Proposal for
Medicare Is Unlike Federal Employee Plan
Published: May 1, 2011 - New York Times
WASHINGTON — House Republicans say their budget proposal would make Medicare
work just like the health
insurance that covers federal employees, including members of Congress. But
a close examination shows the two plans are very different, and the differences
help explain why the Republican plan has set off a political uproar.
Under the federal employeesf health plan, which covers eight million people,
the government pays a fixed share of premiums. So the federal contribution
generally keeps pace with rising premiums, which in turn reflect rising health
costs.
No such guarantee exists under the Republicansf plan to transform Medicare,
approved by the House on April 15 as part of a budget blueprint to cut federal
spending and deficits.
Medicare and the budget will be high on the agenda when Congress reconvenes
Monday after a two-week recess in which Republicans were barraged with
complaints from constituents alarmed about the possible erosion of Medicare
benefits.
Under the House Republican proposal, starting in 2022 new Medicare
beneficiaries would receive coverage through private insurance plans, and
Medicare would subsidize the cost.
The federal payment for a typical 65-year-old would be set at $8,000 a year
in 2022, about the same as what Medicare is expected to spend under current law.
In later years, the federal payment would be increased to reflect the age of
a beneficiary and general inflation, measured by the Consumer
Price Index. But health costs and insurance premiums have, for years, been
rising faster than consumer prices in general.
So, the Congressional
Budget Office says, under the Republican plan, Medicare would pay a
shrinking share of beneficiariesf total health costs, and seniors would pay a
growing share. For a typical 65-year-old, that share would be 68 percent in
2030, more than twice what it would be under current law, the budget office
said.
Today, Medicare is an open-ended entitlement. It does not have a fixed
budget, though Congress has defined the benefits and prescribed payment rates
for doctors and hospitals.
House Republicans have repeatedly likened their proposal to the Federal
Employees Health Benefits Program, in which most lawmakers are enrolled.
gWe want to prevent Medicare from going bankrupt,h said Representative Paul
D. Ryan of Wisconsin, chairman of the House Budget Committee and the lead
advocate for the budget proposal. gWe want a system thatfs sustainable. We want
a system thatfs solvent and that people can rely upon: guaranteed coverage
options just like we have in Congress. Thatfs what we are proposing.h
Beginning in 2022, Mr. Ryan said, gnew Medicare beneficiaries would be
enrolled in the same kind of health care program that members of Congress
enjoy.h
Under their proposal, House Republicans say, Medicare would subsidize private
health plans offered to beneficiaries, just as the federal government helps pay
premiums for private health plans offered to its employees.
But Representative Chris Van Hollen of Maryland, the senior Democrat on the
House Budget Committee, said the similarities ended there.
gWe keep hearing that Republicans are offering seniors exactly what members
of Congress get,h Mr. Van Hollen said. gIt simply is not true.h
Under the federal employee program, the governmentfs share of premiums is set
at 72 percent of the average premium for all plans, but it cannot exceed 75
percent of the premium for any particular plan.
The health care handbook for federal employees explains, gThis formula is
known as the efair sharef formula because it will maintain a consistent level of
government contributions, as a percentage of total program costs, regardless of
which health plan enrollees elect.h
In practice, the government pays three-fourths of the premium for relatively
inexpensive health plans and about two-thirds of the premium for those that cost
more than the average.
The maximum annual government contribution this year is $10,503 for family
coverage.
An example shows how the formula works. For family coverage under the most
popular plan — the standard option offered by Blue Cross and Blue Shield — the
total annual premium is $15,682 this year. The government pays $10,503 (67
percent) and the federal worker pays the rest, $5,179.
For family coverage under the cheaper Blue Cross basic option, the total
premium is $12,744; the government pays $9,558 (75 percent) and the employee
pays $3,186.
Even so, Conor Sweeney, a spokesman for Mr. Ryan, insisted that the
comparison to the federal employeesf plan was valid. gThe model, the structure,
the approach is inarguably similar: the government pays a share of the
individualfs premiumsh in both the employee program and the House Republicansf
Medicare proposal.
If Democrats showed any interest in this approach, lawmakers could still
negotiate the amount of the federal payment to private health plans, and how to
adjust it from year to year, Mr. Sweeney said. Earlier versions of Mr. Ryanfs
Medicare proposal, he added, would have allowed the federal contribution to grow
at a somewhat higher rate than assumed in the House budget blueprint.