[House Report 108-552]
[From the U.S. Government Publishing Office]




108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     108-552
======================================================================


 
 OFFICE OF PERSONNEL MANAGEMENT REPORT RELATING TO DENTAL, VISION, AND 
           HEARING BENEFITS FOR FEDERAL EMPLOYEES AND OTHERS

                                _______
                                

 June 17, 2004.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Tom Davis of Virginia, from the Committee on Government Reform, 
                        submitted the following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                        [To accompany H.R. 3751]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Government Reform, to whom was referred 
the bill (H.R. 3751) to require that the Office of Personnel 
Management study and present options under which dental and 
vision benefits could be made available to Federal employees 
and retirees and other appropriate classes of individuals, 
having considered the same, report favorably thereon with 
amendments and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Committee Statement and Views....................................     3
Section-by-Section...............................................     3
Explanation of Amendments........................................     4
Committee Consideration..........................................     4
Rollcall Votes...................................................     4
Application of Law to the Legislative Branch.....................     4
Statement of Oversight Findings and Recommendations of the 
  Committee......................................................     4
Statement of General Performance Goals and Objectives............     4
Constitutional Authority Statement...............................     4
Federal Advisory Committee Act...................................     5
Unfunded Mandate Statement.......................................     5
Committee Estimate...............................................     5
Budget Authority and Congressional Budget Office Cost Estimate...     5
Additional Views.................................................     7

    The amendments are as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. REPORTING REQUIREMENT.

  (a) In General.--Not later than 6 months after the date of the 
enactment of this Act, the Office of Personnel Management shall submit 
to Congress a report describing and evaluating options whereby 
additional dental, vision, and hearing benefits could be made available 
to--
          (1) Federal employees and annuitants;
          (2) qualified relatives of Federal employees and annuitants; 
        and
          (3) other appropriate classes of individuals.
  (b) Required Content.--The report shall include--
          (1) a description of the dental, vision, and hearing benefits 
        currently available under the Federal employees health benefits 
        program;
          (2) a description of the supplemental dental, vision, and 
        hearing plans currently offered by carriers participating in 
        the Federal employees health benefits program;
          (3) a description of specific dental, vision, and hearing 
        benefits that could be offered in addition to those described 
        in paragraphs (1) and (2), including any maximums, limitations, 
        exclusions, and definitions that might be relevant;
          (4) a description of the specific classes of individuals (as 
        referred to generally in paragraphs (1) through (3) of 
        subsection (a)) to whom those additional benefits should be 
        made available, including any definitions and other terms or 
        conditions that might be relevant;
          (5) a description and assessment of the various contracting 
        arrangements by which the Government could make those 
        additional benefits available, including whether such benefits 
        should be contracted for on a regional or national basis;
          (6) the estimated cost of those additional benefits, 
        including an analysis relating to whether any regular 
        Government contributions or allocation for start-up costs might 
        be necessary or appropriate;
          (7) a description of how those additional benefits could be 
        made available through--
                  (A) the Federal employees health benefits program;
                  (B) one or more plans outside the Federal employees 
                health benefits program, including supplemental plans 
                referred to in paragraph (2);
                  (C) the program described in subparagraph (A) in 
                combination with one or more of the plans described in 
                subparagraph (B); and
                  (D) any other dental, vision, and hearing coverage 
                delivery method;
          (8) an analysis of the advantages and disadvantages 
        associated with the alternatives described under paragraph (7), 
        including--
                  (A) the relative cost-effectiveness and efficiency of 
                each;
                  (B) the likely impact of each alternative on the 
                overall attractiveness of the Federal employees health 
                benefits program to individuals eligible to enroll, 
                particularly Federal employees and annuitants; and
                  (C) the extent to which each alternative might affect 
                the relative competitiveness of the various carriers 
                and plans currently participating in the Federal 
                employees health benefits program (including as a 
                provider of supplemental benefits);
          (9) a recommendation from the Office as to its preferred 
        method or methods for providing those additional benefits; and
          (10) any proposed legislation or other measures the Office 
        considers necessary in order to implement any of the foregoing.
  (c) Screening for Glaucoma.--For purposes of this Act, the term 
``vision benefits'' includes benefits relating to screening for 
glaucoma.

