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Members of Congress get the same choices as the rest of us

"My proposal," Obama said today, "would give uninsured individuals and small-business owners the same kind of choice of private health insurance that members of Congress get for themselves." It's worth noting that this is more than a rhetorical flourish. It's Section 1312 of the bill:

(D) MEMBERS OF CONGRESS IN THE EXCHANGE—

(i) REQUIREMENT—Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are—

(I) created under this Act (or an amendment made by this Act); or

II) offered through an Exchange established under this Act (or an amendment made by this Act).

(ii) DEFINITIONS—In this section:

(I) MEMBER OF CONGRESS—The term ‘‘Member of Congress’’ means any member of the House of Representatives or the Senate.

(II) CONGRESSIONAL STAFF—The term ‘‘congressional staff’’ means all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.

By Ezra Klein  |  March 3, 2010; 4:23 PM ET
Categories:  Health Reform  
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Comments

What about committee staff members? Do they get something else?

Posted by: ctnickel | March 3, 2010 4:35 PM | Report abuse

Why not apply this to all federal employees?

Are the exchanges in the final Obama proposal national or state-based? Where does DC fit in?

Do the free-onsite medical staffs and facilities in the Capitol somehow relate to this?

Posted by: JimPortlandOR | March 3, 2010 4:43 PM | Report abuse

I'd be really happy if the government provided the same level of subsidy that federal workers, or better yet members of congress, get when they purchase their insurance to all people buying individual insurance. Getting purchase the same insurance as federal employees is one thing. Being able to afford the premiums when there is no employer subsidizing them is something else.

Posted by: srw3 | March 3, 2010 5:10 PM | Report abuse

This is a dream come true for my Ivy League educated niece, who has successfully avoided a real job in the 4 years since she graduated. Now she'll NEVER have to get a real job. And all you suckers will subsidize her health care. Oh happy day!

Posted by: bgmma50 | March 3, 2010 5:21 PM | Report abuse

If this stays in, most excellent.

Posted by: steveboyington | March 3, 2010 5:23 PM | Report abuse

bgmma50 you really should have a word with your brother or sister about teaching your niece to work or paying her way because anyone can abuse the system and teaching them not to begins at home

Posted by: hector23 | March 3, 2010 5:27 PM | Report abuse

So is FEHBP dissolved and everyone put into the exchanges, or are members of Congress simply removed from FEHBP?

Posted by: Isa8686 | March 3, 2010 5:27 PM | Report abuse

Would this include the Veep since he's President of the Senate?

Posted by: ardurbin | March 3, 2010 5:30 PM | Report abuse

ardurbin - Cheney made it clear that the Vice President is not a member of Congress or the Executive branch.

So I am guessing that Cheney, and now Biden, work for Halliburton.

Posted by: nisleib | March 3, 2010 5:37 PM | Report abuse

Why would members of congress WANT anything other than FEHB?

hector23, I think bgmma50 is just ginning up some resentment about his niece who may well be a graduate student, research, or a teacher or is working for a non-profit or otherwise doing something that bgmma50 doesn't consider "real work" and, combined with her degree, a target for his righteous indignation and resentment?

Posted by: constans | March 3, 2010 5:50 PM | Report abuse

I didn't read it that way at all.

I understood the President to say that if the bill is passed, uninsured people would (in the future) get the same private health insurance choice as members of Congress (currently) get for themselves.

The verb forms "would" (future) and "get" (present) are key here. (If he had said members of Congress "would get" then I might agree with your analysis.)

In other words, what the President said was that uninsured folks will get the choice of many private health insurance plans (presumably in the Exchange) just as MOC now get the choice of many plans in the FEHBP.

But that isn't entirely true, based on the Senate bill. Several of the standard FEHBP plan choices are high deductible health plans (HDHPs) with HSAs.

HDHPs might not be able to the minimum actuarial values required by plans in the Exchange. This is because it is unclear whether HSA contribution amounts are included in the actuarial value calculation of a plan. See Sec. 1302, "The Secretary MAY issue regulations under which employer contributions to [an HSA] MAY be taken into account in determining the level of coverage for a plan of the employer." (Emphasis mine)

If the HSA contributions are not included, then HDHPs could probably no longer be sold in the Exchange(s), because they would likely not meet the minimum actuarial values required for plans to play in the Exchange(s).

Additionally, HDHPs might not be able to meet the minimum loss ratios required under the Senate bill.

Although the President said yesterday in his letter that HDHPs/HSAs could be offered in the Exchange, it's not clear how they would be able to meet the actuarial value and MLR requirements currently in the Senate bill.

