don't have more to say...).

    Actually, I've always disliked kool aid (none / 0) (#28)
    by christinep on Sun Dec 06, 2009 at 04:13:31 PM EST
    Don't make it so personal, ChiTown (and, I won't either.)

    It's not personal. (2.00 / 1) (#30)
    by ChiTownDenny on Sun Dec 06, 2009 at 04:17:14 PM EST
    You just think stupid.  And you document it.  That's all, friend.  

    Disagree (none / 0) (#37)
    by christinep on Sun Dec 06, 2009 at 05:13:05 PM EST
    and what do you think (none / 0) (#47)
    by lilburro on Mon Dec 07, 2009 at 08:13:36 AM EST
    you bring to the table with this kind of comment?

    Uh, Denny? (none / 0) (#34)
    by lambert on Sun Dec 06, 2009 at 04:47:11 PM EST
    I don't think she wasted her time. I'm sure your comment caused many readers besides me to go back and read what she wrote more carefully.  Thanks for the tip!

    You're welcome, Lambert. (none / 0) (#35)
    by ChiTownDenny on Sun Dec 06, 2009 at 04:57:30 PM EST
    Please feel free to follow all of this commenters posts.  As I've already said, 'nuff said by me about this commenter.  With one caveat, perhaps she would be welcomed on your blog.

    Also (none / 0) (#20)
    by christinep on Sun Dec 06, 2009 at 02:22:19 PM EST
    'Forgot to mention an assumption about expanding the current FEHB process to include a private sector component: Incorporation of the proposed subsidies considered throughout into a new FEHB Plus program--such incorporation being the mechanism by which OPM would continue to advocate for lower costs.

    Not quite true (none / 0) (#45)
    by BrassTacks on Mon Dec 07, 2009 at 01:18:03 AM EST
    At 65 retired federal workers MUST enroll in Medicare, just like everyone else.  Federal health insurance plans then work as a backup.  I would LOVE to stay with the insurance I have and avoid medicare all together but we are not allowed to.  

    We pay almost $500 a month for our government plan, to include dental.  I'm not sure exactly what we're getting that others don't get since all my friends in private industry pay MUCH less than we do.  We all get to choose our doctors, it's not an HMO.  But they all have the same coverage for much less.  

    People should be clambering for the policies that the beltway consultants offer rather than the federal plans.  


    What do you get--probably (none / 0) (#48)
    by oculus on Mon Dec 07, 2009 at 11:19:20 AM EST
    no bar for preexisting conditions or cancellation once you become ill.  At least that is what I get, which is a huge benefit.

    Actually, you enrol and... (none / 0) (#49)
    by christinep on Mon Dec 07, 2009 at 02:40:55 PM EST
    you can elect to keep your insurance that you have had up to the point of being enrolled (on the phone by an HHS rep) in Medicare. The whole thing is mindboggling in a way, until you see your own husband (in my case) simply enroll in Medicare and keep the plan that we have had under FEHB throughout our careers. (Same for one of my best friends who also kept her plan at 65.) In practice, the enrollment is primary--as you note--but, that really is an accounting and finance system for coding, etc. You definitely get to stay in your plan. In the past few months, I've had routine yearly visits with the same doctors in the same place using my Kaiser card that I always used.

    Giving insurance entities like (none / 0) (#7)
    by MO Blue on Sun Dec 06, 2009 at 10:17:43 AM EST
    Blue Cross/Blue Shield more business ($$$$) is a "pretty good doggone" idea.

    What your tax money will also subsidize:

    ThinkProgess has documented how the private health insurance industry is waging a duplicitous, "two-faced" campaign to kill health reform. Because the industry understands that the public views it in a largely negative light, the industry presents itself as proactively working hand-in-hand with legislators to produce reform. However, behind the scenes, the industry is coordinating a massive effort to kill all reform -- employing attacks from front groups, allied politicians, think tanks, lobbyists, and right-wing media.
    Yesterday, the BCBS Association released yet another industry-sponsored study to distort health reform and falsely claim that premiums will skyrocket because of the legislation. However, the nonpartisan CBO reported earlier this week that under the Senate health reform bill, "most Americans would pay the same or less in premiums." A New York Times editorial yesterday criticized BCBS Association's study, and noted correctly that it is yet another example of the private insurance industry doing whatever it can to frighten Americans. link

    Here's one issue (none / 0) (#10)
    by TheRealFrank on Sun Dec 06, 2009 at 10:58:21 AM EST
    "Not for profit". How do you verify if a plan is not for profit?

    Existing insurance companies could just participate and say "sure, it's not for profit". But how do you verify that? What would be the conditions?

    I've given up on anything that actually changes things coming from the Senate. It is a useless institution that enables and rewards obstructionism. Perhaps there is some merit to this idea, but I'd like to see the details.

    You can't. (5.00 / 1) (#12)
    by inclusiveheart on Sun Dec 06, 2009 at 11:01:08 AM EST
    That is why this is a scam imo.

