Perks Ease Way in Health Plans for Lawmakers

From The New York Times:

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.

      

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.

 

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 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 on 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.

 

[T]he 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, though some have voluntarily done so.

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See also article in The Wall Street Journal entitled "For Lawmakers, Staff, on Capitol Hill, Obamacare Rollout Goes Smoothly - Lawmakers' experience with Affordable Care Act isn't always the same as their constituents'"

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