  Amend the title so as to read:

      A bill to require that the Office of Personnel Management 
study current practices under which dental, vision, and hearing 
benefits are made available to Federal employees, annuitants, 
and other classes of individuals, and to require that the 
Office also present options and recommendations relating to how 
additional dental, vision, and hearing benefits could be made 
so available.

                     COMMITTEE STATEMENT AND VIEWS

Purpose and summary

    H.R. 3751 would require the Office of Personnel Management 
(OPM) to study and evaluate options under which increased 
coverage for dental, vision, and hearing benefits could be made 
available to participants in the Federal Employees Health 
Benefits Program (FEHBP) and to present those findings in a 
report to Congress within 6 months of enactment.

Background and need for legislation

    The FEHBP provides health insurance benefits to nearly 9 
million federal workers, retirees and their families. While the 
FEHBP offers the widest selection of health plans in the 
country, enabling enrollees to compare the costs, benefits, and 
features of different plans; coverage of dental, vision and 
hearing benefits are not a significant part of the basic health 
insurance packages offered.
    Around 1987, OPM, which administers the FEHBP, stopped 
allowing plans to add new dental, vision and hearing packages 
or to increase packages they already had in place. The stated 
reasoning for this decision has been the belief that providing 
these benefits could lead to much larger premium increases or 
tradeoffs in the traditional areas of hospital, surgical, and 
medical benefits, which provide protection against significant 
and largely unforeseeable health care expenditures.
    In recent years, other health benefits, such as 
contraceptives, mental health aid, and long-term care 
insurance, have been added to the FEHBP. Today, an overwhelming 
majority of private-sector plans provide dental and vision 
coverage. In addition, according to focus groups and a recent 
survey conducted by OPM, federal employees and annuitants 
desire better dental, vision and hearing care coverage more 
than any other benefits. In addition, most federal employees 
now have the option of establishing Flexible Spending Accounts, 
which enable them to put away more tax-free money for health 
care needs.
    In light of these recent trends, the time has come to 
determine how best to add coverage for dental, vision and 
hearing care to the insurance options provided under the FEHBP. 
H.R. 3751 seeks to begin a collaborative process by which 
Congress and the Administration can develop an appropriate and 
cost-effective solution to the need for these benefits.

Legislative history

    H.R. 3751 was introduced by Subcommittee Chairwoman Jo Ann 
Davis on January 30, 2004. Following mark-up by the 
Subcommittee on Civil Service and Agency Organization on March 
17, 2004, the Committee met in open session on April 1, 2004, 
and by voice vote, ordered the bill favorably reported to the 
House of Representatives.

                           SECTION-BY-SECTION

Section 1

    Section 1 outlines the required content to be included in 
the report to Congress, which must be submitted no later than 
six months following enactment of the legislation. These 
requirements include a description of the coverage currently 
available for dental, vision and hearing care under the FEHBP, 
a description of the supplemental plans offered by carriers who 
participate in the FEHBP, a description and assessment of the 
various delivery methods through which these benefits could be 
provided, and the estimated cost and impact to carriers of 
these changes.

                       EXPLANATION OF AMENDMENTS

    The provisions of the substitute are explained in this 
report.

                        COMMITTEE CONSIDERATION

    On April 1, 2004, the Committee met in open session and 
ordered reported favorably the bill, H.R. 3751, as amended, by 
voice vote, a quorum being present.

                             ROLLCALL VOTES

    No rollcall votes were held.

              APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

    Section 102(b)(3) of Public Law 104-1 requires a 
description of the application of this bill to the legislative 
branch where the bill relates to the terms and conditions of 
employment or access to public services and accommodations. 
This bill studies options for increasing benefits under FEHBP. 
Legislative branch employees and their families, are eligible 
to participate in FEHBP. To the extent that they are otherwise 
eligible for the benefits under FEHBP, legislative branch 
employees would have equal access to future improvements to the 
program.

  STATEMENT OF OVERSIGHT FINDINGS AND RECOMMENDATIONS OF THE COMMITTEE

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are reflected in the descriptive portions 
of this report.

                   CONSTITUTIONAL AUTHORITY STATEMENT

    Under clause 3(d)(1) of rule XIII of the Rules of the House 
of Representatives, the Committee must include a statement 
citing the specific powers granted to Congress to enact the law 
proposed by H.R. 3751. Article I, Section 8, Clause 18, the 
Necessary and Proper Clause, of the Constitution of the United 
States grants the Congress the power to enact this law.

