New York Times
POSTED: 01:30 a.m. HST, Nov 20, 2013
WASHINGTON » Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges.
That is true. As long as their constituents have access to "in-person support sessions" like the ones being conducted at the Capitol and congressional office buildings by the local exchange and four major insurers. Or can log on to a special Blue Cross and Blue Shield website for members of Congress and use a special toll-free telephone number -- a "dedicated congressional health insurance plan assistance line."
And then there is the fact that lawmakers have a larger menu of "gold plan" insurance choices than most of their constituents have back home.
While millions of Americans have been left to fend for themselves and go through the frustrating experience of trying to navigate the federal exchange, members of Congress and their aides have all sorts of assistance to help them sort through their options and enroll.
Lawmakers and the employees who work in their "official offices" will receive coverage next year through the small-business marketplace of the local insurance exchange, known as D.C. Health Link, which has staff members close at hand for guidance.
"D.C. Health Link set up shop right here in Congress," said Eleanor Holmes Norton, the delegate to the House from the nation's capital.
Insurers routinely offer "member services" to enrollees. But on Capitol Hill, the phrase has special meaning, indicating concierge-type services for members of Congress.
If lawmakers have questions about Aetna plan benefits and provider networks, they can call a special phone number that provides "member services for members of Congress and staff."
On the website run by the Obama administration for 36 states, it is notoriously difficult to see the prices, deductibles and other details of health plans offered by different insurers.
It is much easier for members of Congress and their aides to see and compare their options on websites run by the Senate, the House and the local exchange.
Lawmakers can select from 112 options offered in the "gold tier" of the District of Columbia exchange, far more than are available to most of their constituents.
Aetna is offering eight plan options to members of Congress, and Blue Cross and Blue Shield is offering 16. Eight are available from Kaiser Permanente, and 80 are on sale from the UnitedHealth Group.
Lawmakers and their aides are not eligible for tax credit subsidies, but the government pays up to 75 percent of their premiums, contributing a maximum of $5,114 a year for individual coverage and $11,378 for family coverage. The government contribution is based on the same formula used for most other federal employees.
In debates leading up to passage of the Affordable Care Act, members of both parties suggested that all Americans should have coverage as good as what Congress had. President Barack Obama said in 2009 that people should be able to buy insurance in a marketplace, or exchange, "the same way that federal employees do, same way that members of Congress do."
For decades, members of Congress have received coverage through the Federal Employees Health Benefits Program. They generally like their coverage, but -- like millions of Americans facing the loss of their policies next year -- they cannot keep it.
In the past, if lawmakers did nothing in the open enrollment period, their coverage would automatically continue. This year, by contrast, they must affirmatively pick a plan. Their coverage under the federal employee program will end Dec. 31. If they do not choose a plan via D.C. Health Link by Dec. 9, they will lose the government contribution to their premiums and could lose their right to retiree health benefits as well.
In addition, lawmakers who go without insurance next year may, like other Americans, be subject to tax penalties.
Some congressional aides, especially older employees who face higher premiums, are unhappy about the changes. But some who compare their options on the exchange find that they can save money.
Jacqueline A. Thomas, a 26-year-old legislative correspondent for Rep. Debbie Wasserman Schultz, D-Fla., said she was able to reduce her monthly premium to $60, from $120, by switching to a Kaiser plan from a Blue Cross and Blue Shield plan.
"I'll be paying half as much for comparable coverage," she said.
The congressional workforce is full of young, healthy people like Thomas, precisely the type of customer insurers want to attract.
Congressional aides naturally have a few complaints. Some are confused by the large number of options. When they sign up for a plan online, they get no confirmation, so they are apprehensive. In addition, the website for the local exchange does not display the government contribution for members of Congress and their aides.
It shows, for example, that a couple with one child may pay $1,300 a month for a plan, when, in fact, their share of the premium is only $352; the government pays $948. Local exchange officials said their website had not been set up to calculate premium contributions using the formula required for lawmakers and other federal employees.
One part of the new insurance program is veiled in secrecy. Lawmakers may allow some or all of their employees to keep their current insurance by declaring that they do not work in the "official office" of a member of Congress. Members do not have to disclose such decisions, although some have voluntarily done so.
Thus, for example, a spokesman for Rep. Darrell Issa, R-Calif., said the congressman had decided that all of his staff members, including those who work in his personal office, could stay in the Federal Employees Health Benefits Program and would not have to go into an exchange.
By making it easier to compare the costs and benefits of different health plans, the exchange could make it easier for insurers to compete with Blue Cross and Blue Shield, which has long dominated the market on Capitol Hill.
For its part, Blue Cross and Blue Shield says it can best meet the needs of lawmakers and their aides because its national plans have a large network of providers, including nearly 90 percent of all doctors in the United States.
One perk is not in danger. Lawmakers can receive care from the attending physician to Congress, conveniently located in the Capitol, for an annual fee of $576. And they can get care at military hospitals.