With all the rhetoric about giving all Americans the same kind of secure health insurance that Congress has, just how good is that coverage?
The answer: pretty good, but not as good as the coverage provided many employees of large companies or state and local workers.
Senate and House members have been perturbed lately at talk about how good they have it, and not the least of their anger is directed at the White House and Hillary Rodham Clinton, who has been among the most vocal in insisting that all Americans get the same “guaranteed health insurance that you have.”
In a private meeting, members of the Senate Finance Committee-a pivotal panel in passing health-care legislation-urged its chairman, Sen. Daniel Patrick Moynihan (D-N.Y.), to tell Mrs. Clinton to lay off.
It’s not known whether Moynihan passed on the message, but Democrats who favor universal health care are not about to abandon one of their best applause lines.
Sen. Harris Wofford (D-Pa.), who is in a tough re-election fight against a conservative Republican, recently has been touring his home state urging constituents to demand “the same kind of health insurance Congress has arranged for itself.”
The use of the word “arranged” is even more charged, insinuating that those arrangements are somehow privileged.
But several details get overlooked in the heat of debate. The insurance plans available to members of the House and Senate are the same ones available to any federal employee, from a janitor to the president.
While those plans approximate ones offered by large companies and other governments, the difference is that federal employees have more choices.
Most companies offer three or four plans at best, while the government offers 17 fee-for-service plans plus dozens of health maintenance organizations and preferred provider organizations.
A fee-for-service plan lets the subscriber choose any doctor, an HMO restricts choices, and a PPO lets subscribers choose among a set universe of physicians.
That kind of wide choice is one of the key elements of President Clinton’s proposals. The Senate Labor and Human Resources Committee was one of the first to include a provision that would allow any citizen to participate directly in the Federal Employees Health Benefits Program, the same one that members of Congress can join.
But ordinary citizens can’t get a couple of things available to the lawmakers. For a $520 annual fee, members of Congress get the services of the Capitol physician for checkups and routine office visits. Recent scandals over congressional perquisites forced Congress to end free doctor visits.
In addition, Congress members have access-just like the president and Cabinet officials-to military hospitals such as Walter Reed Army Medical Center and the National Naval Medical Center in Bethesda, Md.
Despite the range of health insurance choices, an informal survey and discussions with congressional leaders reveal that by far the most popular health insurance choice for Congress members is an old-fashioned fee-for-service plan, Blue Cross Blue Shield Standard Option.
For the family plan, lawmakers pay $101.25 monthly and the government pays $303.77 a month. That’s close to the nationwide average for workers in large firms.
This is the plan that got House Minority Whip Newt Gingrich (R-Ga.) in trouble when he stated incorrectly that he paid about $400 a month for health insurance. In this instance, the government acts like many large employers, picking up 72 percent of the health insurance premium, while employees pay 28 percent.
Clinton’s health-care proposal would require employers-and presumably the federal government as well-to pay 80 percent of the health-care premiums for its employees.
According to the Employee Benefit Research Institute, the average health insurance premium paid by employers in 1987, the last year for which figures were available, was 79 percent of the total for family plans and 84 percent for individual plans.
That means the government actually makes its employees, including Congress, pay more than the average for the standard Blue Cross-type insurance.
Sen. Edward Kennedy (D-Mass.), who proposed that every American be eligible for the government employee plan, has standard Blue Cross. So do Sens. John D. “Jay” Rockefeller IV (D-W.Va.), Bob Dole (R-Kan.) and Bob Packwood (R-Ore.), and Rep. Dan Rostenkowski (D-Ill.).
Some large employers, especially those with strong union contracts, pay the entire health-care premiums for their employees, although that trend has been diminishing in recent years as health insurance costs escalate.
The Research Institute’s figures show that 22 percent of large firms-those with 100 or more employees-paid the entire premium for family coverage in 1991, down from 29 percent in 1988. But only 15 percent of small employers pick up the whole health insurance tab.
State and local governments have been more generous to their employees. The institute found that 30 percent of them pay the entire health premium.
The City of Chicago used to pay the whole premium for its workers until about four years ago, according to John Holden, a spokesman for the city Department of Finance. “The city still pays the lion’s share but in the last few years we have had to require employees to pick up a portion of the cost,” he said.
The city currently pays 94 percent of the employees’ premium, which amounts to an average of nearly $400 a month per worker, with the employee paying about $25 a month on average.
The State of Illinois pays only 46 percent of the premium, about $150 a month, for an average employee who opts for a fee-for-service plan, according to Mark Schmidt of the Department of Central Management Services.
The second most popular health insurance plan among representatives and senators is the Beneficial Association of Capitol Employees version, which is a modified PPO. Under this plan-chosen by House Speaker Thomas Foley (D-Wash.) and Sen. Paul Wellstone (D-Minn.), among others-a subscriber must generally stick to a specified physician network, but can get some of the costs covered if he or she chooses a physician outside the group.
The monthly premium for family coverage under this plan is $169.09, with the government picking up $306.41.
