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Administration moves to limit, but not end, health insurance subsidy for Congress

Members of Congress and their staff who will have to get their health insurance through the Affordable Care Act would continue to receive a government contribution toward premiums next year but only if they enroll in a specific ACA plan, under a revised Obama administration policy unveiled Monday.

The policy was issued as House Republican leaders floated a plan, as part of the maneuvering over the budgetary deadlock, to end that contribution for Congress and certain employees who will be forced out of their current health program.

The administration’s policy would keep the subsidy in place only for members of Congress and affected staff who enroll in a Small Business Health Options Program (SHOP) plan to become available in the District of Columbia. Such plans most commonly will be aimed at employees of businesses with fewer than 50 workers.

Members of Congress and Capitol Hill workers, like almost all other federal employees, currently are eligible for the Federal Employees Health Benefits Program, in which the government pays about 70 percent of the total premium cost on average. However, under the ACA, House and Senate members and certain personal staff — although not other Hill employees — instead will have to get their insurance through the ACA’s marketplace effective with the 2014 calendar year.

That provision was put in the law because of pressures to have Congress experience the same health coverage under the ACA as what’s to be available to the general public. However, it caused uncertainty over which congressional staffers will be affected and the status of the employer contribution. Those questions resulted in a hold being placed for a short time on the nominee to head the Office of Personnel Management, a position that has been vacant since April.

Proposed rules issued in August by OPM said that each member of Congress would decide annually who are employees of their “official offices” as described by the law; some Capitol Hill employees are paid partly from office funds and partly from committee funds, for example.

Those rules also said that the government-paid share of premiums could continue for those forced out of the FEHBP program, reasoning that the ACA did not repeal the separate authority covering the FEHBP premium formula. OPM further decided to apply the same cost-sharing formula as for an FEHBP plan, meaning an employer share of up to 75 percent.

In final rules set for publication Wednesday, OPM says that “numerous” commenters on the proposed rules “asserted that Members of Congress and congressional staff should be subject to the same requirements as citizens purchasing insurance on the Exchanges, including individual responsibility for premiums and income restrictions for premium assistance.”

Some members of Congress have raised similar arguments since even before the draft rules were issued, leading to a series of proposals to end the subsidy, at least for themselves.

The final rules state that while the administration has not changed its view that the ACA provision did not override the FEHBP premium-sharing authority, “SHOPs are designed to provide employer-sponsored group health benefits and are, therefore, the appropriate environment in which to provide an employer contribution to Members of Congress and congressional staff. Further, this ensures that Members of Congress and congressional staff do not have additional choices in the individual Exchanges with a Government contribution that other individuals lack.”

To receive the government contribution, members of Congress and affected staff would have to enroll in the DC Health Link Small Business Market. Specifically, their choice for 2014 must be made from among that plan’s “gold”-level options, according to separate guidance.

They could purchase other coverage through the exchanges on the same basis as other eligible persons without an employer share, the rules add: “Nothing in this rule or the law prevents a Member of Congress or designated congressional staff from declining a Government contribution for himself or herself by choosing a different option for his/her health insurance coverage.”