When enrollment opens for Maine’s new health insurance exchange this fall, the four members of Maine’s congressional delegation and their staffs are expected to join potentially thousands of other Maine residents signing up for coverage.
While the federal Affordable Care Act generally will let people stick with the health insurance they already have, that principle doesn’t extend to members of the U.S. Senate and House and the staffers who run their offices.
A provision in the controversial law subjects Congress to one of Obamacare’s major initiatives. Senators, representatives and their staffers will drop the coverage they currently receive through the Federal Employees Health Benefits program on Jan. 1. In its place, they’ll choose from the plans offered in their states through health insurance exchanges.
The exchanges are online marketplaces for individuals who aren’t otherwise covered by employer-sponsored insurance plans, Medicare or Medicaid. Some small businesses also will buy exchange plans to cover their employees. According to the Congressional Budget Office, about 85 percent of those expected to sign up for insurance through the exchanges this year will qualify for federal subsidies to help them afford their monthly premiums.
Sens. Susan Collins and Angus King and U.S. Reps. Mike Michaud and Chellie Pingree won’t qualify for that federal support. Their salaries — they each earn $174,000 — place them well above the maximum income for receiving subsidies.
They’ll still get help paying for their health insurance, though. The federal government will continue to pay 75 percent of premiums for individual plans, but that assistance likely will buy less comprehensive coverage than it’s currently buying.
“If it’s the Maine exchange, the plans … are going to be less generous than the plans that the federal employees had previously received,” said Linda Riddell, a population health scientist in Cape Elizabeth who works with employers on cutting health care costs.
Congress and the exchange
Maine’s senators and representatives said this week they haven’t thought much yet about the insurance plans they’ll choose come Oct. 1, when open enrollment starts for the state’s insurance exchange.
The federal Office of Personnel Management released insurance guidelines for members of Congress and their staffs on Aug. 7. Around the same time, the Maine Bureau of Insurance released a breakdown of insurance plans that will be available through Maine’s exchange.
In Maine, two insurers will offer coverage — the nonprofit Maine Community Health Options and for-profit Anthem — and their proposed plans are awaiting official approval from the federal government.
“This is symptomatic of a broader concern with the law as a whole,” Collins said in a statement. “Deadlines for implementation are fast approaching, and there are still so many unanswered questions.”
Maine’s congressional delegation includes two members who voted for the Affordable Care Act in 2010, Democrats Michaud and Pingree. Collins, a Republican, has opposed the law. King, an independent, supports the law, but he joined Congress too late to vote for it.
Collins said it’s “too soon to know what health care plans will be available and in which exchanges we will be eligible to participate.”
Insurance will change for 21 of Collins’ staffers at six offices in Maine and 19 in the senator’s Washington, D.C., office. Eight other staff members who work on the Special Senate Committee on Aging report to Collins, the committee’s senior Republican. Collins will have to decide whether those staffers will receive insurance through health insurance exchanges or continue with their current coverage.
Through a spokesman, Pingree said she plans to buy insurance on Maine’s exchange. Her 18 staffers in Maine and Washington, D.C., will buy insurance through the exchanges where they live, as well, unless they opt out of receiving insurance through Congress.
“If covering members of Congress and their staffs with exchange plans gives people the confidence they need to participate, then that’s a good thing,” Pingree said in a prepared statement.
“As the law is implemented it’s only right to have members of Congress participate in these new health care marketplaces,” Michaud said in a statement.
Michaud has 18 staffers working for him in Maine and the nation’s capital. In addition, a spokesman said the lawmaker will decide in the coming weeks whether eight additional staffers who report to him will be covered through an exchange plan or through their current insurance.
Those staff members work in the House Veterans’ Affairs Committee’s minority office. Michaud is the ranking Democrat on that committee.
King, 69, could purchase insurance through the newly deployed health insurance marketplace. He also qualifies for Medicare. King has 23 staff members in Washington, D.C., and 18 in Maine.
“Sen. King is hopeful that the transition to the new health plan will be seamless for staff,” King spokesman Crystal Canney wrote in an email.
In Maine, insurance premiums will vary based on age and geography, with higher costs for older residents and those living in more rural counties.
Premiums also will vary with the level of coverage. Someone choosing a more comprehensive, gold-level plan that carries a lower deductible and fewer out-of-pocket expenses would pay more each month than someone who chooses a bronze-level plan.
Premiums are 30 percent higher for smokers if they purchase an Anthem plan from the health insurance exchange. Maine Community Health Options won’t charge different premiums for smokers and nonsmokers.
Collins, who is 60 and lives in Bangor, would pay $910 monthly in premiums if she purchased Maine Community Health Options’ gold-level plan, according to Maine’s Bureau of Insurance. That plan would carry a $650 deductible, and she would pick up 20 percent of costs after she spends that amount.
The gold-level HMO plan from Anthem would cost her $981 monthly before the federal government kicks in 75 percent of the cost. That plan’s deductible would be $750. After subscribers spend that amount, the insurance plan would cover 100 percent of costs.
Michaud, 58, would have similar options since he also lives in Penobscot County and is around the same age.
King, who lives in Brunswick, would pay about $800 monthly in premiums if he chose a gold plan from either Anthem or Maine Community Health Options.
Pingree, who’s 58 and lives in Knox County, would pay $861 monthly for a Maine Community Health Options plan or $963 for the gold-level Anthem plan.
Outside the norm
Members of Congress and their staffers will be among the 7 million people expected to purchase insurance through exchanges in 2014. Exchange enrollment is expected to ramp up after that and reach 24 million by 2017, according to Congressional Budget Office projections.
In Maine, the insurance bureau expects 5 to 8 percent of the state’s population to buy insurance through the exchange.
Among that crowd, senators, representatives and their staffs likely will stand out. Their incomes will be higher. In addition, they’ve been employed and insured.
“Just even knowing that a person is employed and is insured tells you a lot about their health status,” said Riddell, the Cape Elizabeth population health scientist, who writes a BDN blog. “They will help the risk pool overall.”
According to the Kaiser Family Foundation, about 65 percent of those buying exchange insurance plans are currently uninsured. About a third have gone more than two years without a checkup.
“There are studies showing adults who have been uninsured and get insured have pent-up demand for services,” said Riddell.
That means once their coverage starts Jan. 1, the newly insured will schedule doctor’s appointments. It’s likely many will be diagnosed with chronic conditions they’ve been living with but have gone undiagnosed. Research shows that medical spending rises once people gain health insurance.
That’s less likely to be the case with the nation’s 535 senators and representatives and their thousands of staffers.
“As a group, they are going to be healthier and have less pent-up demand than an uninsured person who is not in a white-collar job,” Riddell said.
Matthew Stone is BDN opinion page editor.