But one overlooked aspect of the Federal Employee Health Benefits Program is that many federal workers go without health insurance for themselves or members of their families.

Meet Lorene Salazar, the mother of Erica and Robert. Salazar, 38, prepares food, serves it and cleans up a canteen in a Department of Veterans Affairs facility in North Little Rock, Ark. Although she makes just $8.56 an hour, Salazar does pay a share of the premium for Blue Cross/Blue Shield coverage on herself.

But she can’t afford to cover her 11-year-old girl and her 9-year-old boy.

So the children are covered by Medicaid.

Private coverage for her kids, both of whom have attention-deficit disorder, “takes too much money out of my check, and I don’t make that much money as it is,” she said. “There’s not much left.”

It’s not certain how many federal workers can’t afford health insurance. Information from the Office of Personnel Management indicates 11 percent of the workforce does not participate in the program. (There are approximately 2 million civilian employees, not including postal workers.) Some of those nonparticipants probably have insurance through a spouse.

The American Federation of Government Employees estimates that 250,000 federal workers cannot afford coverage. “OPM is loath to draw attention to uninsured federal employees, so there has not been a serious attempt to measure the size of this group, as well as its reasons for declining to participate in FEHBP” since the OPM had Gallup conduct a survey several years ago, a union statement said.

Jacqueline Simon, AFGE’s public policy director, said 250,000 is a conservative figure that has probably grown since surveys were done in the 1990s. She said the OPM has not disputed the estimate.

“We think it’s a terrible indictment of the FEHB program that it doesn’t achieve universal coverage of its target population,” she said during a telephone interview. “And we think it’s because OPM hasn’t taken steps to bring down costs and, therefore, the premiums are much higher than they should be given the benefits that are provided.”

Uncle Sam’s portion of the premiums are capped, she said, leaving federal employees to pick up a greater share of the costs when insurance companies raise rates.

The OPM declined to respond directly to Simon’s comments or to questions about the number of federal workers without insurance. All the office would offer is this general statement from its director, John Berry: “There’s no question that increasing health care costs are squeezing Americans in every line of work. Health-insurance reform will offer more stability for those who have insurance and access to affordable coverage for those who don’t — and it will bring down costs for families, businesses, and governments.”

Affordable coverage also can be a problem for federal retirees and the survivors of federal workers. The National Active and Retired Federal Employees Association says there are 338,720 federal retirees — 18 percent of that group — who receive a federal civil service annuity of less than $1,000 a month and 262,058 federal survivors, or 44 percent, who get an annuity of less than $1,000 a month. For those with no other income — and it’s not clear what percentage that is — buying health insurance would be very difficult, said Dan Adcock, NARFE’s legislative director.