If you have been a consistent reader of our blogs, you have probably noticed that when it comes to health insurance reform, our focus has been on moving the country to a national exchange of private plans akin to the FEHBP. It is of interest to note that in a recent Washington Post op-ed, Rahm Emanuel (the former chief of staff to President Obama) proposed that “we should make good on the promise of a true public option by giving private citizens access to the same insurance covering federal employees.”
When we raised the question with politicians, policy makers, regulators, and media about why FEHBP-for-all is not being discussed as an option by either Congress or presidential candidates, what we heard back was: “It’s a great idea, but it will never work because Democrats don’t like the idea of relying on existing programs, especially those based on private coverage/insurers; in turn, the idea of means-tested government premium support, even in a market-based environment, is too much government involvement for the Republicans.” And yet, it is interesting that members of both parties do not and have not argued about their own insurance. In fact, just the opposite, they seemed to have put aside all partisan positions and found a way to be more than content with their health insurance coverage, despite its private insurance, market-based, government premium support structure.
When we raised the same question with Congressional staffers (why not give the rest of us what they have), what we heard back was: “Well, we are not in the FEHBP, we have to buy our insurance through the exchanges, like everyone else since Obamacare was passed”…except that this isn’t quite true… members of Congress and their staff are now required by statue to purchase their plans through the DC exchange (DC SHOP): “A SHOP is designed specifically for employer-sponsored health insurance coverage, whereas the individual Exchanges are designed for individual health coverage that is not tied to one’s employment.”
So, how do the options on the DC SHOP compare with those available on the individual exchanges, as well as the FEHBP? The statue states that in order to receive the federal employee premium support, members of Congress and their staff must purchase a gold level plan on the exchange. “Congress, following guidance from OPM regarding the actuarial value of FEHB benefits, will be allowing its employees to choose among Gold metal level plans, as those are most comparable to the OPM-contracted FEHB plans offered to other federal employees.”
We decided to go ahead and do a little bit of research and compare the number of gold-level plans on the DC SHOP with the number of plans in the traditional FEHBP, as well as gold-level plans available to us mere mortals on the individual exchanges. Since the availability of plans can differ by location, we chose the locations of the headquarters/offices of the various presidential candidates on both the Democratic and the Republican side. Table 1 below summarizes the number of options available for each of these zip codes. So, despite the need to purchase their coverage through an exchange, members of Congress and their staff, have actually more options to choose from than even those in the FEHBP (with 35 of the 66 DC SHOP gold plans classified as “national”), not to mention the rest of us. Given these findings, we would be more than happy to change our motto from “FEHBP-for-all” to the “DC SHOP-for-all”…after all – if it’s good enough for Congress, it should be good enough for the American people.
Table 1: Number of Gold-tier or actuarially equivalent plans
| State (zip code) | DC SHOP | FEHBP1 | ACA individual/ family exchange |
| California (95815) | 29 | 6 | |
| Colorado (80204) | 34 | 11 | |
| Hawaii (96707) | 27 | 6 | |
| Indiana (46624) | 23 | 6 | |
| Maryland (20813) | 38 | 6 | |
| Massachusetts (02117) | 23 | 19 | |
| Massachusetts (02196) | 23 | 19 | |
| Massachusetts (02205) | 23 | 19 | |
| Minnesota (55415) | 25 | 8 | |
| Nevada (89120) | 28 | 3 | |
| New York (10018) | 29 | 15 | |
| New York (10022) | 29 | 15 | |
| New York (10036) | 29 | 15 | |
| Pennsylvania (19102) | 29 | 6 | |
| Vermont (05401) | 23 | 6 | |
| Washington, DC (20003) | 66 | 38 | 8 |
1Does not include plans offered to special populations (typically 2-4 additional options)
*Robert Moffit; Consumer Choice in Health: Learning from the FEHBP
