What does Congress pay for its health care?

With Congress poised to increase the numbers of uninsured and underinsured as health care costs continue to rise, it begs the question: What kind of deal do lawmakers get?

There’s a lot of confusion about health insurance benefits for Congress. Ask three members, and you’ll probably get three different answers.

That’s because there isn’t just one plan. Like the rest of us, they have choices. Some pay less, others more. And yes, they do get perks, such as access to a low-fee physician at the Capitol, and treatment at military medical centers.

But no, they don’t get even close to free health care.

According to economist Mark McLellan of the Brookings Institute — a century-old D.C. research group generally considered centrist — the average health care package for Congress is “significantly more generous than most Americans are getting.” McLellan did his homework, preparing a report on health care for the Bipartisan Policy Center.

You might see Congress as neither a business nor small, but members and their staff are nevertheless eligible to buy insurance on the D.C. small business health exchange, because each member qualifies as a small business of 50 or fewer employees. Without this perk, their $174,000-plus salaries would make their insurance choices costlier.

Before the Affordable Care Act, federal employees had a really nice plan that just about everybody used. After Obamacare began, some members opted for spouses’ plans, or bought their own on the private market. The rest buy insurance from the D.C. health exchange. So what they pay, and what they get, varies. Definitive numbers and choices are hard to pin down; the Office of Personnel Management doesn’t track it.

Now about the subsidy: Whether you consider it a perk depends upon how you look at it. Those who buy from the exchange also receive, courtesy of taxpayers, a subsidy for premiums, of up to 75 percent. Wow, right? Before you react, note that this is the equivalent of the “employer contribution” for the average insured worker. Most employers share the cost of premiums with employees to roughly the same extent — paying for between 65 and 85 percent of premiums, according to the 2016 Kaiser Family Foundation’s annual survey.

Put that way, the subsidy sticker shock is more a matter of terminology, and the fact that taxpayers are the “employer.”

According to the non-partisan Congressional Research Service and the Kaiser Family Foundation, the most popular member’s choice is apparently a PPO, one with lower deductibles than a typical PPO plan. What do most Members pay for premiums? Compared to non-government plans, federal health insurance premiums tended to be a little higher for individuals, but lower for families. Probably a wash.

Here’s what you don’t see in the numbers. For 50 years before the Affordable Care Act, Congress and federal employees had the FEHBP — the Federal Employees Health Benefits Plan. In reality it wasn’t a single plan; the New York Times once described it as a competitive supermarket offering 300 private health plans. It was very inclusive, and should sound very familiar. No one could be refused based on health status. No one could be charged more due to preexisting conditions. Dependents under 26 were automatically covered.

Yup; those key benefits looked a lot like the ACA. Pretty ironic.

So when the country’s ACA is repealed, some are asking, will the Congress get their old one back?

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Sholeh Patrick, J.D. is a columnist for the Hagadone News Network. Contact her at Sholeh@cdapress.com.