What Constitutes Adequate Health Insurance? Karen Politz’s evaluations tells us more

A critical decision congressional policy-makers must make in health reform is to define what constitutes adequate health insurance. Minimum coverage standards have been suggested, and one potential benchmark often mentioned is Federal Employees Health Benefits Plan (FEHBP), the health insurance program for federal employees and members of Congress.

Karen Politz of Georgetown’s Health Care Policy Institute considered the coverage provided by the plan most often chosen by federal employees, for four serious medical conditions -- breast cancer, colon cancer, heart attack, and diabetes – and estimated what patient out-of-pocket treatment costs would be under the plan. The conditions chosen are examples that occur commonly in the population and that generate the kinds of large medical expenses for which most people would hope to have health insurance protection. Patient-care scenarios were developed based on published treatment guidelines and the patients were assumed to have no other complications. Yet out-of- pocket costs to the patient ranged from $10,000 – $13,000 for the woman with breast cancer to 15,000 -$17,000 for the colon cancer patient. Out–of-Pocket costs for a well controlled diabetes patient amounted to more than $7,000 a year. Read the report here.