If the republic were Titanic and the year-end government shutdown is over health care On the iceberg, Congress would be the first-class passengers already in the lifeboats, with their doctors on board, their gold-level coverage guaranteed, and the rest of the country left to drown in the icy waters.
What began as a modest workplace amenity for public servants has become a taxpayer-funded citadel of privilege: a concierge service on Capitol Hill that offers the kind of 24-hour care and personalized access that, in the private sector, is the kind of luxury care only millionaires can afford. Meanwhile, the country’s public health care system ranks below it.
When a lawmaker collapses, Washington treats it as a national emergency. In 2012, Senator Mark Kirk suffered a stroke and was transported by a Coast Guard helicopter from a community hospital in Illinois to Northwestern Memorial in Chicago, where neurosurgeons operated on him within hours. Bob Dole, Ted Kennedy, Robert Byrd, all were stabilized in their treating doctor’s office before being transferred to elite medical centers. The same medical crises ruin ordinary Americans. The difference is structural: Congress wrote the laws that allowed them to get out of the machine.
The agreement began quietly, almost a century ago. In 1928, Congress created the Office of the Attending Physician, a Capitol Hill clinic staffed by U.S. Navy doctors to care for members too essential to have to wait in line. It was emergency preparedness, but now it’s the fastest medical treatment in the country: same-day exams, x-rays, blood tests and referrals to Walter Reed National Military Medical Center. For about $650 a year, which is less than I pay per month for health coverage as a single woman, members receive unlimited access.
What started as a contingency became a habit. In 1959, members became further isolated by joining the newly created Federal Employees Health Benefits Program. It seemed like a simple inclusion, but the government’s share of its premiums (limited to about 75 percent) made it one of the best deals in American medicine. They were covered by statutes, funded by federal funds, and protected by a bureaucracy they controlled. During the Cold War, doctors treating them stored morphine and stretchers in the basement of the Capitol in case of a nuclear attack. In peacetime, members were rescued from crashes in military helicopters, treated in federally funded hospitals, and cared for by Navy doctors whose salaries were hidden in the Defense budget.
As the Affordable Care Act moved toward passage in 2010, the disparity in options for members of Congress and their constituents became impossible to ignore. Lawmakers were designing a public insurance market while sitting on an older, wealthier one. To deflect outrage, they added a provision requiring members and their staff to purchase insurance through the DC Health Exchange. On paper, it was a reform. In practice, it was theater. They kept their 75 percent contribution from the federal government and selected gold-level plans—protection against the very insecurity they publicly worried about.
Now, as the ACA itself hangs by a thread during the year-end shutdown, the contrast is obscene. Medicaid reimbursements are stalling, community clinics are approaching closure, and millions are preparing to lose their insurance. Inside the Capitol, the Navy clinic bustles, subsidies flow, care never stops. Republicans denounce “government health care” while relying on a government-run medical staff. Democrats defend the ACA from the comfort of benefits they will never lose. Immunity is bipartisan.
The current Congress has completely abandoned the pretense of public service. As the government approached budget paralysis, lawmakers stuffed the bill to stop the gap with gifts to themselves: a long-frozen cost-of-living increase and a quiet move to rejoin the Federal Employees Health Benefits Program, the platinum-level insurance system they theatrically abandoned under the ACA. It’s legislative sleight of hand in its most American form: the house is on fire and parliamentarians are adjusting the lighting.
This latest confrontation is more of an act of self-preservation disguised as stagnation. The government has seized enhanced ACA subsidies that are about to expire. Without an extension, premiums will skyrocket next year (double or even triple for many families), the steepest increase since the law went into effect. The Congressional Budget Office estimates that nearly 4 million people will lose coverage, in addition to millions more estimated to lose coverage as a result of the Medicaid cuts in the so-called “Big Beautiful Bill” that Donald Trump and the Republican Party passed earlier this year. Republicans call ACA subsidies wasteful; Democrats refuse to reopen the government without them. Between the two is a country that is running out of time to afford treatment.
The numbers tell the story. The uninsured rate, once around 16 percent before the ACA and now 7.7 percent, is expected to rise again. Medicaid rolls are shrinking as states reduce eligibility faster than people can reapply. Nearly 40 percent of Americans say they wouldn’t be able to cover a $400 emergency expense, but a single trip to the emergency room can eliminate it. Lawmakers argue from inside a Navy-run clinic, whose premiums are publicly insured, while the people who fund it wonder if they can afford to be sick.
Congress built a system to ensure its own survival and legislated one that endangers everyone else. They are transported by helicopter while their constituents await treatment. Each republic leaves a record of what it decided to save first. Ours saved the politicians.
