Congress and the Taxpayers: A Double Standard on Health Care Reform? | The Heritage Foundation

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April 16, 1992

Congress and taxpayers: a double standard in health care reform?


Millions of Americans may be concerned about the cost and long-term security of their work-related health benefits. and more than 35 million Americans worry they don’t have any kind of health insurance coverage. but not members of congress, their staff, and other federal employees. they enjoy special health care privileges denied to other Americans.

Members of Congress and other federal employees can choose from dozens of alternative health plans each year, regardless of their families’ health status. And when federal workers move to different jobs within the federal sector, they can maintain coverage under their chosen plan without any break in benefits. they can even keep their chosen plan when they retire. Few Americans enjoy such security in health care.

Congressmen, like other federal workers, understandably like their system. So much so, that buried in many of the major bills to restructure America’s health care system, they exist. provisions that would quietly exempt members of Congress, their staff and their dependents from the effect of each bill. [ref]

Among the bills that exempt members of Congress and other federal employees:

“the healthamerica law”, art. 1227, sponsored by Senate Majority Leader George Mitchell, a Democrat from Maine. This bill would require employers to provide private health insurance for their workers or pay for a public health insurance plan called “Americare.” this is the main measure called “play or pay”. a revised version of s. 1227 was approved on January 22 by the Senate Labor and Human Resources Committee, chaired by Senator Edward M. Kennedy, the Democrat from Massachusetts.

“the health insurance and cost containment law”, h.r. 3205, sponsored by Rep. Dan Rostenkowski, the Illinois Democrat who chairs the powerful House Ways and Means Committee. The bill would also establish a pay-or-play system.

“the pepper commission health care access and reform act”, h.r. 2535, sponsored by Rep. Henry Waxman, the California Democrat who chairs the House subcommittee on health and environment. this bill also proposes to reform the system following the play or pay model. it is based on the september 1990 recommendations of the bipartisan united states commission on comprehensive health care, named the pepper commission in honor of its main congressional sponsor and first chairman, the late representative claude pepper of florida.

“the pepper commission health care access and reform act”, s. 1177, sponsored by Sen. Jay Rockefeller, the West Virginia Democrat who chaired the pepper commission. this is the senate companion to the waxman bill. unlike the waxman bill, it does not specify the financing of the new health insurance system.

the “american health program law”, h.r. 3535, sponsored by Rep. Edward Roybal, a Democrat from California. this bill combines elements of the play or pay approach with a single payer system. Employers are required to enroll their workers in a “qualified employer health plan” or the new US health program. The US health care program would replace the current public insurance systems of Medicare and Medicaid.

It’s not hard to see why some members of Congress are trying to exempt themselves from many of the same health care reform proposals they want to impose on the rest of America, or why they’re simply keeping quiet on the subject. Members of Congress and their staff are currently enrolled in a program known as the Federal Employee Health Benefits Program.

This program, known as fehbp, serves some nine million federal workers, retirees, and their families, including the president, vice president, white house staff, cabinet secretaries, and federal judges.[ref] this makes them the only Americans with a major health care program based on consumer choice within a system of market competition. While far from a perfect system, FEHBP has many beneficial features not found in most existing private sector insurance plans. examples:

personal choice. Most Americans are locked into “one size fits all” company-based health plans, with little or no personal choice over their health benefits. But members of Congress and their staff enjoy a wide range of plan options, from traditional fee-for-service plans like the Giant Blue Cross and Blue Shield, to smaller group plans sponsored by employee organizations, to options less expensive managed care. , such as geographically based health maintenance organizations wos).