                     FEDERAL ADVISORY COMMITTEE ACT

    The Committee finds that the legislation does not establish 
or authorize the establishment of an advisory committee within 
the definition of 5 U.S.C. App., Section 5(b).

                       UNFUNDED MANDATE STATEMENT

    Section 423 of the Congressional Budget and Impoundment 
Control Act (as amended by Section 101(a)(2) of the Unfunded 
Mandate Reform Act, P.L. 104-4) requires a statement whether 
the provisions of the report include unfunded mandates. In 
compliance with this requirement the Committee has received a 
letter from the Congressional Budget Office included herein.

                           COMMITTEE ESTIMATE

    Clause 3(d)(2) of rule XIII of the Rules of the House of 
Representatives requires an estimate and a comparison by the 
Committee of the costs that would be incurred in carrying out 
H.R. 3751. However, clause 3(d)(3)(B) of that rule provides 
that this requirement does not apply when the Committee has 
included in its report a timely submitted cost estimate of the 
bill prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act.

     BUDGET AUTHORITY AND CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause (3)(c)(3) of rule XIII of the Rules 
of the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee has received 
the following cost estimate for H.R. 3751 from the Director of 
Congressional Budget Office:

H.R. 3751--A bill to require that the Office of Personnel Management 
        study current practices under which dental, vision, and hearing 
        benefits are made available to federal employees, annuitants, 
        and other classes of individuals, and to require that the 
        office also present options and recommendations relating to how 
        additional dental, vision, and hearing benefits could be made 
        so available

    H.R. 3751 would direct the Office of Personnel Management 
(OPM) to study current dental, vision, and hearing health 
benefits offered to federal employees through the Federal 
Employees Health Benefits Program and recommended improvements. 
The bill would require OPM to submit recommendations to the 
Congress within six months of enactment.
    CBO estimates that implementing H.R. 3751 would have no 
significant impact on the federal budget. Based on information 
from OPM, we estimate that the cost to complete and distribute 
the report would be less than $500,000, assuming the 
availability of appropriated funds. Any potential costs for 
changes to federal health benefits would be subject to future 
legislation because H.R. 3571 would only require a study with 
recommended improvements. H.R. 3751 would not affect direct 
spending or revenues.
    H.R. 3751 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Matthew 
Pickford. This estimate was approved by Peter H. Fontaine, 
Deputy Assistant Director for Budget Analysis.

 ADDITIONAL VIEWS OF REPRESENTATIVES HENRY A. WAXMAN AND DANNY K. DAVIS

    We support H.R. 3571 to require the Office of Personnel 
Management (OPM) to study the feasibility of including vision, 
dental, and hearing benefits as part of federal health 
insurance plans.
    Originally, the bill only covered vision and dental 
benefits. At the Subcommittee markup, Representative Danny 
Davis offered an amendment, which was accepted, to require OPM 
to study the feasibility of providing hearing benefits to 
federal employees, retirees, and their families. Like vision 
and dental benefits, most insurance plans do not provide 
hearing benefits, such as coverage for hearing aids.
    Currently, over 28 million Americans suffer hearing loss, 
half of whom are under the age of 50. Hearing loss is not just 
a problem affecting adults. Thirty-three children are born 
everyday with some form of hearing loss. With early detection 
and treatment, these children can be taught in regular classes, 
saving a school system as much as $500,000 during a 12-year 
education.
    Representative Danny Davis also added language to the bill 
to require OPM to include glaucoma screening in its study. This 
amendment is being offered to better understand the need for 
H.R. 3268, which was introduced last year by Representative 
Elijah Cummings. H.R. 3268 would extend the same glaucoma 
screening coverage provided by Medicare to federal employees 
who are in high-risk populations.
    Although we support a study of vision, dental, and hearing 
benefits, a larger issue is the rising cost of health insurance 
premiums. For federal employees, premiums have risen by 10 
percent annually in recent years. More needs to be done to help 
federal employees. Representative Steny Hoyer has introduced 
H.R. 577 to increase the federal government's share of the 
costs of health insurance premiums. It is our hope that the 
Committee will mark up this important piece of legislation this 
year.

                                   Henry A. Waxman.
                                   Danny K. Davis.

                                  
