Tags: Congress | Obama | health

You Get the Health Plan Congress Gets? Not Really

Monday, 07 December 2009 09:43 AM EST

You should get the same health insurance deal that members of Congress get.

That was the gist of President Barack Obama's message as he tried to drum up enthusiasm for his health care overhaul at a Minneapolis town hall meeting a few months ago. But the legislation taking shape now in Congress is no carbon copy of what lawmakers get through the federal employee plan, even if Democrats cite it as their inspiration.

In some cases, benefits under the House and Senate health care bills look like a better deal than what's available through the federal health plan, particularly for low-paid, entry-level workers and their families. Others, such as 50-year-olds, come out ahead in the government employee plan.

It's not an apples-to-apples comparison.

Republican Sen. Charles Grassley of Iowa wants to give Congress and the president a taste of what they're designing for average Americans. "People want Congress to experience what they experience," Grassley said last week as the Senate began work on its health care bill. He plans to offer an amendment that would force lawmakers to leave the federal plan and sign up in new insurance exchanges, the marketplaces for coverage created by the bill.

Government workers and members of Congress belong to the nation's largest employer-sponsored health plan, covering 8 million employees, dependents and retirees. The 30 million people who'd buy coverage in the new insurance markets would be independent actors, even if most would be eligible for government help to pay premiums.

The No. 2 Senate Democrat used the popularity of the plan that now covers lawmakers to taunt Republicans. "I don't find any Republicans who find government health insurance repugnant bailing out of their own health insurance plan that they enjoy as members of Congress," Sen. Dick Durbin of Illinois said on "Fox News Sunday."

There'd be many differences between the new insurance exchanges and the federal employee plan.

For example, the federal employee plan does not cover abortions, except in cases of rape, incest, or to save the life of the mother. But under the Senate bill, health plans could cover abortions if the plans pay out of the beneficiary's own share of the premium. The House bill has strict prohibitions on abortion coverage by plans in the new markets.

If there's a parallel between the two systems, it's the idea of choice.

Like the federal workers' plan, the health care bills would offer broad insurance options, from preferred provider plans to low-premium catastrophic coverage. There would be a government-run plan not available to federal workers.

"The legislation delivers on offering a choice of plans in a similar range to what is offered to Congress," said Roland McDevitt, director of health care research for the consulting firm Watson Wyatt. "Whether it's affordable for all is a different question. There are some pretty substantial subsidies for lower-income people, but middle-income people might still be struggling."

Health care isn't free for members of Congress. They pay premiums, like other government employees. (They also pay a separate annual fee for the services of the U.S. Capitol physician.)

The government contributes a generous share of insurance premiums for its employees. But a senator making $174,000 a year is treated no differently than a custodian making $30,000. They each get the same contribution, assuming they pick an identical plan.

"If you are a low-income fed, you don't get any special subsidy," said Jacqueline Simon, policy director for the American Federation of Government Employees. "We estimate there are about 250,000 federal employees who are uninsured. They're eligible, but they can't afford the premiums."

The Democratic health care bills would offer a better deal for the custodian because government subsidies are aimed at lower income people. Under the Senate version, for example, the custodian would pay about $600 a year for family coverage, while the senator would have to shell out $14,100 for a comparable policy.

That shouldn't be a problem for a senator, but a middle-class family might find itself struggling. A family of four making $66,000 would have to pay $6,100 in premiums under the Senate bill, close to 10 percent of its income.

"The cost is still more than many would like to see," said Gary Claxton, an insurance expert with the Kaiser Family Foundation.

Other big differences set the health care bills apart from the federal employee plan.

In the government plan, employees of all ages pay the same premium. Under the health care bills, plans could charge people in their early 60s up to three times as much as those in their 20s.

Also, the most popular plan for federal employees -- Blue Cross Blue Shield standard option -- is on the rich side of offerings expected in the new markets.

Such differences could be of more than passing interest in the Senate health care debate.

Grassley, the Iowa senator, plans an amendment requiring the president, vice president, members of Congress, executive branch political appointees and congressional staffers to leave the federal employee plan and get their coverage under the new system.

But the exodus would stop short of a populist leveling. Those forced to leave would get a contribution representing what the government would have paid for their premiums, plus an age allowance, according to Grassley aides.

Members of Congress may always be just a little bit different.

Associated Press writer Ken Thomas in Washington contributed to this report.

Federal employees' program: http://www.opm.gov/INSURE/HEALTH/

© Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

You should get the same health insurance deal that members of Congress get.That was the gist of President Barack Obama's message as he tried to drum up enthusiasm for his health care overhaul at a Minneapolis town hall meeting a few months ago. But the legislation taking...
Monday, 07 December 2009 09:43 AM
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