  • balance price and benefits. Most Americans don’t have the opportunity to decide which health insurance package offers the best value for money and best meets their needs and those of their families. they must take any plan, if any, sponsored by their employer. not members of Congress. each year they can choose from competitive plans, assess the costs to themselves and their families, and make judgments about quality and price. it is your decision. it is not the decision of a corporate benefits manager whose primary concern is the “bottom line” of the company.
    • portability. Most Americans risk losing health coverage altogether if they change jobs or are laid off, and virtually every job change forces a plan change health of a family. But in the federal system, workers can change jobs while keeping the same plan.
      • retirement security. Many private companies are cutting back on the health care coverage they promise retirees, if they offer such coverage at all. and most Americans cannot continue their private health insurance plan until their retirement years. non-members of Congress and their staff. If they and other federal employees meet certain lenient eligibility conditions, they can continue their family plan at the same premium price until retirement, even if they are eligible to retire at age 55. and, when a federal employee or retiree dies, his or her spouse continues to be covered. in certain cases, even former spouses are covered.
        • lack of red tape. Unlike doctors and patients in other federal health programs, federal and congressional employees, as well as the doctors and hospitals that treat them, do not they are drowning in a sea of ​​regulations. The increasingly unintelligible rules, regulations, and guidelines that plague Medicare are largely absent from the FEHBP.
          • costs under control. fehbp has been a leader in controlling costs, thanks to the ability of members of congress and other federal worker families to “shop for the best value among dozens of competing plans.” During most of the 1980s, average premium increases in the FEHBP were below typical private sector plans. In recent years, even though the FEHBP enrolls 1.5 million higher-cost retirees and dependents and includes progressively higher benefits, the FEHBP’s performance has improved even more. this year, costs for typical business-sponsored plans will increase by about 20%-25%[ref], but average fehbp premium increases this year will only be 8%.[ref]
          • the fehbp is not perfect. But it gives members of Congress a solid foundation of experience on which to build a comprehensive health care system for the United States based on the key market principles of competition and consumer choice. tax credits or vouchers. The Heritage Foundation’s Consumer Choice Health Plan is based on these principles and would give every American family access to affordable health insurance through major changes to the federal tax code. tax relief, particularly tax relief for employer-provided health insurance, with a national system of tax credits or vouchers for families to purchase health insurance and routine medical services.

            Congress is debating the best way to increase the availability of affordable insurance for American families. By introducing market forces on a national scale, Congress could seize the opportunity to address the problems of uninsured Americans through the FEHBP. In particular, Congress could allow the more than 400 plans that already compete in the fehbp across the country to cover Americans who don’t have any insurance, and empower these Americans with tax credits or coupons to help them buy the coverage they love so much. they need, including catastrophic coverage, for themselves and their families. families.

            By building on the principles of consumer choice and market competition that characterize its own health care system, Congress could help restore public confidence in itself and its deliberations on this great public issue. In any event, Congress should not develop one set of rules on health care reform that applies to itself while imposing another set of rules on the rest of America. If members of Congress have the right to freely choose what kind of health care they will have for themselves and their families, at prices they are willing to pay in a competitive market, they should not deny this same right to all other Americans and their families.

            How Major Health Care Bills Exempt Congress

            There are many bills now before Congress that would reform the US health care system through government control or increased government regulation. While these bills would profoundly affect the health care services available to typical families, many of the bills would exempt members of Congress and other federal employees from their core provisions, allowing them to continue using the FEHBP system. These bills fall into two broad categories.

            Category #1: Play or Pay Bills

            Several of the major bills in the House and Senate incorporate a play-or-pay approach to health care reform. Under this approach, employers would have to “play” by providing at least a minimal package of health benefits for employees and their families, or “pay” a new payroll tax to fund an expanded version of Medicaid or a new retirement program. public insurance. for your employees and others who are not in a company-sponsored health plan. the key is how the payroll tax will affect the employer and their employees.[ref]

            Whatever the purported merits of the pay-or-play approach, it would have significant, and in many cases unintended, effects on American workers. for example, when faced with the choice between paying an additional payroll tax or providing health benefits to their workers, many companies simply paid the additional tax, thus laying off their workers from their current plan and moving them to the new insurance plan public. According to the Urban Institute, a Washington-based research organization, a new 7 percent payroll tax would result in 51.7 million Americans covered by an employer-based plan switching to the public plan. According to calculations by the urban institute, moreover, a 7 percent payroll tax would still not cover the costs of a new public program. would be in the red for $36.4 billion per year. to make up the shortfall, the payroll tax would need to be increased further or additional taxes levied on businesses. this would jeopardize the jobs of many Americans.

