"Your health is obviously not
anything that you should play around with," says Toni, a high-school
freshman. She's pretty, smiling and stylish from her bangs angled across her
forehead to her sparkly red fingernails.
"You should take it very
seriously and when you have a chronic illness like what I have and other kids
have, it's very important that we take care of ourselves because there's a lot
of preventable stuff that can happen to us."
It helps that her mother, Rhonda
Dorsey, has good insurance, which she gets as a federal employee. She's covered
by the Federal Employees Health Benefits Program, or FEHBP. It insures 8
million federal workers, retirees and their families and members of Congress.
That federal health insurance program has been held up by the President,
lawmakers and other players in the health care debate as a model of the kind
of good insurance that should be available to all Americans.
Dorsey and others who are covered
under FEHBP do report high levels of satisfaction, but it's not some kind of
super insurance. It's pretty much like most insurance people get through their
jobs. Federal workers, too, sometimes complain about the rising costs of their
premiums and co-payments and about the hassles of getting care.
The Option To Choose
Toni was five years old when she
was first diagnosed with diabetes as long as she can remember. "At five,
I really didn't know what was going on, but I remember having my mother and my
grandfather holding me down to give me shots and prick my fingers. And I was
scared, I was confused, and it wasn't a good time."
In those early, stressful days of
her daughter's illness, Rhonda belonged to a traditional HMO through FEHBP.
She'd take Toni to see an endocrinologist, an eye doctor and one specialist
after another. "I'd always have to get a referral. And sometimes I would
forget and I'd get to the doctor's office and it would be a mess. And so I'd be
very apologetic and we'd have to call the pediatrician's office, and it just
was a waste of time in my opinion."
There were limits, too, on the
supplies she needed to manage Toni's diabetes. Sometimes a prescription refill
for needles or testing strips would be denied.
So Rhonda switched insurance
companies. Her new plan allows her to keep taking her daughter back to the
specialists who know her best. "I have the standard plan which means that
I pay a little bit more up front," she explains. "My deductible is a
little bit higher, but I don't have to deal with the referrals. I can go to any
Federal employees get a lot of
choice. That's what makes the Federal Employees Health Benefits Program stand
out compared to other insurance. In the Washington, D.C. area, there are at
least 16 health plans to choose from. Nationwide, according to a new report by
the Kaiser Family Foundation and the Health Research & Educational Trust,
most companies offer only one health plan to their employees, and just one
percent of companies offer three or more.
The federal Office of Personnel
Management conducts annual negotiations with each health plan to set benefits
and rates. That has allowed it to claim some success in constraining cost
growth. But last year Blue Cross and Blue Shield which covers about 60
percent of FEHBP enrollees increased the premium for its standard option by
13 percent. As a result, the average for all federal plans went up 7 percent.
The year before, the annual premium increase was just 2.1 percent.
Her Life Depends On It
For Dorsey, an information
specialist at the Nuclear Regulatory Commission, her insurance through FEHBP
has been central to keeping Toni healthy. "In order to live a healthy life
with Type 1 diabetes or any kind of chronic illness," she says, "it's
so important to have good insurance. And I tell Toni all the time how blessed
we are because we've met a lot of people who don't have insurance at all."
Still, even with good insurance,
it's expensive to manage diabetes. Toni pricks her calloused finger tips
several times a day to check her blood sugar levels. Rhonda pays a little more
than two hundred dollars a month for supplies.
Toni wears an insulin pump it's
the size of a cell phone and it's pink. "It had to be pink," Toni
says with a laugh. Adds her mother, "Pink is definitely her style."
The first pump cost five thousand dollars. Insurance paid all but five hundred
Toni knows she's fortunate. This
summer, she went to a summer camp for kids with diabetes. And she saw what kids
do when they don't have good health insurance. "At camp they provide you
with supplies, but I've seen kids who have saved their needles and taken them
with them," she says. "Even though you weren't like supposed to, they
would kind of sneak them just to make sure they would have something when they
got back home."
Toni and Rhonda know that when
people don't have good insurance, they're so desperate they will even reuse a
needle. "It gets dull. And so it really hurts. But you have to have
insulin, just like I said," Rhonda says. "I mean, without insulin,
Toni would die. So you, take the pain in order to live."
Toni listens to her mother and
adds, "I do feel very grateful for all that I have because that could be
Source: Kaiser Health News