Posted by: Policywonk14 | March 3, 2010 5:51 PM | Report abuse

"bgmma50 you really should have a word with your brother or sister about teaching your niece to work or paying her way because anyone can abuse the system and teaching them not to begins at home."

hahaha. It's actually my husband's side of the family, and rather than rely on the questionable efficacy of preaching, I think it would be much more prudent to set up a system that does not invite abuse and subsidize sloth.

Posted by: bgmma50 | March 3, 2010 6:01 PM | Report abuse

*I think it would be much more prudent to set up a system that does not invite abuse and subsidize sloth.*

The problem with the current system is that you can conscientiously put in a good 30-40 hrs/wk of honest work and *still not have health insurance*. That is the reality for a lot of people in this country. But keep grinding that axe of resentment!

Posted by: constans | March 3, 2010 6:10 PM | Report abuse

"I think bgmma50 is just ginning up some resentment about his niece who may well be a graduate student, research, or a teacher or is working for a non-profit or otherwise doing something that bgmma50 doesn't consider "real work" and, combined with her degree, a target for his righteous indignation and resentment?"

Not at all. I'm sure that folks who live in subsidized Section 8 housing would be completely delighted to find out that the taxpayer will, in the future, provide them with housing just like the housing their Senator has, without the inconvenience of having to work for it. I'm sure that folks would be ecstatic if their unemployment check was the same size as their paycheck. And don't even get me started on how deliriously happy it would make Food Stamp recipients to find they could eat filet mignon every day of the week. But most people realize that you have to actually work for that stuff. Or at least you used to have to work for that stuff. Oh Brave New World of subsidized health care just like our Senators have, and we don't even have to do anything to get it. Isn't that nice?

Posted by: bgmma50 | March 3, 2010 6:14 PM | Report abuse

"The problem with the current system is that you can conscientiously put in a good 30-40 hrs/wk of honest work and *still not have health insurance*. "

I have no problem with subsidizing catastrophic health insurance for working people and creating exchanges that will enable them to purchase prepaid health services or health savings accounts at reasonable additional cost. Unfortunately, that's not what these bills do.

Posted by: bgmma50 | March 3, 2010 6:16 PM | Report abuse

Too bad health insurance isn't fillet mignon.

Healthcare should be a fundamental right, not a luxury.

Also, I'd like to know what kind of fake job an Ivy League educated woman can get that doesn't provide her with basic healthcare benefits.

Posted by: flightofheaven | March 3, 2010 6:31 PM | Report abuse

bgmma50, the bills precisely *do* give subsidies to people to purchase health insurance, which is precisely what they should be doing.

But what it sounds like you're angry about is that the health care reform bill is making it easier for working people to access *real* health insurance plans for them and their families once they make too much money to qualify for medicaid.

I consider it sad that people consider having decent health coverage to be some kind of wonderful accomplishment in their lives that they need to jealously guard lest someone else they think is less deserving have access to the same things they do: if you want the pride that comes with exclusivity, go out for a dinner at a pricey restaurant or join a country club.

That one associates having health insurance with "abuse" and "subsidizing sloth" says a lot about what she thinks the place of less fortunate people in our nation should be: and even the position of the fortunate, whom she believes should be in constant fear of losing their health coverage or coming down with conditions that make them uninsurable.... and it's washed down with resentment against people who might have gone to a fancier college than they did.

Posted by: constans | March 3, 2010 6:32 PM | Report abuse

And this is what's funny about the contradictions of the right, which we see in bgmma5: it's a combination of resentment towards the "slothful" poor yet at the same time there is a focus of rage directed at those whom she is convinced must secretly believe themselves to be "better" than bgmma5-- her ivy-league-educated niece whom she is convinced is just WAITING to have someone else pay her health insurance premiums. Opposition to health care reform appears to be a stick that conservatives wield to lash out at the groups they don't like, it seems.

Posted by: constans | March 3, 2010 6:39 PM | Report abuse

constans, you have yet to refute my point that HCR, as envisioned by you and the Democrats, is a disincentive to work for many people. Instead you indulge in series of misperceptions about my philosophy that are as erroneous as your misperception of my gender.

I have purchased insurance in the individual market for my family, and have chosed high deductible insurance. Why should I be forced to subsidize cadillac insurance for other people when I won't buy it for my own family because the cost is ridiculous?

Posted by: bgmma50 | March 3, 2010 6:51 PM | Report abuse

"Also, I'd like to know what kind of fake job an Ivy League educated woman can get that doesn't provide her with basic healthcare benefits." Posted by: flightofheaven

Sigh. Believe it or not, flightofheaven, success in school does not necessarily translate into a good work ethic. And the more of life's necessities that you subsidize, especially on a lavish scale, the less work ethic we as a society will be able to instill in our members. Which is pretty much the point I was trying to make all along.