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            While the play-or-pay legislation could have such serious implications for millions of Americans as being involuntarily transferred to a public health care plan, special provisions on all major play-or-pay bills in capitol hill will free Americans congressmen and other federal employees from such adverse effects. for example:

            “The HealthAmerica Act” (s.1227), sponsored by Senate Majority Leader Mitchell, requires employers, including state and local governments, to provide insurance to their employers. employees or pay for a new public program, “americare”. the bill came out of the senate labor and human resources committee on january 22 and is the main healthcare reform proposal in congress. the americare program would replace medicaid and cover all people who are not covered by private insurance. The bill introduces federal regulation for the insurance industry, which is currently regulated by the states, and specifies minimum benefit levels for public and private plans. The bill also creates a new government agency, the Federal Board of Health Expenditures, to set annual goals or target limits on total spending on health care services. maximum prices for medical services would be negotiated by the board and representatives of health care providers, such as doctors and hospitals.

            how the mitchell bill exempts federal workers: the definition of “employer” under title 11, section 2713 (3)(ii) of the bill specifically states that the definition of “employer” “does not include federal government workers or a subdivision thereof.” meaning: s. 1227 deliberately and explicitly exempts Congress, its employees, and other federal employees, from the requirements that the bill imposes on all other Americans and on the state and local government.

            “The Cost Containment and Health Insurance Coverage Act” (H.R. 3205), introduced by Representative Rostenkowski, also establishes a gambling or payment system. Although similar to the Mitchell bill in most respects, the Rostenkowski bill raises additional funds through an income tax surcharge. and the bill gradually lowers the age of eligibility for Medicare coverage from the current age of 65 to 60. This Medicare expansion will be financed by increases in payroll taxes. The Rostenkowski Bill also places limits on overall national spending on health care by the public and private sectors, as well as on payments to doctors and hospitals.

            how the rostenkowski bill exempts federal workers: title 1, section 101 of the bill amends the internal revenue code to give congressmen and other federal employees an exemption from tax provisions of the bill if they are registered in the fehbp. in addition, title i, part d “-definitions and miscellaneous”, section 2181 (a)(2)(c) of the bill amends the social security law to exclude congressmen and other federal employees affiliated with the fehbp of the provisions governing “employment” as defined in the bill. What it means: The Rostenkowski bill deliberately and explicitly exempts congressmen and other federal employees from the impact of the legislation.

            “The Pepper Commission’s Health Care Access and Reform Act” (H.R. 2535), sponsored by Rep. Waxman, also takes a play-or-pay approach. Like the Mitchell legislation, the Waxman bill requires employers to provide a minimum level of insurance for their employees or pay for a new public plan. Waxman’s new public plan would be funded by contributions from employers and employees, plus increased personal and business income taxes.

            how the waxman bill exempts federal workers: title i, section 101 of the bill amends the social security law by creating a new section 218 1(a) (3)(a), which governs federal employment treatment. this specifically states that the bill’s provisions governing employment do not apply if a person is “enrolled in a health benefit plan under chapter 89 of title 5, united states code…” title 5 it is the federal law that governs the fehbp. meaning: the waxman bill deliberately and explicitly exempts congressmen and other federal workers from the terms of the legislation.

            the “pepper commission health care access and reform bill” (s. 1177), sponsored by senator rockefeller, would also establish a pay-or-play system. The legislation is much like the wax man bill, except that it does not specify the funding source for the new public plan.

            how the rockefeller bill exempts federal workers: section 101 of title i of the bill amends the social security law, so that the language governing the treatment of employment federal and the fehbp is identical to that of the wax man ticket. meaning: like the waxman bill, the rockefeller bill deliberately and explicitly exempts congressmen and other federal employees from the terms of the legislation.

