By Mary Love

Since Jan. 1, 2014, all members of Congress and their designated staff have been required to obtain their health insurance through the Affordable Care Act marketplace unless they get insurance through their spouses. Prior to Jan. 1, 2014, all members of Congress and their designated staff qualified for the same health insurance benefits as all other federal employees in the United States through the Federal Employees Health Benefits Program, or FEHBP.

The FEHBP pays approximately 72 percent of every federal employee’s health insurance premium. This payment is known as the employer contribution and is similar to the health insurance employer contribution enjoyed by many employees of large companies in the United States.

For those of us who have questioned how members of Congress get their health insurance, it seems very fair that they are now required to purchase their health insurance through an ACA exchange. If you ask a member of Congress how he or she gets health insurance, the answer is typically, “Through the ACA, just like millions of Americans.” While this is technically true, the real truth lies in the details.

DC Health Link is the exchange residents of Washington, D.C., including members of Congress, use for purchasing an ACA health insurance plan. Based on the Kaiser Family Foundation Calculator, a family of four can earn up to $97,440 and have part of their health insurance premium paid for by an ACA subsidy. Such a family would pay $787 per month, or $9,444 per year, for a silver tier health insurance plan. This family would never pay more than 9.69 percent of their income for health insurance. If a family of four had an income of $97,441 per year, however, it would not qualify for any health insurance subsidy through the ACA exchange. Such a family with adults who are 40 years old would pay $11,949 per year for a silver health tier insurance plan, but if the adults are over 56 years old, the plan would cost $18,008 per year. In other words, if a family earns just $1 over the 400 percent FPL cutoff point, it gets no health insurance subsidy on the ACA exchange and the older the adults, the more costly the family’s insurance.

Now let’s consider a family with a 56-year-old member of Congress, a spouse and two children. The current salary for a member of Congress is approximately $174,000 per year. This salary should make the Congress member’s family ineligible for a health insurance subsidy through the ACA because it is approximately 714 percent of the FPL. But guess what? When members of Congress were transferred to the ACA from the FEHBP in 2014, the federal government’s employer contribution for their health insurance transferred with them. All members of Congress continue to get approximately a 72 percent employer contribution for their health insurance premiums. So instead of paying $18,008 per year for an unsubsidized silver tier plan on the DC Health Link exchange, a member of Congress with a family of four pays $5,042 per year, or $420 per month. Somehow, this no longer seems quite so fair.

When members of Congress say they get their health insurance through the ACA just like millions of Americans, that’s not exactly true. Despite their higher-income salaries, which should disqualify them from any subsidy, members of Congress get super-subsidized health insurance through the ACA. They pay only 28 percent of their premiums while the federal government pays a whopping 72 percent. Oh, and by the way, members of Congress get the 72 percent subsidy for a high-end gold tier plan, not a silver tier plan.

— Mary Love lives in Bend.

16805015