It just hit me this morning.
As a Federal employee, I assumed that whatever havoc Trumpcare would wreak on the population, our benefits under the Federal Employee Healthcare Benefits (FEHB) plans would not be affected.
I forgot a few things that became clear when reading more on Trumpcare.
First, Federal health care means you don’t get insurance from the government itself, or from Congress. Private insurers and union care insurers (like Mail Carriers) choose to participate.
When I started in the civil service in 1985, there were pages of plans that participated in FEHB. Making a choice among all those plans was a challenge.
Now there are only about 1/3rd as many plans to choose from reflecting a consolidation of the insurance industry. Still, plans seem to compete for Federal workers most likely because the government pays 70 percent of the premiums. Plans still hold ‘fairs’ during every open season. I used to go for the swag. There’s much less swag today. You’re lucky to get a pen or a plastic bag.
One thing I’ve only become dimly aware of: since returning to the Civil Service in 2009, I’ve noticed that premiums keep rising (as they have, but at a higher rate), the co-payments and yearly deductibles keep rising, and the coverage itself shrinks a little every year.
Making that year deductible has become a pain. I was recently charged $425 for c-pap supplies I could have bought on Amazon for $100 less. If I had met the $1,500 yearly family deductible, I would have gotten them for a pittance.
Now the saving grace is that the Federal government dictates the rules of coverage for insurers participating in FEHB. In order to be a part of the program, plans have to agree to abide by coverage rules.
I bet you see where I am going with this.
With this administration, it’s a whole new ballgame. Although our union (the American Federation of Government Employees, or AFGE) doesn’t know what will happen, it’s a sure bet that those coverage rules will probably be loosened dramatically.
Back in January there was a lot of chatter about changing Federal benefits in general, including the FEHB. I give you Spicey:
“Federal employee health and retirement benefits continue to be based on antiquated assumptions and require a level of generosity long since abandoned by most of the private sector,” Spicer said. “Those costs are unsustainable for the federal government, just as they are proving to be unsustainable for state and local governments with similar health and retirement packages.”
They would also like to give us vouchers (from a December CBO report):
Under a voucher system, the government share would start as a fixed dollar amount—potentially $6,100 for self-only, $13,200 for self plus one and $14,000 for family coverage, CBO said—and increased by general inflation, not by the typically higher rate the FEHB program experiences. That would “increase enrollees’ incentive to choose lower-premium plans” CBO said, and for the lowest-cost, the voucher could cover the entire premium. However, overall, “participants would eventually pay more for their health coverage” and some might give it up altogether.
Why am engaging in a discussion of Federal employee insurance arcana?
There are approximately 22 million Americans employed by the government. Add the military and it’s around 23.5 million – dwarfing any private employer. In fact, the entire employee base of all Fortune 500 companies checks in at 26.8 million people.
That’s a huge chunk of the American population. And to hear the Republicans say it, we’ve been coddled for too long with too generous a list of benefits.
Call me a socialist, but I think, at the very least, the entire population should get the health care benefits we get. Actually, I would like a national health care system in America but to believe that is possible would be akin to believing in unicorns.
Our benefit package and especially our health care benefits, have been sticking out like a middle finger in the face of the right for a long time. They are personally aggrieved by what we get and believe we should feel the same pain and frustration as every other ordinary American they will throw to the tender mercies of the private insurance market.
This is their big opportunity to get us. And they probably will unless the tide turns in 2018.
The other major point to all of this is that, in the discussion of Trumpcare’s effects on private plans, almost every analysis concludes that coverage for mental health will be first on the chopping block and may disappear completely as a benefit on many major plans.
I have no doubt when private employers are freed to do what they want with their FEHB offerings, the same thing will happen.
So let’s bring the Federal and private insurance pools together and discuss what this will mean for the people who depend on insurance for mental health issues.
As the number of people covered decreases, you can expect:
- More homeless
- More violence from people who can’t afford their meds anymore
- More suicides
- More emergency room visits
- More dysfunctional family situations with people marrying for benefits (it happens)
- More people trying desperately to retire on disability
This will, ultimately, cost more to the public than providing decent coverage. What I’m more concerned with is the social cost.
The big one up there is suicide. The numbers should grow dramatically.
Maybe that’s what they want – trim the herd of the mentally ill, the ‘takers,’ and create a new Randian world of normals producing and consuming like a herd of contented cows.
I had hoped we wouldn’t turn into that kind of nation.
So eventually, the civil service will no longer be a place of refuge and 22 million Americans will be added to the Vegas roulette table of private insurance.
How many of the total population suffer from mental illness?
According to 2014 figures:
Every year, about 42.5 million American adults (or 18.2 percent of the total adult population in the United States) suffers from some mental illness, enduring conditions such as depression, bipolar disorder or schizophrenia.
I think if the right is going to do what they want to health insurance for the mentally ill, there is one humane and lost cost service they could provide.
I am reminded of two movies.
The first is ‘Children of Men.’ In a future society in which all women are rendered infertile, violence ensues as the population inevitably declines. Britain, in this story, is trying to prevent refugees from flooding its shores (sound familiar?). As you might guess, people living in such situations are not at all happy. The government, in its benevolence, hands out suicide kits for those to whom living has become too much. They advertise them on TV with tag lines like – ‘it’s your choice; when the time is right’ and so on.
The other is, of course, ‘Soylent Green,’ where, in this dystopian nightmare, ‘ethical suicide parlors’ are provided for those who wish to end it all (and be turned into food). They look like abandoned sports arenas, where people can have a happy euthanasia complete with movies about how the planet used to look like and Beethoven playing on the sound system. In the movie, Dick Van Patten takes you under.
Now to suggest such a thing is dystopia on hyper drive. But look at what has happened up until now and what is rumored to be in the works. There is now loose talk, especially in the UK, of internment camps, ostensibly for refugees. In a future world where the sick and dying are literally in the streets or robbing pharmacies and supermarkets, it’s not out of the realm of possibility that the government, under Trump or someone like him, could decide to speed up the process, if for no other reason than area beautification for city centers.
I should point out that in Cleveland, when downtown festivities would take place and the city wanted to show a clean, family friendly public square, the police would round up all the homeless people and take them for a little drive out to Brookpark Road and dump them.
Some people are such a nuisance, like Donald Trump Jr. has tweeted, that they can scarcely be regarded as human at all.