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Maybe a dumb question but are clerks and their spouses offered health insurance?

For federal clerks at least, yes.
You get standard non-postal government rates.
Go here to look at the plans and their costs.

Might vary by district/circuit, but they are in every federal jurisdiction I'm familiar with.

ETA https://oscar.uscourts.gov/qualificatio ... y_benefits

Yes, for Feds everyone is offered individual or family health plans, except temporary clerks (less than one year). Also dental and life, but no retirement stuff except for career clerks.