One of the largest and most successful group-health-insurance programs in history, the Federal Employees Health Benefits Program (FEHBP), is based on consumer choice and competition. Its market-based character — hundreds of private health plans competing for the business of millions of individual consumers on a level playing field — is a welcome exception in the distorted health-care sector of America’s economy.
Incredibly, the Obama administration wants to surgically remove a key feature of the FEHBP: the competitive pricing and purchasing of prescription drugs. It would outlaw private-sector drug negotiation in the competitive market, and replace it with direct government purchasing of drugs for federal workers, retirees, and their dependents, roughly 8 million Americans.
On Oct. 14, Sen. Daniel J. Akaka (D., Hawaii) wrote the Joint Select Committee on Deficit Reduction (a.k.a. the super-committee), urging it to include the president’s recommendation, “because it would give OPM greater purchasing power and helps ensure lower prescription drug prices that will reduce costs not only for enrollees but also for the taxpayer.”
OPM’s direct purchasing of drugs, according to administration figures, would secure savings of just $1.6 billion over ten years. What’s the point? FEHBP’s annual cost is roughly $40 billion, and these savings would appear miniscule over a ten-year period. Of course, the issue is not now, and never has been, savings; the issue is centralized control over drug financing and delivery. Officially, the administration’s argument is that the government will “negotiate” a better deal for federal workers and retirees than private health plans in a competitive market.
There is one little problem. The government does not “negotiate” anything. The policy: Take it or leave it. You accept the government “price,” which is unrelated to consumer demand for the benefit, or you are excluded from the “market.” It’s another form of price fixing, pure and simple. Can you get savings that way? Well, Yes You Can! But only if you reduce the level of benefits you provide at the artificially low government price, which is what the Veterans Administration (VA) does today. Not surprisingly, roughly one third of the patients covered by the VA, which provides “cheap” or “free” drugs, are nonetheless enrolled in Medicare Part D, which provides a much broader range of competitively priced drugs.
Federal workers might not be so lucky. When crunch time comes to secure bigger savings, OPM will, like the VA, resort to a tougher drug formulary, which will reduce workers and retirees’ access to a broader range of prescription drugs and therapies. (Expect frenzied lobbying efforts to block formulary restrictions.) Today, if you are in the FEHBP and you don’t like a health plan’s drug coverage, you dump that plan and get a better one. Tomorrow, if Obama’s allies in Congress are successful, you will not have that option: You will get the restricted range of drug options that government officials decide to give you. That’s the way it’s done in Medicaid, for example, the poorly performing welfare program for the poor and the indigent.
Politically, if one is an ideological zealot for central planning, the attack on the FEHBP makes perfect sense. The FEHBP has been a successful model for the opposite: plan competition. For 2012, for example, FEHBP premium increases are projected to grow by 3.8 percent, while growth in private employer premiums is projected to be at least 5.4 percent, according to a September 2011 Mercer survey. While performance varies from year to year, the FEHBP enjoys historical superiority in cost control. Choice and competition work.
Like private-sector workers enrolled in comprehensive employer coverage, federal workers enjoy ample drug coverage. Because FEHBP also enrolls retirees, as well as an older active workforce, the demand for medical services is proportionately higher than that found in conventional employment plans covering younger workers. Older workers and retirees are often sicker, more likely to suffer from chronic conditions, and have higher rates of health-care spending than younger workers. So, of course, there is a higher demand for drug coverage. The administration estimates that drug payments represent 30 percent of FEHBP claims. Among retirees who are enrolled in Medicare Part A and B, FEHBP drug coverage is provided as supplemental coverage. Not only is that strong demand for drug coverage not surprising, recent research confirms that appropriate drug utilization can offset other health-care spending, reducing hospital costs.
This latest attack on competition in FEHBP is the prelude for yet another assault on Medicare Part D. That’s the ultimate target. In the FEHBP, just as in conventional employment-based insurance or in Medicare Part D, the common practice is for private health plans to negotiate with prescription-drug companies and secure drug discounts. In Medicare Part D, the Medicare Modernization Act of 2003 preserves these private market negotiations to ensure a system of competitive pricing. That private market delivery system has been an enormous success. According to Medicare’s Office of the Actuary, the competitive system of Part D has resulted in a reduction of its projected ten-year cost of over 41 percent.
The FEHBP is one of the few areas in health care that already does a good job of controlling costs, thanks to market forces. Meanwhile, the White House is doing a superb job of making a mess of the rest of the health-care system, accompanied by extravagant health-care promises that it cannot and will not keep. Federal workers would be best served if the administration kept its hands off the FEHBP.
— Robert E. Moffit is a senior fellow at the Heritage Foundation’s Center for Policy Innovation.
