Lawmakers Get 'Generous' Health Plans; Research Finds They Paid Less For Doctors, Received Other Perks

Thursday, Jun 25,2009, 10:19:00 AM Click:

WASHINGTON -- They don't receive "Cadillac" insurance plans, but when it comes to health benefits, studies suggest members of Congress are at least driving the best Buicks on the block.

Congressional lawmakers, embroiled in a debate over how to provide coverage to 46 million uninsured people in the country, paid less at the doctor's office under their own insurance than the national average in 2008 but also shelled out up to 13% more for premiums, the studies show.

Some proponents of overhauling health care, including President Obama, have suggested everyone should be entitled to the coverage members of Congress receive. At a news conference Tuesday, Obama said he wants people to be able to choose their insurance "the same way that federal employees do, same way that members of Congress do."

Mark McClellan, a doctor and economist at the Brookings Institution, said he believes members of Congress are getting a good deal. McClellan helped develop a report for the Bipartisan Policy Center that recommends using lawmakers' premiums as a benchmark for taxing purposes.

"It's significantly more generous than most Americans are getting," said McClellan, who suggests Congress could raise money for a health care overhaul by taxing premiums that exceed those included in their own plan.

Lawmakers' health insurance, which is the same available to all federal workers, is part of the equation. Members of Congress also receive care by a physician at the Capitol for a small fee and treatment at military hospitals -- the same offered to presidents and visiting dignitaries, watchdog groups say.

"They get what bureaucrats get -- plus," said Steve Ellis with Taxpayers for Common Sense.

Lawmakers are wrestling with how to expand insurance coverage and contain medical costs, which could consume 20% of the economy by 2017, according to the non-partisan Congressional Budget Office. Obama has said he wants to sign a health care bill by October.

Like millions of employees, lawmakers choose from a range of private insurers. The U.S. Office of Personnel Management does not track how many members of Congress enroll in individual plans, but a Blue Cross Blue Shield preferred provider organization (PPO) is the most popular for all federal employees, according to the agency.

That Blue Cross plan scored well in an analysis by the non-partisan Congressional Research Service. The report found the federal plan had lower deductibles and co-pays than "typical" PPOs but did not rate as well as an average health maintenance organization (HMO). Most people insured through work, 58%, are in PPOs, according to the Kaiser Family Foundation.

Roland McDevitt, director of health care research for consulting firm Watson Wyatt, which performed the analysis in the report, called the federal plan "slightly more generous."

A Kaiser survey found the average PPO premium for individual coverage was $4,802 in 2008. For a family, the premium was $12,937. The federal plan's premiums were higher ($5,386) for individuals but lower ($12,335) for families, according to the Office of Personnel Management.

The government paid 69% of that premium for a family, less than the 73% average.

"These aren't the wonderful, exemplary plans ... that many people think they are," said Jon Gabel of the National Opinion Research Center at the University of Chicago. "They are not the Cadillac plans."

Lawmakers can also utilize taxpayer-subsidized care at Walter Reed Army Medical Center in Washington and the National Naval Medical Center in Bethesda, Md. Senate Minority Leader Mitch McConnell, R-Ky., had bypass surgery at Bethesda in 2003. Rep. Debbie Wasserman Schultz, D-Fla., battled cancer last year with treatments received at both sites.

Pete Sepp, a spokesman with the National Taxpayers Union and an expert on benefits received by members of Congress, questioned whether those additional perks skew how lawmakers look at health care.

"It sure can't help their perception of what the average consumer has to deal with," he said.