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Lessons for Health Reform from the Federal Employees Health Benefits Program (PDF)
Urban Institute Link to more items from this source
Aug. 21, 2009

10 pages. Excerpt: Politically, the program as a model for reform has appeal across the spectrum. Conservatives like the program's reliance on private health plans and market competition. Liberals like the prospect of expanding to everyone the FEHBP's large-employer-style benefits, community rating, and close oversight of insurer pricing. However, it does not seem to be wise simply to open the existing FEHBP to non-federal enrollment nor feasible to precisely replicate the FEHBP and its national approach outside the context of federal employment. FEHBP experience suggests three main lessons for new reforms. First, selection issues can be severe and program altering. It seems very likely that stronger countermeasures will be needed for a new exchange than the FEHBP has as yet deployed. Second, it is challenging to maintain a wide spread of benefit packages for enrollees to choose among. Plausibly, better risk adjustment or other anti-selection mechanisms would assist in achieving this goal. Third, the FEHBP approach of negotiating with health plans and maintaining reserves that can be used to offset unexpected costs in a given year or temper year-to-year premium fluctuations is an alternative to direct public regulation of premiums.

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