While millions of Americans are about to be left out in the cold without health coverage, members of Congress enjoy a great health insurance by any standard. House and Senate members are allowed to purchase inexpensive private health insurance offered through the Federal Employees Health Benefits Program.
It’s not a “single-payer” system where the government acts as the one and only health insurance company. According to the Congressional Research Service, the FEHBP offers about 300 different private health care plans, including five government-wide plans and many regional health maintenance organization (HMO) plans, plus tax-advantaged plans.
All plans cover hospital, surgical and physician services, and mental health services, prescription drugs and “catastrophic” coverage against very large medical expenses. There are no waiting periods for coverage and there are no exclusions for preexisting conditions. The FEHBP negotiates contracts annually with all insurance companies who wish to participate. There is plenty of competition for the business; FEHBP is the largest employer-sponsored health plan in the U.S.
And those who don’t like their coverage may switch to another plan during a yearly “open season” period. To help with the choices, FEHBP conducts an annual “satisfaction survey” of each plan with more than 500 members and publishes the results.
And —get this— on average, the government pays 72 percent of the premiums for House and Senate members, up to a maximum of 75 percent depending on the policy chosen. For example, the popular Blue Cross and Blue Shield standard fee-for-service family plan carries a total premium of $1,327.80 per month, of which a congressman pays only $206.29. What a deal!
And it gets better: Members of Congress also qualify for medical benefits that ordinary federal workers do not. They are eligible to receive medical services from the Office of the Attending Physician of the U.S. Capitol. House and Senate members also are eligible to receive care at military hospitals. For outpatient care, there is no charge at the Washington, D.C., area hospitals.
In the fall of 1994, the Clinton Administration’s much debated comprehensive, and complicated, health-insurance bill—known derisively as Hillarycare—died quietly on Capitol Hill. It was a moment that, the Princeton sociologist Paul Starr later argued, would “go down as one of the great lost political opportunities in American history.”
But, before the end, talk of another approach kept bubbling up: to allow those Americans who couldn’t get insurance elsewhere to buy a policy that was just as good, and inexpensive, as what members of Congress got. When Senator Edward M. Kennedy, of Massachusetts, said that Americans should get “exactly what we have,” he meant the Federal Employees Health Benefits Program.
For all its flaws, bumbled launch, and absence of Republican support, the Affordable Care Act (Obamacare), has provided health insurance to some twenty million Americans who didn’t have it before. Republicans have been venomously eager to dismantle it ever since. On Wednesday, the Senate took a big step in that direction by passing a budget “blueprint” that will make it easy for Congress, controlled by Republicans, to repeal the act.
It’s sometimes hard to understand what makes Republican legislators so angry, but here is a theory:
You see, until 2014, members of Congress were covered by private health insurance paid by the federal government with no deductible.
But starting Jan. 1, 2014, House and Senate members, can only obtain employer-subsidized, private coverage through the exchanges established under the ACA.
So their fury may not stem from some ungraspable principle, or hatred of President Obama’s historic victory (or of Obama himself), but, rather, from something personal, and selfish. Under the A.C.A., members of Congress, and congressional staff, among other Capitol Hill employees, were no longer eligible for the F.E.H.B.P.
In the chilly language of government directives, the Office of Personnel Management Web site said that “Section 1312 of the Affordable Care Act requires that Members of Congress and their official staff obtain coverage by health plans created under the Affordable Care Act or coverage offered via an Affordable Insurance Exchange.”
Ouch! In other words, the comfortable choices that were available for more than fifty years were suddenly transferred to the slightly murky passageways of Obamacare. And it follows that, if the Affordable Care Act is repealed, members of Congress would be able to return to the federal plan that they were so fond of.
Twenty million other Americans won’t.
If Congress is serious about repealing, and replacing, the act, then they must find a path to finally offer their beloved, and well-administered, federal plan to the rest of the uninsured nation.
We can almost hear America demanding, “We want what they’re having.”