Issue Briefs

Some federal employees and retirees face increasing health care premiums and difficulty affording paying their share of premiums, as well as health plan copayments and coinsurance. Image: Christian Delbert/Shutterstock.com

Following are sections in an OPM report outlining its planning under Biden administration economic and social equity initiatives relating to the FEHB and paid parental leave programs for federal employees.


Advance the equitable participation of federal employees in the Federal Employee Health Benefits (FEHB) Program by conducting an FEHB Affordability Study to identify barriers and potential solutions to accessing health benefits.

Some federal employees and retirees face increasing health care premiums and difficulty affording paying their share of premiums, as well as health plan copayments and coinsurance. To address these barriers and others, OPM will:

• Conduct a mixed methods study that will access and analyze data on FEHB enrollment and use patterns by health plan and enrollee demographics to explore demographic and geographic variation in FEHB enrollment and affordability.

• Review existing studies on methods for improving access to employer-based insurance coverage.

• Document findings that will help OPM understand the trends and the reasons behind employees not accessing FEHB.

• Provide OPM with actionable insights and policy recommendations based on steps taken by other public and private sector employers to improve participation and reduce inequities in the program.

• Model coverage improvements based on proposed policy options, to the extent allowable by law.

• Identify participants and conduct focus groups to understand the root causes leading to non-participation in FEHB.

Advance equitable access to and the quality of maternal health benefits by expanding the scope and availability of covered prenatal and postpartum FEHB services.

As stated in the White House Blueprint for Addressing the Maternal Health Crisis, women in the U.S. die from pregnancy-related causes at a higher rate than any other developed nation in the world. The maternal mortality rate is even higher for Black women, Native American women, and women who live in rural areas – all are significantly more likely to die due to pregnancy-related complications. But there are other barriers including access to prenatal care (particularly for marginalized communities), inadequate reimbursement for services offered by appropriate providers (e.g., midwives and doulas), and providers insensitive to the needs of women of color regardless of income. To address these barriers and others, OPM will:

• Strengthen coverage, benefits, and services around maternal healthcare, especially in support of prenatal and postpartum care, such as improving reimbursement and coverage of perinatal support visits and providing coverage of self-measured blood pressure cuffs and associated services to prevent hypertension.

• Increase reimbursement and coverage for childbirth education classes, group prenatal care, home visiting programs, care management for high-risk pregnancies, self-measured blood pressure monitoring, certified nurse midwives, birth centers, and perinatal support services, like doulas.

• Encourage FEHB Carriers to provide quality bonuses to maternity providers whose Consumer Assessment of Healthcare Providers & Systems (CAHPS) scores improve, reimburse at a higher rate those health systems using Alliance for Innovation on Maternal Health certification, use the “Birthing-Friendly” hospital designation coined by the Centers for Medicare and Medicaid Services (CMS), and to adopt the Centers for Disease Control (CDC) HEAR HER® campaign.

• Work with FEHB Carriers to improve the collection of maternal race and ethnicity data.

• Analyze race and ethnicity data on maternal health quality metrics from the National Committee for Quality Assurance for possible inclusion in the FEHB Plan Performance Assessment program and identify appropriate next steps.

• Continue work to make improvements in access to postpartum depression care and services offered by FEHB plans, as measured by reported increases in coverage of postpartum depression screening and treatment.

Assess use and equity of use of paid parental leave (PPL) to identify potential areas where employees may not be maximally using this new benefit or may be constrained from using the full amount of the benefit.

Multiple studies have shown that parents often do not take advantage of the full duration of their paid parental leave benefit, with men and people of color reporting less leave use. Research suggests that the longer the leave for mothers, the greater the benefits to improved child health, and the longer the leave for fathers, the greater their later involvement in child caretaking. To address these barriers and others, OPM will:

• Leverage existing data including payroll data (use of leaves and use of PPL by type of qualifying event), employee personnel status data (for example, retention status and base pay), employee performance data (for example, award hours and award pay), Federal Employee Viewpoint Survey and Federal Employee Benefits Survey data, and employee demographic data (for example, gender, race and ethnicity, age, work schedule, and agency) to assess use and equity of use by demographics.

• The focus of the evaluation for FY 2024 will be on identifying short-term outcomes for federal employees for which there is sufficient, good quality data.

• Produce a report to help the federal government understand where employees are not fully accessing PPL.

• Identify areas where agencies can provide more informational support on use of this benefit.

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