Head Strong: Health plan levels playing field

'I'll have what she's having." Moviegoers no doubt remember that famous line from When Harry Met Sally . . .

A similar sentiment has been on the minds of many Americans watching House Speaker Nancy Pelosi and her colleagues during the health-care debate. They wonder whether a new health system would apply to members of Congress, their staff, and their families the way it applies to the rest of us.

That was the first question I asked Health and Human Services Secretary Kathleen Sebelius during an interview in July. But I emerged from the discussion unsure as to whether she fully appreciated its importance to the American people.

The same issue came up at the White House during my interview with President Obama in August. He offered a lengthy response, but it, too, failed to provide a definitive answer.

Fast-forward to last week. The president was on the road campaigning for health-care reform. And his message was noticeably clearer.

"For the first time, uninsured individuals, small businesses, they'd have the same kind of choice of private health insurance that members of Congress get for themselves," he said to applause. "Understand that if this reform becomes law, members of Congress, they'll be getting their insurance from the same place that the uninsured get theirs."

Is that true? Yes, according to a former Senate aide who helped draft the bill.

Before stepping down in January, John McDonough was senior adviser to the U.S. Senate Committee on Health, Education, Labor, and Pensions. Who better to ask if the plan being fashioned by Congress would apply to its authors as well as the public?

"Yes, and the specific reference to it is Section 1312 of the bill," he told me. "And you can go and look up the bill online, and you can actually see it there in the bill, starting on page 157."

McDonough said that instead of getting their insurance through the Federal Employees Health Benefits Program, members of Congress and their staffers would be directed to one of the new state-based exchanges. The exchanges would "probably not pay the same percentage of premium that the federal government now pays," he said. That could mean a worse deal for federal workers.

As the Wall Street Journal reported this month, almost five million of the eight million federal employees insured under the government program are enrolled in a Blue Cross Blue Shield plan that pays an average of 87 percent of their premiums. The newly created exchanges, meanwhile, would generally cover only about 70 percent of the costs for those enrolled in them (though that figure could rise for those who choose to pay more for a higher level of coverage, McDonough said).

But I was still unclear on the fate of the tens of millions of other Americans who already get insurance through their employers. Would that coverage survive in the new system?

"Absolutely," McDonough said. Small employers, he explained, could opt to enter the new exchanges if they felt they could get a better deal. But most large employers wouldn't be eligible to do so.

"Overwhelmingly, the expectation is, if you work for a large employer today, you're going to continue to have coverage from that large employer forever into the future, as long as the employer decides to offer coverage, and virtually all large employers do," McDonough said.

So the short answer is that members of Congress - unlike most Americans who are receiving benefits through their employers - will have to enroll in the state-based health-care exchanges alongside the currently uninsured.

That point is one that reform proponents should have emphasized earlier. Instead, the wrangling and posturing over health care have served largely to widen the gulf that many Americans see between themselves and Washington. That was illustrated by the latest Wall Street Journal/NBC News poll, in which 50 percent of respondents said they would vote to "replace every single member of Congress."

Much of that sentiment can be explained by the feeling among many Americans that the rules in Washington are different from the rules everywhere else. And during most of this protracted health-care debate, those crafting the overhaul did little to convince those Americans otherwise.

Paraphrasing Abraham Lincoln in St. Louis last week, the president summed up his attitude about the role of government this way: "You let people do for themselves what they can do for themselves; and then if there are some things that we do better together, we should do them together."

When it comes to health care, reform proponents should have started by helping Americans believe they can have what Congress is having.