The 5-4 decision upholds the individual mandate included in the 2010 law, which requires almost all citizens to carry health insurance or pay a fine. The ruling interpreted that fine as a tax, bypassing the government’s argument involving the commerce clause.
For federal employees already enrolled in the FEHBP, “it basically means very little,” Walton Francis, primary author of the Consumers’ Checkbook Guide to Health Plans for Federal Employees, said of the ruling.
Some changes from the 2010 law already are in effect for FEHBP enrollees -- and everyone else with insurance. The legislation allows children to stay on their parents’ health plans until age 26 and prohibits insurers from turning people away for pre-existing conditions -- measures that federal labor unions long have cheered.
“Millions of Americans are already benefitting from the law, including federal employees, and the court’s decision ensures that all of the law’s provisions will become reality,” American Federation of Government Employees National President John Gage said in a statement Thursday.
Children who were added to their parents’ plans began to receive coverage in January 2011. Children who lose FEHBP coverage when they turn 26 are eligible for temporary continuation of coverage for up to 36 months.
The National Treasury Employees Union cited an Office of Personnel Management estimate that 288,000 young people have received FEHBP coverage since the enactment of the Affordable Care Act.
NTEU President Colleen Kelley said she is pleased the policy covering older children will continue. “Federal families were increasingly being caught in the gap with young adult children slipping through the cracks of the health care system because they were unable to secure affordable health care on their own or through their first jobs,” she said.
Under OPM regulations released last fall, FEHBP premiums are expected to jump an average of 3.5 percent in 2012, marking the smallest jump since 2008. Francis said many factors affect premiums and it is hard to gauge whether the implementation of the law will drive up premium costs in years to come.
“The [FEHBP] plans have been getting better at disease management, better at controlling prescription drug costs,” Francis said. “The reform law had only very modest effects on premiums.”
Upholding the individual mandate does mean federal employees who have chosen not to enroll in any FEHBP plans must purchase health insurance. While there are no good data for determining precisely how many feds have opted out of health plans, the number is believed to be well below 10 percent of the workforce, according to Francis. “The law says you’re going to have to buy insurance, but we’re going to try to make it as inexpensive as possible,” he said. “If they are really low income, they do get subsidies.”
OPM had implemented other provisions in the law for FEHBP beneficiaries prior to Thursday’s decision. For example, the law requires nearly all preventative health care services be covered free of co-pays. “That was pretty much the case already in most FEHBP plans,” Francis said. “In most cases there will be either no charges or they will be very low.”
Correction: The initial version of this story misstated the length of time children of FEHBP beneficiaries are eligible for temporary continuation of coverage. They can arrange to continue coverage for up to 36 months after they turn 26.