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Congress not exempt from health care law

Posted: Wednesday, June 16, 2010

Is it true that members of Congress are exempt from the provisions of the new health-care act? Such as they're not required to buy insurance?

No, it's not true. All members of the House of Representatives and Senate are subject to the law. They must have insurance and, according to FactCheck.org, those plans must meet the same minimum benefit standards that other insurance plans will have to meet.

Here's the exact language from the Patient Protection and Affordable Care Act:

"Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are-(I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act)."

Members of Congress and their staff currently buy private insurance offered through the Federal Employees Health Benefits Program, which has more than 350 plans that charge different premiums, according to the FEHB handbook.

The government pays up to 75 percent of the member's insurance, the handbook states, and each plan includes hospital and doctor services, as well as coverage for prescription drugs and large medical expenses ("catastrophic coverage"). Like most group plans, there are no physicals required to join, no waiting periods and all pre-existing conditions are covered, according to the Congressional Research Service.

Members of Congress also have benefits that other federal employees don't have, FactCheck.org notes. They can receive (for a fee) some services from the Office of the Attending Physician of the U.S. Capitol, and they can get care at military hospitals. FactCheck.org is a nonpartisan, nonprofit fact-finding project of the Annenberg Public Policy Center at the University of Pennsylvania.

That's pretty good. But under the health-care act, Congress and its staff members must join a plan created by the law, or offered through a health exchange. So, as PolitiFact.com points out, "to our knowledge, members of Congress and their aides are the only people who are being forced to give up their employer's health care plan - in this case, one administered by the federal government." PolitiFact.com is an independent, nonpartisan Pulitzer Prize-winning project of The St. Petersburg Times.

Members of Congress also are not exempt from other regulations under the new health-care law. For example, the act applies a Medicare tax to individuals earning more than $200,000 or couples earning more than $250,000 who file a joint income tax return. Congress members must pay the tax, too, if relevant. Rank-and-file House and Senate members earn $174,000 a year.

FactCheck.org traced the exemption misinformation to John Fund, who used the "E" word in a June Wall Street Journal opinion piece to describe a draft of a Senate committee health care bill. The final version of the Senate bill read exactly as does the language in the law above.

But the misinformation was carried forward by various talk show hosts and is still making the Internet rounds.

By the way, the first family and the vice president's family get free medical coverage from White House physicians, according to Kaiser Health News.

"The personal physicians and access to military hospitals come on top of a choice of 10 family health insurance options that Obama receives along with all other federal employees," Kaiser states. "The president is responsible for his own co-pays and deductibles. Under the most popular plan, a doctor's visit costs $20 and generic drugs are $10."

President Barack Obama has said, however, that he plans to get his health care through the exchange, The Associated Press reported.



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