The FEHB program is generally successful in providing quality care at affordable prices, one reason there have been so many proposals over the years to use it as a vehicle for changes in health care policy affecting the private sector, according to a report for Congress.
The Congressional Research Service report examined the underlying structure of FEHB, which over the years has been the subject of numerous proposed changes—with largely unknown effects on coverage, premiums and other features for those currently eligible.
"Since its inception, policymakers and researchers have been interested in FEHB both as a model for private and public health insurance programs (e.g., Medicare) and as an avenue for expanding coverage to certain individuals (e.g., the uninsured)," CRS said. "The FEHB model consists of competing insurers providing numerous types of coverage to enrollees with minimal intervention from OPM. Many view this model as generally successful in giving enrollees the opportunity to make cost-conscious choices and in constraining the program’s overall cost growth."
For this reason, some would like to export aspects of the FEHB model to other health care programs, it said. For example, some policymakers and researchers believe that Medicare could benefit from implementing aspects of the FEHB model. Others are interested in expanding access to FEHB or creating new programs modeled after FEHB to provide coverage to individuals who are not federal workers or annuitants, such as small business employees or the uninsured.
"Some policymakers have embraced these ideas, introducing legislation to create new programs or opening FEHB to individuals who are not federal employees or annuitants," the report said. "In the past, it has also been suggested that certain features of FEHBP are a good model for state-level health insurance exchanges, and some would say that lessons learned from FEHB may be instructive for state and federal officials that are establishing health benefit exchanges as created by the Patient Protection and Affordable Care Act.
It added that congressional interest in FEHB extends beyond FEHB’s potential applicability as a model for other health care programs or as an avenue to provide coverage. Congress "has a financial interest in the program, as the federal government has always paid a portion of FEHB’s costs." In addition, members of Congress themselves are eligible for FEHB and the majority of them enroll; additional benefits through an in-house Capitol Hill physician’s office and through military medical centers also are available to them, at least on a limited basis.