Many federal workers, postal employes and retirees would pay higher health insurance premiums next year under legislation cleared by the House Ways and Means Committee. It would require the Federal Employees Health Benefits program (FEHB) to be the primary payer of medical costs (Part B of Medicare) for persons under the Social Security program, and, beginning next January, would make FEHB the primary payer of both medical and hospital (Part A of Medicare) costs for persons reaching age 65 on or after than date.

The House action is less drastic than a bill approved earlier this month by the Senate Finance Committee. The Senate would make FEHB the primary payer of both medical and hospital costs, which are now handled primarily by Medicare for persons under Medicare.

A spokesman for the National Association of Retired Federal Employees explained that the House action would have two effects: First, for persons currently covered by FEHB and Medicare Part B (medical), Medicare would become the secondary carrier or payer, and FEHB the primary payer of settling medical claims. Secondly, for persons becoming eligible for Part A of Medicare as of January 1982, Medicare would become the secondary payer and FEHB the primary payer.

Federal officials, who oppose making FEHB the primary payer of both medical and hospital costs of government retirees, say they do not have an official estimate of how high premiums would jump for workers and retirees if the change is made. But of the record, they say that premiums paid by employes could go up between 80 percent and 100 percent, because the FEHB plans would be paying costs now handled by Medicare. Government unions argue that the Senate and House actions are discriminatory because no other health plan in the country is the primary payer over Medicare. In other words, they say Congress is sticking it to the feds.

The even thougher Senate proposal (outlined here May 8) would make the FEHB the primary payer of health and hospital costs of all present and future retirees. The House plan would keep Medicare as the primary payer of Part A Medicare benefits (hospitalization) for retirees who are already 65 or who will be 65 before next Jan. 1.

Rep. Richard A. Gephardt (D-Mo.) says the House change is fair to the taxpayers who partially subsidize the government's in-house health benefits insurance program. In a letter to this column dated May 19 he wrote, ". . .the idea of having an ailing program for the elderly [Social Security] subsidize health insurance for people who are young and healthy is crazy. Usually the subsidy goes the other way. Tapping the Medicare trust fund for this purpose [as in the present arrangement] has nothing to commend it."

The St. Jouis Democrat believes that the changes will make the federal health insurance system "more rational" and improve the financial health of the Social Security system. He says it will make federal workers, and retirees, better health-plan shoppers "because the price of health plans will reflect their actual costs." Gephardt believes that many federal workers and retirees are paying more than they have to for health insurance by signing up for most expensive "high option" coverage.

Gephardt says the changes being considered by the Senate and House (both approved by overwhelming committee votes) may boost premiums "but the change reflects a move toward fairness and rationality, not an unfair imposition on government employees . . . .My suspicion is that the change will make many look again at their health insurance choice and encourage a shift toward low option plans. If this happened, high option rates would rise even more, but premiums for thos shifting into sparer plans would actually drop. The cost to the government could drop also."

Federal workers and retirees will have an open season this fall during which time they may change plans, or options within their current plan. A lot of what they do will depend on big changes in the works in Congress as to who pays the lion's share of health and hospitalization bills for retired government workers.