Question of the Week: Health Care Reform
These questions are culled from phone calls, letters, faxes and e-mails sent to my Thousand Oaks, Solvang, and Washington offices. Each week I will add another question and answer.
Week of August 14, 2009
• Question: Is the government-run option included in H.R. 3200 the same as the health care offered to Members of Congress?
→ Answer: Members of Congress, like all federal employees, are eligible to voluntarily participate in the Federal Employee Health Benefit Program. The federal employee program is private insurance for which I pay part of the premiums, co-pays and deductibles. It does not include a government-run plan.
The Office of Personnel Management, similar to a human resources department in private industry, ensures these plans are financially sound and establishes minimal standards of quality. The federal employee program includes a wide selection of private health care options, including:
• Fee-for-Service (FFS) plans, which may include Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO), and
• High deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums.
Federal employee plans have the flexibility to determine benefits. Under H.R. 3200, the government-run plan would establish a new Health Benefits Advisory Committee, which would determine what health coverage all individuals must have (Section 123(b), pp 28-30).
Like all private insurance plans, federal employee plans must negotiate with hospitals and doctors to determine fair reimbursement levels. The government-run plan created by H.R. 3200 would allow the government to establish reimbursement rates (Section 223(f), pp. 96-97).
There is an attending physician, with an office in the Capitol, who addresses the health care needs of Members of Congress while they are in Washington. However, Members of Congress must pay an additional fee for this service.
During the House Ways and Means Committee markup of H.R. 3200, Rep. Dean Heller of Nevada offered an amendment that would have required Members of Congress to enroll in the new government-run option. The Heller amendment was defeated by a vote of 21 to 18. Members who voted against the amendment included Chairman Charles Rangel of New York and Rep. Pete Stark of California.
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