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Health Insurance for Congress and Staff: It’s Complicated

DC HealthLink sent representatives to the Hart Senate Office Building to help employees with health insurance enrollment last December. (Photo By Bill Clark/CQ Roll Call)
DC HealthLink sent representatives to the Hart Senate Office Building to help employees with health insurance enrollment last December. (Photo By Bill Clark/CQ Roll Call)

As members of Congress and their staffs head into their second year of enrollment in D.C.’s health exchange, they’ll decide among plans that range from a double-digit increase to a double-digit percent decrease in premiums, even as providers go in different directions that will result in fewer overall plans to choose from.  

Congress accounts for more than a quarter of the 50,520 people enrolled in the D.C. health exchange. As of July 1, there were 12,906 members of Congress and staffers enrolled in DC SHOP plans, according to D.C. Health Benefit Exchange spokeswoman Linda Wharton Boyd.  

It is unclear which of the four carriers providing coverage to Congress is most popular among members and staffers. Boyd said D.C.’s health benefit exchange did not release carrier statistics to the public. But each carrier has taken a varied approach to premiums and the number of plans offered to Capitol Hill workers.  

CareFirst BlueCross BlueShield, the dominant player in the Federal Employees Health Benefits Program, and thus an easy transition for the members and staffers shifting to DC Health Link, has proposed rate increases of 10 percent or more for all of its Small Business Health Option Program plans in 2015.  

Crucial to staffers who live outside D.C., but enroll in coverage through its exchange in accordance with Office of Personnel Management rules governing federal health care under the Affordable Care Act, CareFirst is the only provider to offer in-network provider access in 50 states and all U.S. territories. CareFirst also proposed expanding the number of top-tier plans offered to 18 from the 16 available in 2014.  

Meanwhile, United Healthcare — the insurance carrier that provided 80 of the 112 “gold” SHOP plans — is proposing an across-the-board 8 percent decrease in rates for 2015 and is cutting the number of “gold” plans from 80 to 32.  

“United had a total of 80 gold plans last year, which was widely determined to be too many to facilitate useful analysis and comparisons, so for 2015, they cut back the number of Gold plans to 32,” said Kate Hartig, a spokeswoman for the D.C. Department of Insurance, Securities and Banking, said in an email to CQ Roll Call.  

According to DISB, a 40-year-old enrolled in a preferred provider organization or PPO-style plan would pay an average of $356.18 for coverage through United Healthcare in January 2015 under the proposed rate increase, compared to $431.91 through CareFirst.  

Aetna and Kaiser Permanente, the other two companies offering insurance to Congress on the D.C. exchange, each proposed expanding the number of “gold” plans they offer to 10. Taken as a whole, the proposed changes mean there will be 70 SHOP Gold plans for 2015, compared to 112 in 2014.  

DISB announced the proposed rates last month, with the disclaimer it would review the rates and could make adjustments.  

Aetna, which offers in-network coverage in 43 states plus the D.C. region, has proposed an 14.1 percent decrease in its rates for “gold” PPO-style SHOP plans, and a 1.5 increase in rates for health maintenance organization or HMO-style plans.  

All “gold” plans offered by Kaiser Permanente, the provider with service areas in D.C. and eight states, would increase by 8.7 percent in 2015 under the proposed rates filed.  

The secretary of the Senate’s office treats information on health care enrollment as “private,” according to deputy chief of staff Mark Tratos. Similarly, House Chief Administrative Officer Ed Cassidy indicated during a congressional hearing  in March that his office was avoiding release of numbers related to enrollment because the CAO did not want the data used for political reasons. CAO spokesman Dan Weiser said he could not provide data for this story.  

Last year, three of the four insurance companies — Aetna, Kaiser Permanente and UnitedHealthcare — lowered rates after their initial filing.  

The D.C. government shared a chart  of the proposed rates for 2015 and plans to update the document as the carriers submit changes.  

Hartig cautioned against comparing the 2015 figures directly to its chart  of final approved rates for the current year, since the number of plans vary. Instead, the department has provided a year-over-year comparison  of rate changes for plans that existed in 2014 and 2015.  

Related stories:
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38 House, Senate Republicans Want Lawsuit Against Staff Health Care Contributions
Capitol Hill Feels Pain of Obamacare Sign-Up Troubles
As Open Enrollment Deadline Approaches, Insurers Scramble to Give Staffers Support
Open Enrollment: The Top 10 Things to Consider

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