Published on 09 March 2013
Health Care Benefits for Members of Congress: Today and Changes in 2014 under ACA

The subject of health benefits for Members of Congress often surfaces in political debates, with some implying that Members of Congress enjoy lavish healthcare benefits.  Many citizens would be surprised to learn that the health insurance coverage available to Members of Congress is the same series of health plans offered to other federal employees.

However, it’s important to note the House and Senate Members and federal employees receive health insurance coverage more generous than most American’s receive from private employers but less than coverage offered to Medicaid beneficiaries and many state and local government employees.

Members of Congress are able to participate in the Federal Employees Health Benefits Program (FEHBP).  Federal workers and their dependants are also eligible to participate in FEHBP.  In addition, Members of Congress and federal employees meeting certain criteria are able to continue participation in FEHBP into retirement.

Federal Employees Health Benefits Program:

The FEHBP, operated by the federal Office of Personnel Management, is the largest employer sponsored health plan in the country, enrolling over 8 million individuals.  There are over 200 health plans available within FEHBP, including regionally and nationally available plans.  They are divided into 3 categories:

  • Government-wide service benefit plan: This is a fee for service (FFS) plan that directly pays health care providers for services.
  • Employee organization plans:  These are fee for service plans and have small annual membership dues.
  • Comprehensive medical plans:  These are capitated health maintenance organizations (HMOs) and vary by region.

A report by the Congressional Research Service (CRS) compares FEHBP to other employer-sponsored health coverage and explores the additional health resources that are available only to Members of Congress.

FEHBP Compared to Benefits from Other Large Public and Private Sector Employers:

The vast size of FEHBP makes it difficult to draw comparisons of employer-sponsored insurance (ESI) offered by the federal government to that offered by other large employers.  However, there are certain points to note:

  • Choice.  Most federal employees are able to choose from 10 to 15 different health plans within FEHBP.  Of other organizations with more than 5,000 employees:
    • 26% offered one plan.
    • 49% offered two plans.
    • 25% offered three or more plans.
  • Share of premium cost.  The federal government’s contribution to premiums is set at 72% of the weighted average premium of all plans in the program, not to exceed 75% of any given plan’s premium.
    • A survey of large firms found that employers paid 82% of the premium for individual plans and 75% of premiums for family plans.
    • A survey of state and local governments found that on average, employers paid 88% of premiums for individual plans and 76% of premiums for family plans.
    • Starting in 2014 under the Affordable Care Act (ACA), employers with more than 50 full-time employees must provide coverage at least at the 60% level.
  • Coverage in retirement.  Federal employees, including Members of Congress and Congressional staff, are eligible for FEHBP in retirement, and receive the same benefits and costs as active employees.
    • Of large firms that offer health coverage to employees, 25% offer benefits to retirees.
    • 77% of state and local governments with more than 200 employees offer benefits to retirees.

In addition to FEHBP and Medicare (for those age 65 or older), federal employees and Members of Congress are also eligible for several additional voluntary programs:

There are also a few specific healthcare options available only to Members of Congress:

  • The Office of the Attending Physician:  The Office of the Attending Physician (OAP) in located in the U.S. Capitol building and provides basic services, exams, consultations, and diagnostic tests for an annual fee of $576.
  • Military Treatment Facilities Current Members of Congress are eligible to receive medical and emergency dental care at military treatment facilities.  Members incur no charge for outpatient care if it is provided in the National Capitol Region.  Inpatient care and any care outside of the National Capitol Region are billed at full reimbursement rates set by the Department of Defense.
Health Insurance Exchange Coverage for Congress and Congressional Staff:

Starting in 2014, Members of the House and Senate and all Congressional staff must select health insurance coverage from among Qualified Health Plans (QHPs) participating in the new Health Insurance Exchanges (HIX) marketplaces created under the the Affordable Care Act.

And yes, this will be interesting to watch.  Will Congressman, Senators, and Hill staff find Exchanges easy to use?  Will Democrats like what their law created?  Will Republican opponents of Obamacare choose to opt out and buy their own coverage?

About Author

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.

Share

Posted In

Tagged In