WASHINGTON — Rep. Adam Smith is married, has a 9-year-old daughter and a 6-year-old son, and pays $356 a month for health care insurance with a little dental and no vision coverage.
Despite what conservative bloggers spin about health care coverage for members of Congress being free, it’s not.
The 535 members of Congress are eligible for the same health insurance programs as 8 million other federal employees, retirees and dependants, including nearly 100,000 in Washington.
The plans aren’t all so different from those offered to the nearly 60 percent of Americans who have employer-based insured.
“There is nothing unique about my coverage,” said Smith, D-Wash. “I am employed by a big company, just like those working for Boeing, Starbucks, Costco or Millgard.”
Rep. Rick Larsen, D-Wash., is also on the family plan.
Larsen is married, has two sons, 10 and 13, and pays $365.59 a month for his insurance, with a $600 annual deductible and a $20 per visit co-pay.
“I didn’t run for this job because of the health care plan,” Larsen said. “I recognize the benefits I receive as a federal employee might be better than my constituents or not as good, but I want them to have the same choices.”
Smith and Larsen say a number of their constituents have misconceptions about health care for members of Congress, believing they have a free government-run-forever plan. They and other lawmakers say the issue comes up repeatedly at town hall meetings, letters to the editor and more casual conversations.
Some constituents also believe lawmakers don’t pay Social Security. They do. “There is no special or free health insurance plan for members of Congress,” said Charlie Keller, a spokesman for Rep. Doc Hastings, R-Wash., who pays $356 a month for his health care. “Members of Congress have the option of participating in and paying for the exact same health insurance plans offered to every federal employee.”
But that’s not to say that lawmakers, who make $174,000 a year, don’t have a few perks when it comes to health care and insurance.
Like other federal employees, they have dozens of plans to choose from, involving various levels of care and costing various amounts. The Congressional Research Service estimates federal employees have about 300 different options.
About three-fourths of all workers in the private sector have no choice in medical insurance, either because their companies don’t offer coverage or offer only one plan.
For an extra $500 a year, lawmakers also can receive health services from emergency care to X-rays and checkups at the Office of the Attending Physician in the Capitol. For a fee, they can also get treatment at military hospitals, including the National Naval Medical Center in Bethesda, Md., and Walter Reed Army Medical Center in Washington, D.C.
“This isn’t necessarily a Cadillac plan, but it is nicer than the average person could get,” said Steve Ellis, vice president of Taxpayers for Common Sense, a government watchdog group. “The Capitol physician is like the school nurse. Imagine not having to go to your primary care physician or make appointments for the little annoying medical needs.”
In some ways, though, employer plans in the private sector are more generous.
For individual coverage, private-sector employers typically pay more of the premium than the U.S. government does under the federal plan, according to a 2007 study from the nonpartisan Congressional Research Service.
Citing Labor Department statistics, the CRS said private-sector employers pay 81 percent of the premium for individual coverage and 71 percent for family coverage. The federal plan pays 72 percent of the average premium of all participants. The CRS also said premium increases in the federal plans have been smaller than under private-sector employer-based plans, an average of 7.3 percent a year vs. 10.5 percent over the past 10 years or so.
Because of the federal program’s size, the largest in the nation, there is competition between the insurance companies participating. Also, the federal program bars insurance companies from denying coverage to workers with pre-existing conditions, and the plans are portable so participants are still covered even if they move from Washington, D.C., to Washington state.
Democrats liken the federal program with all its options and regulations to the health insurance exchanges they have proposed as part of the overhaul bills being considered by Congress. The exchanges would make it easier for individuals and employers to shop for health insurance.
“The point of this debate is to focus on reforming health care by lowering costs and increasing choice and quality,” said Rep. Dave Reichert, R-Wash., who pays $469 a month for health, dental and vision coverage. “Members pay premiums and participate in employer-based plans like other Americans but have a choice of plans because of the large number of federal employees.”
President Obama has promised that under his health care proposal, “You will be able to get the same kind of coverage that members of Congress give themselves.”
Republicans have sought to take him up on that promise.
Earlier, Reichert, a member of the House Ways and Means Committee, supported a measure that would have required members of Congress to participate in any new system created by the health care bills under consideration in Congress. That measure was defeated in committee.
“Congress should only consider health care reforms that they would willingly accept for themselves and their families,” Reichert said.
California Rep. Darrell Issa, the leading Republican on the House Committee on Oversight and Government Reform, has been even more direct. Issa introduced legislation that would give Americans access to the same health care programs members of Congress and federal employees have.
“I’m sure it’s not perfect but it’s a concept people understand,” said Kurt Bardella, a Republican spokesman for the committee.
Democrats are also playing the angles.
Sen. Barbara Boxer, D-Calif., a strong supporter of including a government-run option in any reform package, wants to know how many senators are participating in the federal health care program while opposing a public option.
“I want to know because so many of my colleagues say a public option is terrible,” Boxer said. “I’m curious as to whether they’ve chosen a public option for their health care or they’ve gone outside to get it.”
-- Les Blumenthal: 202-383-0008; firstname.lastname@example.org