Public-employee health benefits have survived major threats so far, but the growing gap between public- and private-sector benefits, coupled with new accounting rules for government agencies, could force public officials to make more far-reaching benefit changes, according to a study by the Center for Studying Health System Change published in Health Affairs.
Public-section unions and political sensitivities have prevented many public employers from shifting higher healthcare costs to workers. Most public employers provide a broad range of plan choices from multiple carriers, and HMOs have retained large public-employee enrollment. Despite the size and geographic concentration of their workforces, most public employers have chosen not to become involved with large purchaser-driven initiatives related to quality or public reporting of provider performance, with the exception of public purchasers in Boston and Seattle. And although public employers have not altered retiree health benefits, the cost of those benefits is likely to be a growing issue as state and local officials grapple with new requirements from the Government Accounting Standards Board to record long-term liability for expected costs of health benefits promised to all current and future retirees.
