Under Clinton's proposal, a separate risk pool would be created for members of the public who joined the Federal Employees Health Benefits Program, the candidate's campaign staff told a federal employee union during a briefing.
"We specifically asked whether the senator's plan would establish a separate risk pool for any enrollees from outside the federal government community and we were assured that it does," said Colleen Kelley, president of the National Treasury Employees Union. "With a separate risk pool, current federal employees and retirees will remain unaffected, and FEHBP will continue as the high-value program it is today."
The Clinton campaign did not return a call seeking confirmation.
The creation of a separate risk pool is a key point for federal employee groups, many of which expressed concern that without a separation, premiums could rise sharply as sicker and less financially secure participants enrolled in FEHBP-run programs.
One strength of the federal program is its risk pool, said John Palguta, vice president for policy at the Partnership for Public Service.
"Federal employees are fairly healthy, and economically, they're well situated," he said. "Poor people, unfortunately, are not as healthy, for a variety of reasons. If the risk pool changes, the [healthy] people who are underwriting a program have to cover costs" incurred by sicker pool members.
Dan Adcock, assistant legislative director of the National Active and Retired Federal Employees Association, said his group would be opposed to any plan that doesn't establish a separate risk pool for nonfederal enrollees. "We would hate to see it become the insurer of last resort," he said.
Yale University health care economist Jacob Hacker said it was likely that insurers who currently participate in FEHBP would have flexibility in terms of the plans they offered.
"Presumably, while the FEHBP framework would be used, insurers would be able to offer a separate set of plans to those enrolled who were not federal employees -- or not participate in the new nonfederal employee pool at all," said Hacker, who consulted with Clinton and her major Democratic rivals on their health plans. "In addition to employers' contributions, there would be subsidies provided by the government to those with middle and lower incomes."
But even if Clinton's plan would not affect federal coverage or premiums, some federal employee groups questioned the wisdom of using the plan as a model, and said it needed further reform.
"Using FEHBP as an answer to what's wrong with health care in America is ridiculous," said Jacque Simon, director of public policy for the American Federation of Government Employees. "What's wrong with health care in America pervades FEHBP."
Simon noted that FEHBP isn't held to the government's regular accounting standards. "There's no way for us to ever be able to know that Blue Cross Blue Shield [which covers the largest number of federal employees and dependents] isn't passing along to the FEHBP costs that it's incurring in caring for its other customers," she said. "If you let 47 million more people in, you have a cost-accounting and auditing nightmare."
"I would think that number one, the insurance companies' procedures and frankly costs would have to become much more transparent, that they would be forced to disclose a lot more about their whole operations including their costs if they are allowed to participate in this windfall opportunity to cover people," said Roger Hickey, co-director of the progressive advocacy group Campaign for America's Future.
Hickey said he thought expanding FEHBP would affect the prescription drug market.
"To be telling the drug industry that they'd be selling to a much larger universe of buyers a much larger quantity of drugs, that would give the government more leverage to get lower prices the way [Veterans Affairs] does it now," he said.
Clinton is not the only candidate to turn to FEHBP as a model. Sen. Barack Obama, D-Ill., proposed creating a new national health plan with a benefits package "similar to that offered through the Federal Employees Health Benefits Program."
In contrast, former Sen. John Edwards, D-N.C., has proposed setting up a network of regional health care markets. The markets would offer a range of plan choices that would be portable when enrollees leave or change jobs.
Sen. John McCain, R-Ariz., said in his proposal this week that "families should be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business," but did not indicate whether FEHBP would be one of the plans he would let Americans purchase.
In 2000, McCain introduced legislation that would have allowed Medicare-eligible military retirees to enroll in FEHBP, but the bill was never debated. It also would have created a separate risk pool for military retirees.
Both of McCain's main Republican rivals, former Massachusetts Gov. Mitt Romney and former New York City mayor Rudy Giuliani, said they will focus on improving health care market competition as a way to eliminate cost-creating inefficiencies.
All of these reform proposals are in their earliest stages, and economists and advocates alike said they were looking to the campaigns to flesh out their ideas.
"All we really can say is that this is simply one proposal among many," said OPM spokesman Michael Orenstein, of Clinton's plan. "Should any proposal become law, then OPM would of course make changes and adjustments to the program to come into compliance."
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