Prior to the passage of the Patient Protection and Affordable Care Act (also known as ACA, or Obamacare), members of Congress received the same healthcare insurance benefits as any other federal employee through the Federal Employees Health Benefits Program, or FEHBP.
During the mark-up of the ACA bill, however, lawmakers inserted a provision (Section 1312(d)(3)(D)) that requires members of Congress and designated congressional staff members to obtain their health insurance through ACA exchanges rather than continue to receive their healthcare coverage through the FEHBP.
As of 1 January 2014, Members of Congress (MOC) and Congressional staff purchase their insurance through the District of Columbia’s small business health options program (SHOP) exchange, also known as DC Health Link. Contrary to popular belief, Congressional members do not receive free health care. As it does for other federal employees who purchase their insurance through the FEHBP, the federal government provides a subsidy equivalent to 72 percent of the weighted average of all FEHBP premiums.
Therefore, MOC and staff pay approximately 28 percent of their annual healthcare premiums through pre-tax payroll deductions.
Although DC's SHOP offers a total of 57 different ACA insurance plans at the bronze, silver, gold and platinum levels, the Office of Personnel Management has ruled that MOC and staff may only receive the employer contribution if they purchase insurance at the gold tier. If we look solely at the District of Columbia's SHOP health plans and federal employer contributions, Members of Congress receive benefits very similar to those enjoyed by any employee of a large company.
The bottom line is this: Members of Congress and their staff members are required by law to purchase their health insurance through the exchanges offered by the Affordable Care Act. However, the federal government subsidizes approximately 72 percent of the premium cost.
Like those late-night Ginzu knife commercials on late-night TV, however: "but wait, there’s more!"
MOC and their staff are also eligible to set salary aside in Flex 125 savings plans, which help the employee pay for healthcare and childcare expenses with pre-tax dollars. If they enroll in high-deductible health plans (which is unlikely, since only the gold plans offer an employer contribution), they can also enroll in health savings accounts. If Members of Congress or staff purchase dental and vision coverage, they pay 100 percent of their premiums through pre-tax dollars. They pay 100 percent of any premiums for long-term care insurance with after-tax dollars.
Again, these benefits are similar to those offered by many large employers. However, there are two areas where Members of Congress (not staff or family members) can receive free or low-cost health care that the average citizen cannot access. The first is having access to the Office of the Attending Physician. For an annual fee (unspecified), MOC can receive limited care for routine examinations, consultations, and certain diagnostic tests.
The second option is also only available to current Members of Congress. In the Capital region only, they may receive free medical outpatient care at military facilities. If they are outside of the Capital region or if they need inpatient care, then MOC must pay 100 percent of the full cost of that military health care.
Finally, upon separation from political life, Members of Congress may purchase FEHBP insurance if they are otherwise eligible for retirement and if they have had five years of continuous healthcare coverage under their DC SHOP plans.
If the Affordable Care Act is repealed, members of Congress have a fallback plan. They would be able to return to the FEHBP. Twenty million other Americans won't.