Employer health-premium share will continue for Hill staff forced out of FEHBP

Members of Congress and their personal staff assistants who will have to leave the federal employee health insurance program and get their health care through the Affordable Care Act’s exchange system starting next year will continue to receive an employer contribution toward premiums, the Obama administration announced Wednesday.

Rules from the Office of Personnel Management address an issue that has caused mounting anxiety among employees of the legislative branch in recent months as the deadline approaches.

(Pete Marovich/Bloomberg) (Pete Marovich/Bloomberg)

“These proposed regulations implement the administrative aspects of switching Members of Congress and congressional staff to their new insurance plans – the same plans available to millions of Americans through the new Exchanges,” Jon Foley, OPM director of planning and policy said in a statement released by the agency.

However, Bradford Fitch, president and CEO of the Congressional Management Foundation, said that “While it’s definitely helpful to see that the new regulations will not penalize congressional staff by eliminating the employer contribution, there remains an incentive for senior staff to leave congressional service who may be nearing retirement.”

Affected employees may want to retain their current health-care plan, and it appears they can only do that by retiring before the end of this year, he said in an e-mail. The Foundation is a nonpartisan group that works with Congress to improve its operations; the potential brain drain due to the switch has been one of the top internal Capitol Hill issues recently.

Under the ACA, also known as Obamacare, House and Senate members and those working for their “official offices” will have to leave the Federal Employees Health Benefits Program due to a provision of the law designed to bring political leaders into the same health-care coverage that will be available to others under the law.

However, there have been open questions since the law passed more than three years ago regarding exactly which Capitol Hill employees will be forced out of the FEHBP and whether they would lose the employer contribution toward premiums in the process.

The OPM policy announcement says that the requirement to change will apply only to members and their personal staffs, whether working here or in their districts. As of January they will have to get insurance through the exchanges where they live. Committee staffers and other Hill employees can stay in FEHBP.

Each congressional member’s office will decide who is an employee of the “official office” if there is any question — for example, for those paid partly from personal office funds and partly from a committee’s budget. That designation must be made before October of each year for the following year, and OPM won’t question it. Coverage is not to change during the course of a year.

Those leaving the FEHBP will continue to receive an employer contribution toward the health insurance equivalent to what they currently get through FEHBP, which averages about 70 percent. That contribution will be based on the total premium cost of the exchange plan and will remain non-taxable to the enrollee. Those who switch will not be eligible for the tax credits to help pay premiums that will be available to some ACA plan enrollees.

General eligibility and enrollment requirements will follow the policies of the exchanges; however, eligibility to continue receiving the employer contribution toward health care in retirement will follow the FEHBP policy — which generally requires having been covered for the five years prior to retirement. However, coverage in retirement will continue to come through the exchange system; they will not be allowed to switch back into the FEHBP at retirement.

The lack of information from OPM on the issue caused Sen. Tom Coburn (R-Okla.) to place a hold on the nominee for OPM director, Katherine Archuleta, after she was approved last week by the Senate Homeland Security and Governmental Affairs Committee. Congress now is in recess through Sept. 9, however, meaning the position will remain vacant for at least another month.

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