Ever wondered about the health of the federal government's own health program?
Well, General Accounting Office auditors have just given the world's largest company health plan a complete fiscal. They have some good news and some bad news.
The congressional watchdog agency found that the $5-billion-a-year program--which covers 9.2 million people worldwide, including about half the people in metropolitan Washington--is generally sound but could take some lessons from private industry, which offers workers fewer options but better benefits.
For example, GAO, which did its financial ferreting for Sen. Ted Stevens (R-Alaska), says that as a fringe benefit Uncle Sam's in-house employe health program doesn't measure up to some of the deals private sector firms give their workers.
Depending on the plan they choose, federal employes and retirees pay anywhere from $300 to $1,600 a year out of pocket for premiums. The government on average pays about 64 percent of the cost of individual employe coverage (and about 58 percent of dependent coverage), according to the GAO report. But the agency says that 90 percent of the private firms it studied pay a bigger chunk of employe health costs than Uncle Sam, and that 68 percent of the firms it surveyed pay the entire health cost package.
In addition, GAO says, benefits offered to federal workers have slipped behind those available to employes in health plans sponsored by private industry. Generally speaking, GAO said, the government plans do not offer coverage as good as that provided private sector workers in the area of hospital care, surgical, major medical or mental health benefits.
The GAO report says that some of the federal health plans may run into trouble in the future, because employes and retirees can switch coverage every year during open seasons.
"Most nonfederal employes . . . have no choice in the level of coverage they receive," GAO said. But the federal health program (which was designed by Congress in the days when Congress looked lovingly on the federal work force) allows feds "the opportunity to choose among different insurance plans there are more than 120 in the program with different levels of coverage . . . ."
Allowing employes to change plans annually, GAO said, encourages "heavy utilizers" to move into plans with best coverage (and often the highest premiums) and drives low utilizers to less costly plans, causing problems--financial and in planning benefit levels--for many plans.
If the so-called "selective enrollment" feature of the federal health plans "remains unchecked," GAO said, the result could be "rate increases, the segregation of high and low-utilizers, and ultimately a reduction in the comprehensiveness of benefit packages . . . ."
GAO says that Congress might want to consider a number of changes that would stabilize benefits and premiums. Among the options: tying government and employe contributions to an enrollee's risk level; holding less frequent "open seasons"; reducing the number of plans in the program, and requiring all plans to accept retirees, who are heavy users. Currently only a handful of plans in the program will accept retirees.
GAO's report is timely, because the House Post Office-Civil Service Committee is looking to make changes in the federal health program. Many members, themselves participants in the health plans, say premiums are too high and benefits too low.