ACA HEALTH CARE - Personal Stories, The Hippocrates in Congress

"Perks Ease Way in Health Plans for Lawmakers" by ROBERT PEAR, New York Times 11/19/2013

Excerpt

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.

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 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.”