For Congress, healthcare plans remain a notch above


WASHINGTON — Trying to align lawmakers with the people they represent, Congress three years ago decided that when the new healthcare plan took effect, members would give up their platinum health benefits and enroll in the online marketplaces created for millions of other Americans.

In typical congressional fashion, however, things have not worked out exactly as advertised.

While many members of Congress are indeed signing up for health coverage through the District of Columbia exchange — which was designated as the provider for all members — their experiences have been significantly better than those of average consumers in several respects, including more generous benefits packages, VIP customer service from insurers and the same government-subsidized premiums they’ve always enjoyed.


It’s a far cry from the experience of millions of other Americans, who have been frustrated by a crash-prone federal website, policy cancellations and confusion over the new program.

PHOTOS: The battle over Obamacare

Some lawmakers are avoiding President Obama’s healthcare law altogether by getting their health benefits elsewhere. Sen. John McCain (R-Ariz.) qualifies for coverage as a veteran. Sen. Dianne Feinstein (D-Calif.) gets insurance under her husband’s plan.

More than a third of senators, and a quarter of House members, are 65 or older, making them eligible for Medicare.

A few Republicans have boycotted the exchanges on principle because they oppose the president’s program. Others are embracing the chance to enroll — with all the potential difficulties — because doing so can give them fodder for their fight against the law.

House Speaker John A. Boehner (R-Ohio), a staunch opponent of the program, posted online about his troubles signing up with the District of Columbia exchange. “Kept at it,” Boehner wrote, after documenting the various error messages he encountered during the process.

Rep. Paul D. Ryan (R-Wis.), the 2012 Republican vice presidential nominee, told a local radio host last month that he was kicked off the website three times when he tried to sign up his family. After calling the help line, he was disconnected, he said. “I still can’t get on,” he said then.

But the griping, which has largely broken down along partisan lines, has served to mask the VIP treatment lawmakers have received.

Though most District of Columbia residents seeking coverage under the Affordable Care Act have 34 individual plans to choose from, lawmakers can pick from 112 “gold” plans. In order to more closely match the generous benefits package to which they are accustomed, lawmakers are treated as “small businesses” rather than individuals.

PHOTOS: 2013’s memorable political moments

The four major insurers with plans available to the congressional pool are aggressively courting their business, providing glossy promotional materials with helpful comparisons of new and old options. Staff and lawmakers receive in-person counseling in the Capitol complex to assist with their questions. All four insurers offer dedicated hot lines exclusively for members of Congress.

Congressional aides insist that the briefings for lawmakers and staff are no different than what would be offered by other large employers. Richard Sorian, a spokesman for the district’s exchange, said the agency was conducting the same enrollment sessions at the Capitol that it had elsewhere in the district.

But others counter that special accommodations have been made for lawmakers and their staff. Originally, a provision by Sen. Charles E. Grassley (R-Iowa) required all lawmakers and their staff to enroll in online exchanges, but over time the mandate was revised and watered down.

Instead of requiring participation, the rules now state that lawmakers and staff who wish to continue receiving subsidies to help pay for their premiums — as much as 75% of the monthly cost — should get insurance next year from DC Health Link, the district’s exchange.

In another variation from the original Grassley proposal, the final regulations gave lawmakers the ability to exempt certain staff members. As a result, staffers who work for congressional committees or leadership offices may keep their old health plans, while those who work directly in a lawmaker’s office are directed to the exchange.

Growing attention to the special treatment for Congress has some members taking steps to inoculate themselves against any public backlash.

The Senate minority leader, Mitch McConnell, is enrolling through the D.C. exchange. But the Kentucky Republican, seeking to ward off a conservative primary challenger and a well-funded Democratic opponent, says he will donate the value of his federal premium subsidy to charity.

Many threatened Democrats, worried about political fallout from their support for Obama’s healthcare law, are also facing pressure to give up their government subsidies in order to demonstrate solidarity with constituents.

On Veterans Day, from his home in Anchorage, Sen. Mark Begich of Alaska signed up for a Blue Cross plan using his own state’s healthcare exchange — thus giving up the federal subsidy he would have received by signing up through the Washington marketplace.

His individual plan carries a monthly premium of $594 — a higher price than what he could have gotten on the D.C. exchange, but one that he hopes brings some added credibility with voters.

“I want to have the exact same experience and go through the same steps as other Alaskans when it comes to signing up for healthcare,” Begich said in a statement issued by his office.

Other Democratic colleagues on the ballot next year appear to be following the same blueprint. Sens. Kay Hagan of North Carolina, Mark Pryor of Arkansas and Mary L. Landrieu of Louisiana, who along with Begich are key red-state targets for Republicans, have said they will enroll in their home-state exchanges rather than the one in D.C.

“The closer that you are aligned with your constituents the more likely it is that you’re going to understand their issues,” said Dan Mendelson, chief executive of Avalere Health, who said he had consulted with Congress members from both parties on their new options.

He said a number of members he had spoken with were experiencing “sticker shock” at their new rates and benefits.

“Many of the members were shocked at how much out-of-pocket costs they were going to need to assume,” he said. “It’s really the personal understanding of the fact that members of Congress have had a really sweet deal for a really long time.”

Twitter: @mikememoli