Congress’ own healthcare benefits: membership has its privileges

Too much, too fast, too expensive. Those are some of the objections lawmakers have voiced against the healthcare overhaul Democrats are attempting on Capitol Hill.

But many Americans think Congress is out of touch. How, they wonder, can lawmakers empathize with the underinsured or those lacking insurance when they receive a benefits package -- heavily subsidized by taxpayers -- that most of us can only envy?

Among the advantages: a choice of 10 healthcare plans that provide access to a national network of doctors, as well as several HMOs that serve each member’s home state. By contrast, 85% of private companies offering health coverage provide their employees one type of plan -- take it or leave it.

Lawmakers also get special treatment at Washington’s federal medical facilities and, for a few hundred dollars a month, access to their own pharmacy and doctors, nurses and medical technicians standing by in an office conveniently located between the House and Senate chambers.


In all, taxpayers spent about $15 billion last year to insure 8.5 million federal workers and their dependents, including postal service employees, according to the Office of Personnel Management.

Generous plans are available in private industry. But the federal coverage far surpasses that enjoyed by 70 million Americans who are underinsured and at financial risk in the event of a major health crisis -- not to mention the estimated 46 million who have no medical insurance.

“For the average worker, the Federal Employees Health Benefits Plan would probably look quite attractive,” said Pete Sepp, a spokesman for the National Taxpayers Union, a pinch-penny advocacy group.

Indeed, a question often surfaces: Why can’t everyone enjoy the same benefits as members of Congress? The answer: The country probably couldn’t afford it -- not without reforms to bring costs way, way down.

Given their choices, lawmakers can tailor coverage in a way most Americans cannot. If a child has asthma, for instance, a federal employee might opt for coverage that costs a little more but has a bigger doctor network and lower office-visit fees.

The plan most favored by federal workers is Blue Cross Blue Shield, which covers a family for about $1,030 a month. Taxpayers kick in $700, and employees pay the rest. Seeing a doctor costs $20. Generic prescriptions cost $10. Immunizations are free. There is no coverage limit.

Federal employees also enjoy a significant benefit denied the average American: There is no such thing as a preexisting condition, which keeps many sick people from obtaining insurance. Once hired, federal workers are eligible for coverage no matter their health, with no waiting period.

Voters sense a disconnect. A recent Gallup Poll found that about half of those surveyed said they have “a good understanding” of the issues involved in the healthcare debate. By contrast, respondents believe that fewer than three in 10 members of Congress share that understanding.


Lawmakers’ ample benefits make a ripe target.

Sen. Tom Coburn (R-Okla.) sponsored an amendment requiring members of Congress to forgo their current health coverage and enroll in any government plan they pass to compete with private insurers.

“Let’s demonstrate leadership and confidence in the system,” Coburn said before his amendment squeaked through the Senate Health Committee. A similar measure was defeated in the House.

A spokesman for Speaker Nancy Pelosi demurred when asked if she would sign up for a government-run plan. The San Francisco Democrat joined President Obama in pushing unsuccessfully for passage of a healthcare bill before lawmakers headed home for their summer recess.


“The point is to give people a choice,” said Pelosi’s communications director, Brendan Daly. “If you like what you have now, you can keep it. If you don’t like it, you’ll have other choices that are available to you.”

Virtually every president since Franklin D. Roosevelt has considered expanded or universal medical coverage. President Eisenhower, a famous cost-cutter, signed into law the legislation giving federal employees their generous benefits. His reasons were partly personal: His mother-in-law’s illness required two years of medical care that took a steep financial and emotional toll on the president. Politically, the hope was to spur more private employers to follow the government’s lead.

Obama, wielding his own prod, opened a recent news conference with a pointed reference to the disparity between lawmakers and those they serve.

“I have great health insurance and so does every member of Congress,” Obama said, noting he also has a doctor standing by around the clock. “This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings.”


Antonia Ferrier, a spokeswoman for House Republican Leader John A. Boehner -- a leading opponent of Democrats’ overhaul efforts -- said the Ohio congressman hears “the exact same concerns that Democrats hear” from constituents.

“There’s no question he wants to do something,” Ferrier said. “He also is concerned, though that, whatever we do, we do it right and don’t exacerbate the economic downturn and make it worse.”

But Rep. Steve Kagen, for one, is skeptical.

The Wisconsin Democrat has refused to accept federal healthcare benefits, making him the only member of Congress to do without. He will continue, he said in an interview, until every American can enjoy the same coverage as federal lawmakers.


Kagen recently had knee surgery, writing checks for more than $4,500 after bargaining for a reduced-rate MRI and a 50% discount on the operation. (He is still dickering over the hospital bill.)

“If every member of Congress put their heads on their pillow every night like I do . . . knowing this could be the night I lose my house, we’d fix healthcare in a week,” said Kagen, who spent decades as a doctor in the Green Bay area before winning office in 2006.

Kagen said his wife and three of his four children have health coverage. But not his oldest daughter, 28, who can’t afford insurance.

She’s a nurse in Miami.






Lawmakers’ healthcare coverage

Here are some of the health insurance options available to members of Congress:

* 10 plan choices with access to doctors nationwide.


* HMOs that provide care in each state (in California, there are 11 options).

* Special treatment at Bethesda Naval Medical Center and Walter Reed Army Medical Center.

* For an extra $300 (House) or $600 (Senate) per month, access to a Capitol Hill team of doctors, nurses and other medical personnel.

* Three-quarters of premium cost paid by taxpayers.


* Coverage regardless of a preexisting condition.

* No waiting period.

* Under the Blue Cross Blue Shield plan favored by a majority of federal employees, a vast array of medical, dental and vision benefits with $20 co-payments for doctor visits. Generic prescriptions are $10 and immunizations free.

Sources: U.S. Office of Personnel Management, National Taxpayers Union