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Denise Dennis Headshot

Health Care Reform: Compromise or Compromised

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The Senate's latest proposal for health care legislation, as an alternative to the now watered-down public option, involves expanding Medicare to cover Americans beginning at age fifty-five. It also entails offering the same plans to Americans that federal employees--including members of Congress--receive. Under this proposal, the Office of Personnel Management would negotiate with insurers to offer one or more national health plans, as they do for the Federal Employees Health Benefits Program. This would be a non-profit, federally regulated plan.

Expanding Medicare to age fifty-five would a good, albeit limited compromise. The problem with having OPM negotiate with insurers to offer national plans, however, is that it could still leave the public at the mercy of the health insurance industry's arbitrary decisions.

This most recent proposal caught my eye because, in September, a retired federal employee called me to ask for help regarding her health care benefits. She had received a letter from her insurer--Blue Cross' Keystone Health Plan East--that for years offered the Federal Health Benefits Program, informing her that Keystone was canceling the federal employees program. The retired employee, whom I will call Mary, had read some of my Huffington Post pieces on health care reform and thought I might be able to get information for her about why the program was canceled--and what her options were for another insurer. Mary is a breast cancer survivor and was afraid that she would not be able to find another plan because her cancer would be considered a pre-existing condition, and because of her age.

The first time I called, Keystone denied that they had dropped the federal program and said the government canceled the partnership. When I called the Office of Personnel Management, they told me Keystone had canceled it. This dance of denial continued through several calls. Finally, I spoke with Keystone's public relations department and told them I was researching an article--and someone returned my call. It was then that I finally learned that Keystone had indeed dropped the program and that it was "a business decision."

Keystone had offered two choices, the HMO through which the federal benefits program was offered and the Preferred Provider Organization (PPO). They decided to "streamline plans" by dropping the HMO and offering only PPO.

Keystone's decision affects 15,000 members who are covered by the federal program. Mary and the other 14,999 members must now choose between a variety of plans offered by Keystone or the Office of Personnel Management. Mary called me again in November. Although she was given a Dec. 31, 2009 deadline to select another plan, every time she called both Keystone and the personnel office, she was put on-hold for up to an hour and then, either told to call again or simply disconnected. She was anxious that she would not have information about the alternative plans in time to make a decision before the deadline.

Keystone sent me a copy of the plans they are offering, which I sent to Mary. The plans are presented in a verbal matrix that is difficult for a younger person to decipher, let alone an anxious senior citizen. Anyone who has read through health insurance literature will recognize how confusing it can be.
Although Keystone told me that the plans they are offering would cost Mary less out-of-pocket than the federal benefits program, after reading the literature, Mary told me it would actually cost her $128 more each month--which is expensive for someone on a fixed income.

Yesterday, Mary finally reached the personnel management office and explained her predicament. They promised to send her literature about the plans they are offering that might replace the Keystone plan and promised, also, to give her a deadline extension for making her decision. They gave her nothing in writing, though, and she is not reassured by their promises.

The health care benefits offered by the Federal Employees Benefits Program, which Mary had during her nearly thirty-five years as a federal employee and her decade of retirement, have been excellent. The federal program offers a variety of affordable plans from which to choose, a marketplace of health insurance alternatives, so to speak. If the government can indeed offer a comparable program for Americans who are without health insurance--at low cost--it would be an improvement over private insurance or none at all.

In choosing this course, though, the Senate's "Gang of Ten" should consider Mary's experience. What will happen if the insurer offering the national plans decides to drop the program? How will implementing a program modeled on the current one prevent the insurers' virtual monopolies that now exist locally? What regulatory measures will be taken to make sure that insurers don't game the system? How will the Office of Personnel Management handle millions of new members? Will it be expanded? If so, what will the costs be?

A health insurance program modeled on the existing system and available to Americans who are without health insurance, coupled with an expansion of Medicare to cover people at age fifty-five would be a major step forward. The Senate committee needs to make sure, though, that in trying to find a compromise that appeals to progressive and conservative Democrats alike--they do not decide on a course that instead merely creates more members for private insurers--who are then left to cancel the national plans and offer their own, more expensive ones. It would be a travesty if the well-intentioned compromise created legislation that leave people compromised.

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