THE ISSUE: What kind of health plans do the president and members of Congress have, and why can’t everyone have coverage like that?
THE POLITICS: The president, current members of Congress and retirees are entitled to participate in the Federal Employees Health Benefit Program that covers about 8 million individuals and their eligible dependents. It’s the nation’s largest employer-sponsored health-insurance program, offering about 300 choices including fee-for-service plans, HMOs and high-deductible plans.
Like all federal employees, lawmakers pay premiums averaging 28 percent of the total, with the government contributing the other 72 percent. That’s slightly less generous than private-sector plans, where employers cover an average 81 percent for workers and 71 percent for family members, according to the Congressional Research Service.
The plan also offers dental and vision benefits and requires no medical examination or waiting period, and enrollees are not subject to being excluded because of pre-existing conditions. The president also has access to a staff of military doctors who serve the White House. Sensitive to the politics of their pay and benefits, members of Congress are fond of declaring that all Americans should have similar coverage.
WHAT IT MEANS: Democratic proposals in the House and Senate are exploring various options, running from government-run insurance plans to regional cooperatives, that would expand insurance pools and increase the alternatives available to people buying health insurance. There is resistance, however, to expanding the federal role in health-care coverage or setting up a government system, with Republicans and other foes arguing that it might drive private insurers out of business.
— Jim Abrams
