Good Question: What Health Benefits Do Members Of Congress Get?

MINNEAPOLIS (WCCO) — While United States Senators are home for a break, they’re hearing from constituents about the health care bill.

At the same time, WCCO is hearing from you.

Lisa from Brooklyn Center and Dennis from Eden Prairie want to know: What kind of health care benefits do Members of Congress get? Good Question.

“What’s interesting about it, while most people think Congress gets some cushy deal in terms of healthcare, guess what,” says David Schultz, a professor of political science at Hamline University. “By law, they have to buy their health care through the health care exchanges.”

Members of Congress used to have the plan that’s currently given federal employees called the Federal Employee Health Benefits Program (FEHB).  Schultz says that plan is comparable to what a large corporation would offer to its employees.

In 2014, that all changed. When Congress passed the Affordable Care Act, it decided Members of Congress – and their staffs – should be required to get their insurance benefits through the ACA exchanges. Members and their staffs are given the choice of 57 plans through the Washington, D.C. exchanges.  According to Adam Hudson, a spokesman for DC Health Link, that adds up to about 11,000 people.

At the time of the ACA debate, Rep. Tom Coburn (R-OK) said, “What’s good for the goose is good for the gander. If we’re going to create a government-run plan, then let’s put us in it.”

According to the Congressional Research Service, the employer (the government) pays between 72 percent and 75 percent of the premium. That’s slightly more than the average of 83 percent covered by large employers and even with the average of 72 percent covered by small employers.

Some Members choose not to take the employer contribution or choose to donate it.

“It’s not a bad plan and it’s certainly not free and it’s certainly not unlimited in your ability to participate in it,” says Schultz. “It’s subject to the same rules and regulations that everyone else who participates in the exchanges across the U.S.”

Members of Congress, though, do get some added perks.  For an annual fee, Members can go to the Capitol’s Office of Attending Physician for routine care. They can also be treated at Washington, D.C. military facilities for free – as long as it is outpatient care.

For any inpatient care, Members are billed at the full reimbursement rates set by the Department of Defense.

Schultz says if the ACA were to be repealed, it’s likely some members and their staffs would go back to FEHB plans that they used to be offered.

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