    I don't (5.00 / 1) (#17)
    by Ga6thDem on Sun Dec 06, 2009 at 12:59:39 PM EST
    know about now but it used to be that you had to meet some specific regulations by the IRS and there a specific number that was given to you by probably the Secretary of State to designate you as a nonprofit.

    American Cancer Society - non - profit (none / 0) (#41)
    by Boo Radly on Sun Dec 06, 2009 at 06:26:07 PM EST
    Slightly off topic, but maybe food for thought. About three years ago, the highest paid not for profit CEO was with the American Cancer Society. He has since gone on to bigger things, but the salary was $455,000 annually. His home town is just down the road and I know the family well. Yes, very politically motivated.

    It seems/seemed so out of kilter to me for a not for profit medical charity to pay almost a half a mil. salary. But, hm, I noticed several years ago that "things are not what they seem" - politics is the hotest event of the "season". It's not about actual policies - or votes -  it's about the money and staying in office. I predict the latest pay back by our present "leader" will be accomplished to another of his campaign donors, with only minor fuss from the middle to lower classes - hardly a mention in our media - maybe a yawn and a couple of twists to the real horrors that is passed. It's a given. JMHO - not to dash your hopes...      


    I am baffled (none / 0) (#13)
    by Steve M on Sun Dec 06, 2009 at 11:07:45 AM EST
    as to how this eliminates the Stupak Amendment problem.  Are we going to reinstate the option for individuals to purchase abortion coverage through the FEHBP, like the Democratic majority did in 1993-94?  If not (God forbid I should doubt the ability of this majority to deliver) then I don't see how this is different from the situation with the exchanges and the Stupak Amendment.

    TalkLeft: the politics of government health care (none / 0) (#14)
    by WC Varones on Sun Dec 06, 2009 at 11:40:09 AM EST
    And this relates to crime how?

    Huh - interesting question. (5.00 / 3) (#15)
    by inclusiveheart on Sun Dec 06, 2009 at 12:45:04 PM EST
    Perhaps it is that the healthcare "reform" effort is fast becoming the second worst example of political corruption and thievery in generations.  Second to the bailout of the financial system of course.

    What Americans pay for health care (5.00 / 0) (#22)
    by MO Blue on Sun Dec 06, 2009 at 02:40:36 PM EST
    and the number of Americans who go without it could definitely qualify as a crime.

    broadly speaking (none / 0) (#24)
    by ding7777 on Sun Dec 06, 2009 at 03:25:15 PM EST
    TalkLeft is exposing the injustice of health care reform

    also see About Talkleft


    How about... (none / 0) (#33)
    by lambert on Sun Dec 06, 2009 at 04:44:35 PM EST
    ... murder by spreadsheet?

    In other words, the crime is what's legal.


    Y'know, if ya dropped by more often (none / 0) (#40)
    by Cream City on Sun Dec 06, 2009 at 05:52:47 PM EST
    than every three to six months, based on your comments history, you could learn the culture of the place, and then you wouldn't ask.

    Or you could click on the explanation.  Takes less time than it did to type your comment.


    dropping by (none / 0) (#42)
    by WC Varones on Sun Dec 06, 2009 at 06:41:58 PM EST
    I came by to see if TL had anything interesting to say about the Amanda Knox case, because it is interesting, controversial, and about crime, which this blog used to cover.

    But I found just post after post after post about health care.  Which, even after reading the About statement, doesn't seem to fit:

    Our mission is to intelligently and thoroughly examine issues, candidates and legislative initiatives as they pertain to constitutional rights, particularly those of persons accused of crime.

    I know you argue that health care is a basic human right, but I don't remember the free health care clause in the Constitution.


    I'd rather be in Philadelphia (none / 0) (#43)
    by Big Tent Democrat on Sun Dec 06, 2009 at 06:48:12 PM EST

    BTW, did you read the part about comments being on topic?

    There is an Open thread available for whining nonsense.


    While the devil is in the details, (none / 0) (#16)
    by ChiTownDenny on Sun Dec 06, 2009 at 12:53:24 PM EST
    it seems, based  on reading many comments in this thread, that many have forgotten that this is a significant part (not solely!!!) of what the left has championed; the public should have access to the same healthcare available to the politicians.  At first blush, this proposal seems fantastic.

    But unless the government intends to (none / 0) (#23)
    by inclusiveheart on Sun Dec 06, 2009 at 03:04:14 PM EST
    subsidize more than 70% of the cost of the premiums, it is not access to the same healthcare at all.

    Yup. (none / 0) (#29)
    by ChiTownDenny on Sun Dec 06, 2009 at 04:15:21 PM EST
    Still negotiating.  And, reconciling the House and Senate bill, even if the Senate bill doesn't include a PO, could give us more of what we want than exists in the current House bill and current negotiated Senate bill.  We could get the PO from the House and FEHBP from the Senate.  That's a win.  (Yeah, It's a stretch, given the past year, but doable...).