Really? Okay so Obama thinks HE is going to "negotiate" a better price for my MS therapy drugs....private sector begs me, the patient, to use their services because of the off sets of the drug companies. My drugs are VERY expensive. A non insured person would pay 3000 dollars a month for my meds. FEDBlue foots that bill, Copaxone foots a bunch more and I am left with a monthly copay of twenty some dollars. Obama thinks the government is going to negotiate a better price for me?? I don't think so. Also, who is to say that "my" drugs wouldnt be trash canned in Obama's plan due to their expensive and "speciality nature." I see this as a lose lose situation for anyone who has on-going chronic illness and disease. For a young healthy person who gets bronchitis one every two years or breaks a leg in a decade and may need pain pills it could work.
Maybe gov't should just get the heck out of MY healthcare?!
Reply to this commentLinkReport AbuseI agree with you completely. I, too, have an illness that requires a brand-name drug. Am I going to be penalized for this? Probably so. The drug I use is only brand name. There is no generic. I think that along with separation of church and state, there needs to be separation of the US from other countries, especially when we have so many of our own citizens who are homeless and/or at poverty level. I say help those in America (with the exception of illegal immigrants) before spending abroad.
Reply to this commentLinkReport AbuseBargaining for a better price is "price fixing." You're running a pharma company and a big customer (among the many customers you have) asks for a better price: the customer shouldn't be allowed to do that! Let's see, I have some negotiaing power that I haven't been using and I decide that I will start using it, and your response is "oh that's so unfair!" Is that how it works at the Heritage Foundation?
Reply to this commentLinkReport AbuseThe author is misleading with his statements about the VA. He tries to make it seem like the VA is the only healthcare system that has a formulary which is far from true. The way healthcare is set up in the US (no incentive to keep people healthy) there is no way an insurance plan can survive if it doesn't have a formulary. Also, just because "roughly one-third of the patients covered by the VA" are enrolled in Medicare part D doesn't mean they actually use their Part D insurance. There is also a large portion of VA patients that are enrolled in other third-party insurance (eg. BCBS, Cigna, etc), this doesn't mean they actually use these insurances. Many patients come to the VA because they can get better care at lower costs and/or prescriptions for much cheaper than their copays for Part-D or third-party insurance. BTW, VA patients can get any drug that is necessary even if it is not on the VA National Formulary and as long as it is FDA approved.
@CRayne, The proposed plan does not say anything about changing how your insurance restricts/limits the drugs offered so FEDBlue and Copaxone's drug subsidy would still cover the cost of your med however any savings would be passed on to FEDBlue (they would get the drug cheaper). The VA has such large purchasing power that drug companies frequently agree to provide drugs at much lower prices than any private health organization/group can get. For example the VA has a federal contract for copaxone at less than 50% of it's $3,300 regular price.
Large purchasing power is one easy way to reduce the overall cost to the FEHBP Insurance Company. This SHOULD allow the FEHBP insurance companies to operate at lower costs which SHOULD result in lower premium costs to its enrollees. However, the only fiscal responsibility the BIG Insurance companies have is to their stockholders, not to it's enrollees. This is part of the reason the US insurance premiums have substantially outpaced inflation over the last several decades.
•Medicare Medical Loss Ratio (MLR) > 98% (only $0.02 of every $1 is spent on admin costs)
Reply to this commentLinkReport Abuse•For-Profit Insurance MLR ≈ 80% (quite a bit of money spent on lobbying, exec bonuses, profits, etc.)
As usual, the Federal Government is trying to put their nose where it does not belong. The Govt. should not be in our lives even if we work for them. They should let the proper, educated, negotiators manage the healthcare and drug pricing and get out of our business. If they go with the proposed drug pricing, federal employees will die off quickly not getting the proper medicing they need. The Govt. should focus on NOT spending and closing our borders... then when that is done, focus on NOT spending and cutting funding to other countries and programs they shouldn't be funding, especially to illegal immigrants. Unelect the Elected - Get them all out of office - both parties. Put the educated business folks who believe in the Constitution in office that can do the job of bringing America back and Securing our Country.
Reply to this commentLinkReport AbuseThat's a direct assault on the managed competition framework of the FEHBP and makes no economic sense. The idea behind the framework of managed competition and the FEHBP is that by setting subsidies below the cost of competing plans, employees will choose the plan that has the benefits that give them the greatest marginal return - the most benefit for the lowest cost - resulting in choice of the most efficient insurance models. Setting prices administratively - which is what this proposal would do - sacrifices the efficiency of market mechanisms in identifying cost-efficient solutions and opens pricing to processes of political rent-seeking. We have seen how wonderful this works in Medicare!
Of course, such a proposal is not surprising given the current administration, which has had no equal in both disdain for market mechanisms OR enthusiastic embrace of rent-seeking politics,
Reply to this commentLinkReport Abuse