Ask The Advisor: May 2017

Ask The Advisor: May 2017

What Kind Of Health Insurance Do Members of Congress Get?

Q:  Repealing Obamacare would affect several people that I know, including my sister who is getting treated for cancer. She can’t afford to lose her insurance and we both are very stressed about what could happen. I’m wondering about Members of Congress.  What sort of health insurance do they get? Who pays for their health insurance?

A: You may be surprised to learn that Members of Congress, and their congressional staff, receive their employer-sponsored insurance through Obamacare. Their health benefits would also be affected by an Obamacare repeal as well — but unlike your sister and millions of other Americans, Members of Congress already have high quality health insurance to replace their Obamacare plans. In fact, the premium costs of some Members of Congress could go down as they transition back to getting insurance through the Federal Employees Health Benefits Program (FEHB).

Under the Affordable Care Act, or Obamacare, private and public sector large employers are responsible for providing health insurance for employees and contributing toward the cost of insurance. Generally, the federal health insurance exchange is only available for people who can’t otherwise afford to purchase the insurance offered by their employer (according to thresholds set by law). But the fight to pass the 2010 Affordable Care Act was so contentious and controversial that some Members of Congress insisted that their colleagues set an example and be required to have the same coverage as all other Americans.

Members of Congress receive their benefits through the District of Columbia’s small business health options program (SHOP) exchange that was established under the 2010 health law.  Effective January 1, 2014, Members of Congress had to give up their previous health benefits received through the Federal Employees Health Benefits Program (FEHB) and get their insurance through the exchange. However, they remain eligible for employer contributions from the federal government (i.e., U.S. taxpayers) toward coverage, just as they previously received for their FEHB coverage.

Unlike the experience of the general public who access state or federal health care exchanges to choose coverage, the choices offered to Members of Congress are dramatically different than those from many other parts of the nation. For 2017, Members had 57 plan options in “Gold” plans alone on the DC shop exchange. In many areas of the nation, particularly rural ones, Gold plans aren’t even available. Unlike the Silver and Bronze level plans, Gold plans have lower deductibles, and cover 80% of costs with patients paying only 20%.  Silver plans, for example, typically come with deductibles ranging from $2,500 - $5,000, and pay 70% of costs while patients pay the other 30%. And in some areas of the country, people are happy if they have a choice of more than six silver plans. Certain parts of the country have only one.

TSCL opposes any plan to hastily repeal our nation’s health law without an acceptable replacement that ensures affordable quality coverage in place. We urge you to contact your Members of Congress and let them know that an Obamacare repeal that puts your family’s access to healthcare into question is unacceptable.

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