Question: “Where do you get your insurance?”

Rep. Glenn Grothman (R-Wis.): “I will say, just because there’s a lot of misinformation on it: I am on Obamacare. So that’s what Congress does.”

— Exchange during a town hall, April 10, 2017

The Fact Checker has been receiving lots of fact-check suggestions from readers who attended district town halls, in response to our new initiative to fact-check what members of Congress tell constituents during the April recess.

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Not surprisingly, some of the most heated exchanges at many of the town halls involved health care and the failed GOP replacement bill for the Affordable Care Act, or Obamacare.

These two answers by lawmakers in Oklahoma and Wisconsin provided an interesting look at the way members are framing their own health-care options. It’s actually quite complicated, and neither member captured the nuances. So we dug into it, for the constituents who didn’t get the full story at their town halls. Here’s what’s really going on.

The Facts

The ACA requires members of Congress and many congressional staffers to leave the Federal Employees Health Benefit Program and join the health-care exchanges in the District. Through the federal plan, lawmakers and their staff members had about 70 percent of their insurance premiums covered by the federal government.

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But members and their staff members generally make too much money to qualify for subsidies in the exchanges, which were intended for people who previously did not get insurance from employers. So the Obama administration made an exception that allowed them to use the D.C. small-business exchange to receive health-care stipends from their employer (the federal government).

Yes, you read that correctly. The law allows individual congressional offices to be counted as small businesses of 50 or fewer employees.

On the exchanges, members and staff members get an employer (i.e., taxpayer) contribution of 72 percent for their premiums. So this allowed them to receive a similar subsidy as they did under the federal health plan. Some members say they donate to charity an amount equivalent to the taxpayer-funded subsidy.

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Not all staffers use the small-business exchange. Staff members on congressional committees may be covered under the Federal Employees Health Benefit Program. (We dug into this in depth here.)

So it’s more complex than how Grothman put it. His spokeswoman, Bernadette Green, explained that he was “referring to the type of insurance that is available for him to purchase” and drawing a distinction between the D.C. small-business exchange and the federal health program.

“There’s a lot of misinformation out there about where members receive their health insurance. Many people in our District, and across the U.S., think that members are on the federal health program, when instead they purchase their health care through the D.C. health exchange,” Green said.

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When enrollment for Obamacare began, some members decided to go on their spouses’ insurance plans or buy their own in the private market. In December 2013, The Washington Post compiled a list of members of Congress who signed up for Obamacare. The list shows that Mullin bought insurance from the private market and allowed his staff to get insurance from the D.C. exchange.

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At the town hall, Mullin repeatedly said that he pays for his own insurance. That may be a reference to his insurance from the private market. But it’s not accurate that members and staff members “go into the D.C. exchange and we personally have to pay for 100 percent of it. Not a percentage, all of it.” And it’s misleading to say that “every member of Congress, they pay for their own insurance, too” — since they can receive a taxpayer-provided subsidy for insurance from the exchanges.

Mullin also repeatedly rebutted claims that taxpayers pay his salary, calling it “bullcrap,” and that he pays enough in taxes to make up for it. His spokeswoman, Amy Lawrence, told a local news outlet: “The congressman is referencing the federal taxes that he and his businesses have paid to the government over the years, prior to his being in office. Like all business owners, Congressman Mullin pays his taxes, which contribute to congressional salaries.”

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Of course, unless he’s donating all $174,000 of his congressional salary, this argument doesn’t make much sense. And he has to earn a lot of outside income to personally pay that money back to the U.S. Treasury. In 2014, the House Ethics Committee found Mullin may have violated House ethics rules and federal laws by earning more than $600,000 in outside income. Yet his attorneys argued that the majority of that amount was through distributions from his family’s plumbing business in Oklahoma and that his earned income did not exceed the $26,955 limit on outside income.

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Mullin’s spokeswoman did not respond to our requests for comment, and we will update this fact check if she does.

The Pinocchio Test

Given Republicans’ push to repeal and replace Obamacare, it’s only natural for their constituents to ask how their policy decisions will affect their own health insurance. Is their insurance funded by taxpayers? How similar is their insurance to their constituents’? How will they be affected if Obamacare is replaced? Lawmakers owe their constituents an accurate and detailed explanation.

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Neither Grothman nor Mullin quite captured the complexities in their answers at their town halls. Grothman’s spokeswoman said he was making a distinction between the federal health insurance program and the D.C. small-business exchange, because many of his constituents believe he’s on the federal program. It would have been better for him to explain that in detail at the town hall, but we’re glad to get a more nuanced explanation from his staff. We won’t rate his claim.

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Mullin, however, went too far by claiming that members and staffers pay 100 percent of their insurance from the D.C. exchanges. That’s not accurate: They receive a taxpayer-funded subsidy for two-thirds of their premiums. And he misled his constituents by repeatedly asserting that taxpayers don’t pay for his salary or his insurance, or his staffs’ insurance. We award Mullin three Pinocchios.

Three Pinocchios

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