Posted by: bgmma50 | March 3, 2010 7:04 PM | Report abuse

"Healthcare should be a fundamental right, not a luxury."

Replete with low copays, low deductibles, low out-or-pocket, prescription drug benefits, wellness care, and unlimited annual and lifetime benefits, delivered courtesy of Other People's Money.

It's a slacker's dream come true.

Posted by: bgmma50 | March 3, 2010 7:08 PM | Report abuse

bgmma5, it's pretty rich of you to want everyone to live in constant fear of being bankrupted by medical expenses. As I said, if you want to maintain an aura of success and exclusivity, make money to buy a nice house, join an exclusive country club, and go out to dinner at fancy restaurants. No one should get screwed over by an insurance company that tells you that your chronic condition can't be treated anymore because you'd run up against the lifetime limit.

Similar arguments were made against social security: that if we guaranteed benefits for old people that it would make us as a nation soft and lazy.

But actually it's just resentment: bgmma5 is barely getting by, screwed over by a messed up health insurance system and gets angry at the prospect that other people might end up not getting screwed over by the system and is upset that she won't get the public accolades she deserves for the health insurance she's managed to scrape by on. The shear rage and resentment she has for people who can't get health coverage is really stunning.

Posted by: constans | March 3, 2010 7:20 PM | Report abuse

Admit it, constans, you secretly relish the idea of receiving world class health care without the inconvenience of holding down a full-time job.

Posted by: bgmma50 | March 3, 2010 7:30 PM | Report abuse

Wow, this is the coolest provision ever. Why did I not know about this? Why isn't everybody talking about it?

Posted by: opinionpieces | March 3, 2010 7:32 PM | Report abuse

As I pointed out, bgmma50, the problem is that people who DO have full time jobs nevertheless can't get good health coverage, and even those that have any health coverage risk bankruptcy, recission, or being told that their child's surgery for congenital conditions means that their insurance company will never pay them any more money every again for any condition. I suppose if we lived in a third world country, this would be fine, but given that we are supposed to be the wealthiest country in the world, that doesn't make a lot of sense, or at least line up with the claims that people make about the United States.

If you want to lord your supposed success and superiority over others, I would suggest you go about buying a nice car or something. Stop trying protect your supposed accomplishments by angrily trying to prevent people from getting decent health coverage and care just because there are certain groups of people you want to lash out at. Perhaps you should look at your political beliefs and identity as something other than a seething cauldron of resentments against people that are either poor, or, like your niece, young and hopeful. Just because you're angry, bitter, struggling, and getting screwed over by the individual health insurance market doesn't mean that everyone should suffer and be as resentful as you are. Instead, we should have access to decent health insurance, as is befitting of a country as great as ours.

Posted by: constans | March 3, 2010 7:39 PM | Report abuse

Policywonk,

I'd dispute your claim that HSA's wouldn't meet the MLR requirements. Remember MLR's are a factor of claims divided by premium and while claims go down with HSA's so correspondingly does premium. I think it'd work although there are issues potentially with the actuarial value. Again a lot of this will factor in after the law is written and then how its interpreted by regulators and then in turn how insurers interpret the laws. Still to this day you get nuances in COBRA law and ARRA law that are treated differently by different insurers reading and intrepreting the law in their own context. Its definitely a gray area sometimes.


Oh and I'd love to see this come into play although i'd be really STUNNED if it ever did.


See here:

(D) MEMBERS OF CONGRESS IN THE EXCHANGE—

(i) REQUIREMENT—Notwithstanding any other provision of law, after the effective date of this subtitle

So all they have to do is put in an ammendment to an obscure bill no one is looking at in 2013 and this is all gone.

Posted by: visionbrkr | March 3, 2010 8:38 PM | Report abuse

"you have yet to refute my point that HCR, as envisioned by you and the Democrats, is a disincentive to work for many people."

Look at the countries in Europe with much more advanced universal health care plans than anything contemplated in this bill. There is no "disincentive to work" there, and in fact unemployment all over Europe is significantly lower than in America right now.

The idea that a working person with no insurance would abandon their job because of health care reform, or that some jobless person will be disinclined to seek gainful employment because of subsidized mandatory health insurance, is balderdash.

The increasingly absurd arguments against the extremely modest reforms that this bill will make to the existing private system are encouraging. They are a sign that opponents can see that the tide is turning, and that we finally have HCR by Easter.

Posted by: Patrick_M | March 3, 2010 10:06 PM | Report abuse

Man, I gotta tell my dad, who works 40-odd hours a week at 70 years of age that he's just a lazy ass that should work harder so we can afford health insurance.

And I guess I should go out and find an additional job on top of the job I already have while putting myself through school.

I didn't even know it was as easy as just working harder! Man, why didn't I think of that?