            “the us health care program act of 1991” (h.r. 3635), sponsored by representative roybal, establishes a hybrid of gaming or payment and the single payer system that outlined below. Under the bill, private employers would be required to offer their employees health insurance coverage. The bill would also establish a public health care system known as “America’s Health Program” to replace Medicare and Medicaid, the two great public health care programs. long-term care would also be covered. all current beneficiaries of these programs would be enrolled in the new program, as would any American who did not have employer-based health insurance coverage. the federal government, rather than the states, would therefore regulate the private insurance industry. all health care spending would be capped at a specified portion of gross national product, and the new public program would be funded through a combination of new government premiums and payroll taxes.

            how the roybel bill exempts federal workers: like the waxman and rockefeller bills, the roybal bill amends social security law. under a new section 2181 on the treatment of federal employees, the bill provides that the term “employment” “…shall not be deemed to include service performed in the employment of the united states if, in connection with the performance of such service, the individual is enrolled in a health benefits plan under chapter 89 of title 5, United States Code …… title 5 authorizes the federal employee health benefits program for federal employees and from Congress, which means: The actual bill deliberately and explicitly exempts members of Congress and other federal employees from the impact of the legislation.

            Category #2: National Single Payer Health Insurance Bills

            Several bills before Congress would establish a national “single payer” health insurance system. Although these differ in details, their common characteristic is that the federal and state governments would become the main purchaser of medical services for Americans; they would become the “single payer”. the government would allocate health care resources, set fees for doctors and hospitals, and finance care with new taxes. quality and cost control would be the responsibility of the government and would be enforced through a formidable price-control regulatory regime, government-set health care standards, and fixed (or “global”) budgets for major health care providers . a system would be similar to canada’s.[ref]

            This system would be an even more radical change for most Americans than a play or pay proposition. their fixed budget, for example, limits the supply of health services. this would require the government to determine who receives care, under what circumstances they receive care, and what care they are allowed to receive. there would, of course, be intense political competition for health care resources. In fact, an explicit attempt at such rationing by Oregon for its Medicaid program has led to intense and bitter political battles in which patients and medical providers fight to ensure that their medical conditions or services rank high. high on the priority list. established by the state government.

            Of particular interest to members of Congress and the federal workforce, a national health insurance system would have a dramatic impact on the character and availability of medical services in the Washington, DC metropolitan area. writes the washington post reporter malcolm gladwell, establishing a canadian-style single-payer system means “hospitals and doctors would act differently; certain operations would be impossible to perform, and certain technologies would be unavailable. some people would pay substantially more for health care and some would not receive the health care they once took for granted. [ref]

            If the structure of the Canadian system were adopted, Gladwell estimates that in Washington D.C. area there would be a sharp reduction in hospital capacity from 11,379 beds to 7,695; a reduction in the number of surgical teams performing coronary bypass operations from 11 to 3; and a significant reduction in the availability of sophisticated medical technology.

            While many members of Congress support a single-payer system for the average American, the bills affect federal workers in different ways. But in stark contrast to all major gambling or pay bills, most single-payer bills would abolish the FEHBP and include congressmen and federal workers in a national health insurance system. others would simply make changes to the fehbp, while the fate of the fehbp is unclear on others. for example:

            “The Comprehensive Health Care for All Americans Act” (H.R. 8), sponsored by Rep. Mary Rose Oakar, a Democrat from Ohio, would establish universal coverage through a program of single payer health insurance operated at the state level. Under the Oakar bill, states can administer different health plans, but they must all meet certain minimum federal standards for health insurance benefits. this structure is very similar to the Canadian system based on provinces. states would set their health care budgets and fee schedules for physicians. each state would receive a financial contribution from the federal government to help fund the system.

            what the oaker bill does to federal workers: division a, title v, section 502(b) of the oaker bill states that “no plan can be offered of health benefits under chapter 89…unless the plan is a qualified plan under this division.” In straight English, Oakar’s bill leaves the FEHBP intact for Congress and its employees, but all FEHBP plans would have to meet the minimum benefit standards outlined in the bill.

            “The National Health Insurance Act” (H.R.16), sponsored by Rep. John Dingell, D-Michigan, would establish a single-payer national health insurance program with a set comprehensive health benefits. the bill establishes a federal board to administer the program. would be financed by a national value added tax (VAT).[ref]

            what the dingell bill does to federal workers: the bill is silent on the fehbp.

            “The Medicare Universal Coverage Expansion Act of 1991” (H.R. 1777), sponsored by Rep. Sam Gibbons, a Democrat from Florida, would expand the federal Medicare program to cover the entire United States territory. population. medicare services would increase and the additional cost of the program would be financed in large part by an increase in the medicare payroll tax.

            what the gibbons bill does to federal workers: although the bill says nothing about the fehbp, presumably federal workers are included. the eligibility language is broad. includes under its terms “every person who is a citizen or national of the United States.”

