According to the National Center for Health Statistics, 45.4 million Americans, or 15.1 percent, were uninsured during the first half of 2009, while 58.4 million, or 19.4 percent, were underinsured. In addition, many people fortunate enough to have health insurance still did not get all the care they needed for the premiums they charged.
There are the waiting periods of six months to a year for insured persons with pre-existing medical conditions. Subscribers to employer group plans usually also have to wait a given time before their medical expenses will be considered for reimbursement. Non-traditional treatments, such as acupuncture, massage, and biofeedback are almost always excluded from coverage.
Insurers furthermore do not like to pay for home care and private nursing expenses. Managed care plans limit patients to their own networks of physicians. So unless your family physician and your specialist belong to that network, you will have to pay all or some of the bills for their services.
Unless you can afford high-priced premiums, you would be better off if you got yourself elected to Congress. As soon as you are sworn in, you, your spouse, and your children are welcome to participate in the Federal Employees Health Benefits Program (FEHBP). It offers an assortment of insurance plans from which to choose, including fee-for-service, point-of-service, and health maintenance organizations. All of these plans include prescription drug benefits. There is no waiting period. Unlike many Americans who are denied coverage because of preconditions, our U.S. senators and representatives do not face that problem.
Under the FEHBP, the government pays up to 75 percent of your Congressman’s premiums and has the remaining 25 percent deducted from his/her $12,500 monthly paycheck. Right in the Capitol building, senators and representatives have their own pharmacy while a team of four Navy physicians and nurses in the Office of the Attending Physician (OAP) and its six satellite facilities stand ready to provide routine examinations, flu shots, on-site X-rays and physical therapy, deal with medical emergencies and biological attacks, and may even treat fainting visitors.
Just as important for the health of our federal legislators are the referrals the OAP provides for them to America’s best medical specialists and best hospitals. Congressmen are also eligible for free out-patient care at military facilities in the Washington, D.C., area, including Walter Reed Army Medical Center and Bethesda Naval Medical Center.
Being very important and busy people, Congressmen can potentially get treated without leaving their place of work. They do not pay for the individual services they receive at the OAP, nor do they submit claims through their federal employee health insurance policies. Instead, members pay a flat annual fee of $503 for all the care they receive. The rest of the cost for this on-site care is subsidized from tax revenue. Obviously appreciative of the OAP’s services, Congress is providing $3.8 million for it in next year’s budget.
Recently, however, the Senate Health Subcommittee voted 12-11 in favor of an amendment offered by Senator Tom Coburn, an Oklahoma physician, that would require all senators and their staffs to enroll in any new government-run health plan. Representative John Fleming, a Louisiana physician, proposed the same kind of amendment. If passed, it would no longer exempt Congressmen from any health care plan enacted for ordinary Americans.
Ironically, both Coburn and Fleming have so far indicated that they will vote against any medical insurance reform proposed by the Democratic majority. So if the two lawmakers have their way and there is no health plan to their liking, Congress would retain its privileged health care. Surely, there do not seem to be many more members eager to reduce the benefits they have.
There is, however, one single Congressman, Steve Kagen of Wisconsin, who turned down the insurance he was offered through the Federal Employee Health Benefits Program. Kagen, one of the fifteen physicians in Congress, favors health care reform. He explained why he declined the privileged health insurance available to him: “Until you can make the same offer to everyone that I have the honor of representing, I just don't think it's fair."