- Premiums-Government plans are more expensive and employees have to contribute less, relatively and absolutely. The standard employee premium share for a family plan is 23% in the public sector and 30% in the private, which works out to a difference of $1,100 annually.
- Out-of-pocket expenses-In addition to paying more for their premiums, private workers face higher deductibles, co-pays and co-insurance costs.
- Eligibility-Governments offer health benefits to more of their employees than private firms (75% vs. 59%).
- Retiree healthcare-Somewhere between 60-80% of large government employers offer it, whereas fewer than 20% of large private employers do.
2 shows that governments are still offering low co-pay, low deductible plans that went out of fashion in the private sector 10-15 years ago. Indeed, the nationwide cost shift from premiums towards out-of-pocket expenses, among many employer-sponsored plans, has played a crucial role in slowing premium growth in recent years.
The good news is that, at least in the case of 2, there is a fix. In 2011, Massachusetts granted "plan design authority" to its local governments, which means that they can now adjust co-pays and deductibles outside of collective bargaining. Unions still have say over premiums, as well as salaries and other working conditions. The savings have been substantial, and, because premium growth has slowed, employees have benefited from the reform, as well as local budgets.