            “the mediplan health care act of 1991” (h.r. 650), sponsored by representative fortney stark, the california democrat who chairs the subcommittee on health of the mediplan committee’s ways and means home. This would extend the Medicare program to cover the United States. population. what the rigid bill does to federal workers: title i of the rigid bill amends the social security law to establish a new “mediplan health benefits” program. Under section 2164(2) of the Social Security Act as amended, FEHBP plans “shall not provide benefits for which payment may be made under this title (MediPlan).” Meaning: The FEHBP would be reduced to providing supplemental coverage similar to “Medigap” insurance for the elderly today.

            The “america health care bill” (s.1446), sponsored by senator robert kerrey, the nebraska democrat, would establish a national system based on state single-payer programs. While most single-payer systems leave no role for private insurance, the Kerrey bill does. according to him, households would be enrolled in a plan operated by the state government or in a private plan certified by the state government. the federal government would set minimum benefit standards for both types of plans. each state would set its own total or “global” budget for health care and set fee schedules for doctors and hospitals. these would apply to both public and private plans. the federal and state governments would jointly fund most of the services provided by these state-sponsored systems. most of the funds would be raised at the federal level. the federal share would be funded by increased personal and business income taxes, payroll taxes, and excise taxes.

            what the kerry bill does to federal workers: title v, section 502(a) of the kerry bill repeals the fehbp. the bill also establishes, under title iv, section 401, a commission to make policy recommendations governing the transition from health insurance coverage for federal employees and retirees under the fehbp to coverage under the new national health insurance system. medical insurance.

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            “The Universal Health Care Act” (H.R. 1300), sponsored by Rep. Marty Russo, Democrat from Illinois, is the leading proposal to establish a national single-payer health insurance system in the Canadian model. the Russian bill would guarantee “universal access” to health care for all citizens. This bill would establish a national health care budget, a wide range of benefits, and flat fees for doctors and hospitals. also introduces a wide range of new taxes to pay for the government’s new health care program, including increases in personal income taxes, corporate taxes, and employer payroll taxes, as well as special premiums to fund health care benefits. long-term care.

            What the Russian bill does to federal workers: All federal and congressional employees and retirees would be included in the new national health insurance plan. section 4 of h.r. 1300 specifically abolished the federal employee health benefits system.[ref]

            “The Universal Health Care Act” (s. 2320), sponsored by Senator Paul Wellstone, a Democrat from Minnesota, is the Senate’s companion measure to the Russo bill. Like the Russian measure, it would create a single-payer national health insurance system on the Canadian model.

            what the wellstone bill does for federal workers: Like the russo measure, the wellstone bill would bring congressional and federal workers into the new national program.

            Regardless of how the merits and drawbacks of a Canadian-style single-payer national health insurance system are judged, the bills sponsored by Kerry, Russo and Wellstone have one appealing feature: They would treat a congressman or senator like any other. another american. his bills would at least not create one system for congress and another for the rest of america. So, in contrast to major play-or-pay bills, which create a double standard – one rule for Congress and other federal workers and another for other Americans – these single-payer bills apply the strong principle of public policy that what is good enough for Americans should be good enough for Congress.

            designing a new health system

            If members of Congress are serious about national health care reform, they should incorporate two fundamental principles into any new national system they create. These principles stem from the need, perhaps better understood by most legislators today than ever before, for members of Congress to treat themselves as they would treat other Americans, and from the experience of their own health care system.

            Principle #1: Congress should not impose any health plan on the American people that it is unwilling to directly impose on itself and all federal employees.

            By routinely exempting themselves from laws such as those governing racial and sexual discrimination and by routinely abusing check writing and many other privileges, members of Congress provoke public anger. Still, while these congressional practices may irritate Americans, they usually don’t affect them directly and personally. Very different are the laws and regulations that govern health care. These have profound consequences for every American family. for members of congress to exempt or insulate themselves, their employees, and other federal employees from laws that would fundamentally change the us. uu. health system would be a serious breach of public trust.

