Prior to Obamacare, members of Congress and their staff were covered by private health insurance provided through the Federal Employees Health Benefits Program. Now they must shop for insurance on an Obamacare exchange.
We dispel rumors that Congress is somehow exempt from the Affordable Care Act (ACA). We set the record straight.
What Do They Get Covered For?
Before the passage of Obamacare, Members of Congress received traditional federal employee health benefits packages through the Federal Employees Health Benefits Program. Rumors about free healthcare for life began circulating shortly before passage of the Affordable Care Act.
Under the Affordable Care Act (ACA), Members and their staff were mandated to obtain health coverage through an exchange. DC Health Link serves as the District’s insurance marketplace offering 57 different plans in its small business marketplace subsidized by 72 percent federal funding.
As well as offering an on-site small business exchange, each House and Senate also has an Attending Physician Office dedicated to meeting Members’ health care needs. The Capitol Medical Office provides basic medical services but should not be seen as a primary care physician. However, it should not be used to cover out-of-pocket expenses such as routine checkups or prescription of medication. If an emergency arises, members and their families can be admitted free of charge into one of two military hospitals (Walter Reed Army Medical Center in Washington D.C. or National Naval Medical Center in Bethesda Md.).
As part of their standard employer-provided insurance plans, members and their staffs can take advantage of dental and vision coverage as well as flexible spending accounts and tax-free contributions to retirement savings plans.
Numerous members have decided to abandon DC Health Link insurance for personal plans or Medicare instead, perhaps out of animus towards the Affordable Care Act or because they can negotiate better coverage with their private employers.
On the other hand, many Democrats have chosen to enroll in DC Health Link so as to gain access to affordable health insurance plans, with Democratic lawmakers accounting for more enrollments than Republican ones. Furthermore, personal financial disclosures of members indicate they hold assets related to healthcare at roughly the same rate as people outside Congress.
Are They Exempt from the Affordable Care Act?
Although it is untrue that members of Congress receive free health care for life, they do not enjoy unfettered access to it and should purchase coverage regardless. Prior to 2014, most Congressmembers and their staff were covered under the Federal Employees Health Benefit Program; this has since changed due to the Affordable Care Act (ACA), which now mandates large employers such as Congress provide their workers insurance through health exchanges – thus including members as well.
In fact, the Affordable Care Act took pains to require congressional staffers to purchase health insurance through DC Health Link; an amendment sponsored by Iowa Senator Chuck Grassley made Congress one of the only large employers who were forced to switch from private insurance plans to health exchanges.
Members and their staff do not pay full price for their health coverage, which is subsidized by the government and has actually become cheaper compared to people outside Congress purchasing health care through exchanges. Furthermore, members and their staff can take advantage of all federal employee dental and vision benefits as well as flexible spending accounts or long term care insurance options available to them.
There have been some members who declined their exchange coverage as a political statement against Obamacare; these individuals will not need to purchase another plan when their current one expires. It should be noted, however, that most Republican members of Congress support an alternative bill called Better Care Act which includes similar arrangements for members and staff of Congress.
Of course, members of Congress also make contributions to the Federal Employee Retirement System and pay Social Security and Medicare taxes. After five years in service or more they may qualify for a pension based on what they put into these systems.
Do They Have a Special Plan?
Many Americans may worry about the cost and long-term security of their employer-related health benefits, while senators aren’t concerned. According to one recent study, members of Congress and their staffs enjoy special access to healthcare that would otherwise not be available elsewhere in the nation.
Congress members, unlike ordinary federal employees who receive pay based on average cost of labor, can choose their healthcare plans from the Obamacare exchange. As of 2017, there were 57 gold tier plans available through ACA exchange for Congress members to obtain coverage; choosing any other plan outside ACA exchange would require congressional employees giving up their FEHB employer contribution which covers 72%-75% of premium costs on typical plans sold outside DC exchange.
According to The Washington Post, most members of Congress and their staff purchase gold-level policies from the Affordable Care Act exchange, with federal subsidies covering 72% of their costs. Coverage provided by Office of Attending Physician of United States Capitol for which an annual fee must be paid; members can also get free outpatient care at military hospitals in DC area; however inpatient care charges set by Department of Defense apply.
According to The Washington Post, members of Congress – as well as their families – can get free vaccinations against diseases like measles, tetanus, diphtheria and whooping cough. Furthermore, they have access to the Capitol’s private medical facility staffed by contract physicians who offer surgery or dental care, although prescriptions must still be obtained separately at their own expense.
Though many of these benefits have caused outrage among taxpayers, it’s essential to remember that Congress laws and regulations affect us all directly – trying to change America’s health care system while exempting yourself would be an unacceptable breach of trust with society at large.
Do They Have to Pay Their Own Medical Bills?
Senators must purchase health insurance from the same providers as regular Americans do and pay their own medical bills; there are no special exemptions or exceptions from the Affordable Care Act available to them as is often the case with regular people. Should lawmakers try imposing any new health care system while exempting themselves, Americans would rightfully be outraged by such actions.
Prior to Obamacare, members of Congress and their staff were covered by a federal plan similar to what large employers might provide their employees. The Federal Employees Health Benefits Program offered various private health plans from more traditional fee-for-service options like Blue Cross/Blue Shield to less expensive managed care plans like regionally based health maintenance organizations; additionally it was portable so if a congressional staffer changed jobs they could take their plan with them.
Members and staffers of Congress now must purchase their own health care coverage through DC Health Link, the federal exchange. According to a report by the Congressional Research Service, you may choose among plans with either nationwide networks or local ones serving your work location. Retirees can still access their pension benefits while receiving limited health benefits associated with working for Congress.
Current members can continue receiving healthcare through either the Federal Employee Health Benefit Plan (FEHB) or by purchasing private coverage on the federal exchange, although purchasing individual coverage through this latter method requires more work because the Affordable Care Act mandates small groups use their own marketplace, with subsidies only provided based on income eligibility. But should it be repealed without being replaced, that solution may no longer be available to lawmakers and their staffs.
Senators and representatives who make personal financial disclosures reveal significant investments in the health care sector, prompting concerns that their personal investments could influence how they vote on health care legislation and monitor this industry.