(P.S. Unless you are a legacy student, getting into and getting through an Ivy League school is no joke. I'm not fortunate enough to go, but I do have friends that are going through the process, and I assure you they are not lacking in work ethic.)

Posted by: flightofheaven | March 4, 2010 12:11 AM | Report abuse

"As I pointed out, bgmma50, the problem is that people who DO have full time jobs nevertheless can't get good health coverage blah blah blah blah blah blah."

As I pointed out, I have no problem subsidizing catastrophic coverage for working people and creating exchanges so that they can get obtain the bells and whistles at a reasonable price.


" blah blah angrily blah blah seething cauldron blah blah resentment blah blah angry, bitter, struggling, and getting screwed over blah blah blah blah blah blah"

There's a word for your condition, constans. It's called projection.

Posted by: bgmma50 | March 4, 2010 12:13 AM | Report abuse

Man, I gotta tell my dad, who works 40-odd hours a week at 70 years of age that he's just a lazy ass that should work harder so we can afford health insurance.

And I guess I should go out and find an additional job on top of the job I already have while putting myself through school.

I didn't even know it was as easy as just working harder! Man, why didn't I think of that?

(P.S. Unless you are a legacy student, getting into and getting through an Ivy League school is no joke. I'm not fortunate enough to go, but I do have friends that are going through the process, and I assure you they are not lacking in work ethic.)

Posted by: flightofheaven | March 4, 2010 12:14 AM | Report abuse


"There is no "disincentive to work" there, and in fact unemployment all over Europe is significantly lower than in America right now."

Oh really? All over Europe? Without even bothering to google it, I can tell you that unemployment in Greece and Spain is abysmal.


"The idea that a working person with no insurance would abandon their job because of health care reform,"

Nice try Patrick. The only thing I said about working people with no insurance is that I support subsidizing catastrophic health insurance to help them and further support the creation of exchanges so that they can purchase reasonably priced enhancements.


Posted by: bgmma50 | March 4, 2010 12:34 AM | Report abuse

"Man, I gotta tell my dad, who works 40-odd hours a week at 70 years of age that he's just a lazy ass that should work harder so we can afford health insurance."

You should tell your dad about Medicare.

"And I guess I should go out and find an additional job on top of the job I already have while putting myself through school."

Give your old man a break and sign up for student insurance at your school.

Posted by: bgmma50 | March 4, 2010 12:40 AM | Report abuse

"Man, I gotta tell my dad, who works 40-odd hours a week at 70 years of age that he's just a lazy ass that should work harder so we can afford health insurance."

You should tell your dad about Medicare.

"And I guess I should go out and find an additional job on top of the job I already have while putting myself through school."

Or, you could give your old man a break and sign up for student insurance through your school. It's cheap.

Posted by: bgmma50 | March 4, 2010 12:43 AM | Report abuse

"There is no "disincentive to work" there, and in fact unemployment all over Europe is significantly lower than in America right now."

Links, please.

Posted by: cpurick | March 4, 2010 6:46 AM | Report abuse

"Notwithstanding any other provision of law..."
First, what does that mean? And second, what about "The Office of the Attending Physician to Congress," which costs THEM $503/ea. per year, while arguably costing all of US a lot more? Are we all going to get that?

Ezra, it was funny when you were a starry-eyed kid who actually believed the fairy tales. But when you shill it's just sad.

Posted by: cpurick | March 4, 2010 6:55 AM | Report abuse

Europe's unemployment rates are all over the place ranging from 4.2% to 22.9%. here is the link.

http://epp.eurostat.ec.europa.eu/cache/ITY_PUBLIC/3-01032010-AP/EN/3-01032010-AP-EN.PDF

Posted by: pjjacobs | March 4, 2010 8:17 AM | Report abuse

Having a sense of déjà vu over the suggestion of expanding FEHBP to cover the uninsured? There's good reason. Learn more about potential unintended consequences at http://www.healthcaretownhall.com/?p=1923

Posted by: JEngdahlJ | March 4, 2010 5:42 PM | Report abuse

pjjacobs-

Thanks for the link.

UK -lower than USA

Netherlands - far lower than USA

Scandanavia - lower than USA

France - about the same

So again, stats from countries with real universal paid health care don't show that there is an incentive not to seek employment (compared to our lousy health care system & high unemployment figures).

bgmma50, yes, the economic situations in Greece and Spain are very bad compared to most of Europe. How does that prove your contention that the unemployed will be happy to remain that way if HCR passes?

You are the one who has said "HCR, as envisioned by you and the Democrats, is a disincentive to work for many people" but you have offered precisely nothing that supports that argument.

Posted by: Patrick_M | March 5, 2010 12:23 AM | Report abuse

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