            Principle #2: Create a now national system based on the consumer choice mechanism, which characterizes the fehbp system that is so popular with congressmen.

            Instead of quietly trying to keep the federal consumer-choice health care system for themselves while imposing another system on other Americans, as major play-or-pay advocates would, lawmakers should give ordinary Americans the same type of system they enjoy.

            An interim step toward achieving this principle would be to open the federal employee health benefits program to the millions of Americans who lack health insurance. While debating how to enforce competition and consumer choice across the US health care system, Congress could quickly certify the roughly 400 plans now available on the FEHBP across the country as eligible to enroll Americans without sure.

            This would involve two basic steps. First, the uninsured would be legally required to enroll in any of the competing plans on the same basis as federal employees, including the right to enroll in the plan regardless of medical condition and would be allowed to do so with the same cousin. accused federal employees. Second, these families would receive coupons or tax credits to help them pay for their new insurance coverage. George Bush has proposed a plan that would provide up to $3,750 each year for low-income, uninsured families to purchase insurance, as well as tax benefits for other currently uninsured families who choose to purchase insurance.

            With this reform, today’s uninsured families would have access to good health insurance coverage, in fact, the same coverage enjoyed by their representatives in Congress. as such, they could choose from several financially sound, federally certified plans.

            A more comprehensive approach would be to introduce a national consumer choice system like the one developed by the heritage foundation. This would allow all Americans to enjoy the benefits of consumer choice in health care and eliminate the fear of losing benefits as a result of a job change.

            Coverage for all Americans. Unlike government insurance or mandatory employer health insurance, where government or corporate officials decide what benefits Americans receive, the health plan of choice The Heritage Foundation Consumer Policy would insure all basic American health insurance under free market competition and consumer choice.[ref]

            Under the inheritance proposal, the health coverage available to Americans and the tax breaks for coverage would no longer depend on where you work. meanwhile, consumer choice would control cost in the same way that it does in the rest of the economy. the consumer choice system would be created by ending the multi-million dollar federal tax break available only for employer-based health benefits and using the money to give American families federal tax credits or coupons to help them buy insurance or medical services.

            Under the consumer’s choice health plan, every American family would have to purchase at least a basic package of health benefits and would receive a financial tax credit or coupon to make the purchase affordable. This new tax relief or bonus would also be extended to individuals and families to pay for out-of-pocket medical expenses.

            empower consumers. credit would be provided directly through the withholding tax system, or in the form of a voucher for the poor. the generosity of tax relief for a family would depend on their health care costs compared to family income. By giving all Americans the same tax breaks, regardless of where they work, and giving them tax credits to buy insurance, such a consumer-based system would allow Americans to shop for the best value for their money when buying insurance and health care.

            If companies wanted to continue providing health insurance, they could still deduct the cost of doing so from their taxable corporate income. But with the same tax treatment for all consumers for the purchase of all kinds of health insurance options, the company’s plans would compete on equal terms with different types of health insurance packages, from union-sponsored plans to extended care programs. managed. By introducing consumer choice and stimulating such extensive competition, the heritage consumer choice plan offers Americans the opportunity to control costs within a budget-neutral framework of unprecedented benefit portability.


            Too often, members of Congress exclude themselves and their staff from the legal or regulatory requirements they impose on all other Americans. these special privileges have justifiably provoked growing anger among taxpayers who must pay for congressional benefits. however, other privileges and exemptions do not have a direct and immediate impact on the lives and livelihoods of most Americans.

            The national health reform is different. Changes in the American health care system will affect the quality of life for all American families. therefore, Americans would likely be especially angry if Congress imposed a new health care system on ordinary Americans and then exempted themselves from that system.

            time for the congress to share. The reason many legislators are including such an exemption in their health reform bills is that Congress already enjoys the hallmarks of market-based health insurance reform. Instead of trying to maintain this system while introducing another system to other Americans, particularly one based on higher taxes, central planning, bureaucracy, and rationing, Congress should give the American people a chance to have a health care system like the enjoyed by the congress itself.

            double standards should not be applied. what’s good enough for the american people is good enough for members of congress. Even better: What’s good enough for Congress is good enough for the American people.

            robert e. moffit, doctorate deputy director of domestic policy studies

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