What Does Reform Do to Your Member of Congress’s Plan?

It’s one of the weirder pieces of snark or vitriol you'll here among those skeptical of the health reform plans moving through Congress. “If this health reform plan is so good,” someone will snarl, “then why do members of Congress make an exception for themselves so they don’t have to participate?” The question is mystifying. For one thing, it’s drop-dead wrong -- the Federal Employee Health Benefits Plan would be affected by health care reform the same way any big employers’ benefits plan would. No exceptions for your Senator. For another, the question misses the larger point -- we’re talking about a reform plan that would actually make your insurance options look more like what your Senator already enjoys.

[Kaiser &] NPR has a good Q&A on how the FEHBP works, but here are the essentials. Every federal employee, be they a postal worker, a paper-pusher, a Cabinet Secretary, or a Senator, is given a menu of insurance plans based on where they live. Some of the plans are national, some of them are regional, but all of them are transparent -- you can compare like to like on coverage. Every plan meets a minimum level of coverage, including primary care and prevention, and no one can be turned away on the basis of pre-existing conditions. The federal government, as your employer, picks up a big chunk of the premiums -- 72% on average, which is equivalent to the average for all private employers who supply benefits. As an extra bonus, most of the standard plans have a cap on your out-of-pocket spending on medical care in terms of co-pays, deductibles, etc.: $5,000 per family for in-network providers and $7,000 overall. The coverage is pretty great, and the costs are relatively low -- the kind of rates you get when you happen to have 8 million members in your plan.

If this plan sounds familiar, it should. It’s the same basic principles as the Health Exchange. Array of private insurance options at affordable rates? Check. Regulations against exclusion on the basis of pre-existing conditions or age? Check. Coverage for primary care and prevention? Check. A cap on out-of-pocket expenses? Check. Putting the choice in your hands to choose what’s best for you and your family? Double check. The idea of giving uninsured Americans the option of enrolling in the FEHBP itself or an FEHBP-like set of options (the Health Exchange) has been at the heart of Democrats’ health care reform proposals since John Kerry ran for president. It’s the controlling idea for the plans offered by Wyden, Edwards, Clinton, Obama and more. Now the Exchange isn’t an identical twin to the FEHBP -- the FEHBP has better cost-sharing, while the Exchange has the public option, which could significantly reduce costs for all the plans in the Echange through competition -- but it’s at least fraternal.

Read it all at Change.org)