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Skin in the Game, Congressional Style

You’ve probably never heard of Section 1312, section D, of the Senate health care reform bill, since it would affect just a few thousand people at most. But symbolically it’s among the bill’s most important provisions. And it's worth mentioning in the days before (hopefully) final congressional voting begins.

The provision would require that members of Congress and their staff get insurance through the new insurance exchanges, once they are up and running. These are the same exact exchanges through which millions of Americans without access to employer policies would be getting their coverage.

It was a Republican idea, originally, introduced during the Finance Committee markup by Charles Grassley. “This is kind of carrying on to what I heard at my town meetings,” Grassley said in September. “Is Congress going to be covered by the same laws we expect everyone else to when it comes to health care” Grassley might have been trying to embarrass the Democrats, figuring senators would never give up their beloved federal employee plans for offerings in the new, untested exchanges. But the Finance Committee accepted the amendment and, after a few modifications exempting Capitol employees and committee staff, the full Senate did too.

Of course, reformers have long claimed their plans would guarantee that everybody could get the same kind of insurance that the members of Congress too. But that boast may not sway people disinclined to have faith in government and trust politicians--the same ones, in other words, most distrustful of health care reform in the first place. One potential virtue of Section 1312 is that it inverts the promise: It's giving Congress what everybody else has, instead of giving everybody else what Congress has. Maybe that will sound more credible to the skeptics. 

Or maybe not. The most important thing is that this provision a good idea on the merits, for reasons Time’s Joe Klein explained in November:

My favorite provision requires that all members of Congress give up their federally-funded health care benefits and join the health care exchanges that will be set up by this bill. This is brilliant politics, addressing the tide of populist anger and fears of incipient socialism. But it also makes an important substantive point. The future of health care reform in this country will depend on how effectively the exchanges--health insurance super-stores--are working. If members of Congress have to participate in this system, you can bet they'll insist on a array of choices, similar to the system they currently use, the Federal Employees Health Benefits Plan.

By the way, if you're the type of person who mistrusts not only politicians but also opinion journalists, here's the actual legislative language:

(i) REQUIREMENT- Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are--
(I) created under this Act (or an amendment made by this Act); or
(II) offered through an Exchange established under this Act (or an amendment made by this Act)
(ii) DEFINITIONS- In this section:
(I) MEMBER OF CONGRESS- The term 'Member of Congress' means any member of the House of Representatives or the Senate.
(II) CONGRESSIONAL STAFF- The term 'congressional staff' means all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.