ABSTRACT
State and federal public employee health insurance programs covered an estimated 19.3 million people in 1993, with annual expenditures in excess of $33 billion. This chapter examines these programs with two goals in mind: to draw on the experiences of these plans to inform the national health care reform policy debate and to understand options for the future of the public employee plans under comprehensive national health reform. It explores public employee plan experiences and examines the nine-million members Federal Employees Health. The direct approach is advocated by so-called "single-payer" proponents. Their proposals would organize an entire state or region into one community group, and then pay for medical service directly through the use of negotiated or legislated fee schedules, capitation, institutional budgets or prospective rates, and total expenditure hospital budgets. Federal and state employee health benefit plans provide the closest model available for evaluating the concept of health insurance purchasing alliances.
