Do lawmakers get better healthcare insurance than the people they represent?

A reader asked: Why do members of Congress and state legislators get better healthcare insurance than the rest of us? Why can’t we have what they have?

It seems like a fair question. As it turns out, healthcare plans available to Mississippi’s state and federal lawmakers are not extraordinary, nor are they free, as some believe. Members of Congress do receive some specific perks, but the biggest disparity in coverage is less the result of what lawmakers get than what the state’s lowest income residents do not.

FactCheck.org notes that the healthcare coverage available to members of Congress is not entirely geared toward them, though they do receive those perks, some of which would no doubt be attractive to their constituents. Coverage in general is the same for a member of congress as it is for any federal employee. The biggest advantage is members’ access to on-demand, on-site medical treatment in Capitol-area clinics funded by the U.S. Navy.

Overall, federal employees do have cheaper insurance than millions of other Americans, including some whose employers pay a portion of their premiums and others who are self-employed and must shoulder the full burden. Cost obviously matters: An estimated 25.9 million Americans, or 7.9 percent of the population, do not have health insurance because they cannot afford it, according to 2022 Census Bureau data cited by Forbes.

U.S. Rep. Alexandria Ocasio-Cortez (D-N.Y.) famously tweeted that she paid twice as much for healthcare insurance when she was a waitress as she does as a congressional representative. It is true that waitresses and millions of other non-federal employees are likely to pay more for their coverage, though the disparity is not due to congressional privilege, according to this healthcare analysis site. Members of Congress choose from various healthcare plans available under the Affordable Care Act, and it is illegal for any plan offered on an ACA exchange to raise or lower prices for a specific group, including members of Congress. The fact is, a waitress is likely to pay more for healthcare coverage than any federal employee.

Under the ACA, members of Congress must choose, at a minimum, a plan that has an 80/20 cost sharing split between the government and the insured. According to Snopes.com, congressional members and their staffs pay on average about 28 percent of their annual healthcare premiums through pre-tax payroll deductions. They are also eligible to set salary aside in Flex 125 savings plans, which help pay for healthcare and childcare expenses with pre-tax dollars.

For an annual fee, members of Congress also have access to special clinics in and around the Capitol operated by the Office of the Attending Physician. The Office of the Attending Physician provides members with physicals and routine examinations, on-site X-rays and lab work, physical therapy and referrals to medical specialists from military hospitals and private medical practices, according to this report. When specialists are needed, they are brought to the Capitol or to a satellite clinic, often at no charge. Members can also get outpatient care at military facilities in the Capitol region or pay for treatment at Veterans Administration facilities elsewhere.

Members do not pay for the individual services they receive at the special clinics, nor do they submit claims through their federal employee health insurance policies, according to the same report (which, it should be noted, is more than a decade old — the topic comes up only sporadically). Instead, they pay that flat, annual fee. The rest of the cost is paid by federal funds included in the U.S. Navy budget. A few lawmakers have opted not to use the service, saying it is an unfair to constituents who do not have similar benefits, but supporters say the arrangement is similar to what some employees of large corporations receive, with on-site nurses and doctors available without an appointment or long wait times.

Members of Congress can also continue their healthcare plans after retirement, and should the ACA ever be repealed, could return to a previous federal employee benefits program, an option that 20 million other Americans would not have, according to Snopes.

Members of the Mississippi legislature likewise have better insurance than many of their constituents, almost 12 percent of whom were not insured in 2021, according to the most recent data cited by the Kaiser Foundation. The plans are not otherwise extraordinary unless you take into account that the legislature has refused to expand healthcare coverage for poorer residents through Medicaid.

Legislators’ healthcare plans are difficult to parse through readily available documentation and are rarely the subject of news reports, but this site, for the National Conference of State Legislatures (one of the few that describes such coverage), reports that members have the same healthcare benefits as other state employees. Mississippi pays about 77 percent of health insurance premiums for state employees, according to Ballotpedia. 

All of which means that although state and federal lawmakers are not the beneficiaries of unusually grand — or free — healthcare plans, they are significantly better off than millions of Americans, and the disparity is particularly striking in a poor state like Mississippi, where lawmakers have been stingy when it comes to dispensing federal taxpayer-subsidized healthcare funds.

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Image: Navy officials tour the rotunda of the U.S. Capitol, courtesy U.S. Navy