Lawmakers and congressional staffers are unlikely to face higher premiums or fewer health-care benefits as a direct result of the House Republicans’ health-care plan for one big reason: They work in the District of Columbia.
That’s the conclusion of health-care experts who said that Congress’s 535 lawmakers and the thousands of Capitol Hill staffers who work for them won’t be much affected by the American Health Care Act, which passed the House narrowly on Thursday.
This is despite the House’s move to nullify a provision in the amended bill that originally exempting them from the plan’s changes, according to several health-care experts.
The AHCA would allow states to opt out of current rules requiring health plans to cover a set of essential benefits and preventing insurers from charging higher premiums to people with preexisting conditions.
Members of Congress and their aides are unlikely to feel the effects of these changes, however, because they generally obtain health insurance through the small-group exchange operated by the District of Columbia. If the D.C. government continues to enforce the Affordable Care Act’s protections, which most experts believe it will, lawmakers and their staffers could end up with more robust and less expensive coverage than constituents in states that are not as friendly to Obamacare.
“Even though they’re no longer exempting themselves, I think the likelihood of any of them facing higher premiums for preexisting conditions or not having access to a comprehensive set of benefits is pretty unlikely,” said Cynthia Cox, associate director for the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, in an interview.
The issue of whether lawmakers and staffers would be affected by Republicans’ ACA overhaul reared its head last month, when Vox reported that a provision in the AHCA known as the MacArthur amendment would protect members and staffers from changes to their health-care coverage.
This cast temporary doubt on the future of the amendment, which was at that point helping Republicans revive their previously failed effort to enact a health-care bill. But concerns were put to rest when the proposal’s authors, Reps. Tom MacArthur (R-N.J.) and Mark Meadows (R-N.C.), promised to remove the exemption.
This effort eventually took the form of H.R. 2192, from Rep. Martha McSally (R-Ariz.), which passed unanimously, 429 to 0, in the House on Thursday.
“Individuals who are stewards of public trust must abide by the rules that they make,” McSally said in a brief floor speech Thursday. “My bill will ensure that Congress abides by the laws they pass and are treated no differently than other hard-working Americans.”
McSally blamed “very arcane Senate procedural rules” for the fact the MacArthur amendment did not apply to members of Congress in the first place.
Congressional Republicans are trying to revise the ACA using the budget reconciliation process, which imposes special rules about what can be included in legislation while allowing bills to pass the Senate by a simple-majority vote. These limits on what may be included in the legislation are known as the Byrd rule.
“The original provision was apparently included to avoid Byrd issues in the Senate so the amendment may cause problems,” wrote Tim Jost, a professor at the Washington and Lee University School of Law and expert on the ACA, in an email.
“It seems to me there are plenty of other Byrd problems already,” he added.
It is unclear how the Senate plans to handle this element of the AHCA. A Senate Republican aide said that any Byrd issues related to lawmakers’ coverage could be addressed with a “surgical strike” that does not change how the overall bill is treated. This could be why House Republicans chose to strike the exemption with a separate bill — the one offered by McSally — rather than simply amend the MacArthur proposal.
“The MacArthur amendment to the American Health Care Act does not and cannot apply to members of Congress,” McSally said Thursday.
The issue of whether members of Congress should obtain health insurance in the same way as their constituents has been politically explosive since before the ACA’s passage in 2010. The Obama-era law required members and staffers to buy insurance on an exchange rather than through the Federal Employees Health Benefits Program, as a way to ensure that Congress experienced the same perceived benefits and hardships under the law as the people they represented.
Lawmakers and staffers, except for a handful of cases, have purchased health insurance through the District’s “SHOP” exchange since 2014. They do this with an employer-based subsidy from the federal government, which some Republicans have denounced as an “exemption” for Congress under the law.
If the AHCA is enacted and the District seeks the ability to opt out of certain insurance rules, lawmakers still would not face some of the changes their constituents might. That’s because they purchase coverage on the small-group market, and states are allowed to seek permission for that market only to waive ACA rules on essential health benefits and how a person’s age affects their premiums.
“If D.C. went waiver-crazy, they wouldn’t be able to waive the community rating provision of the ACA for the small-group market,” Cox said, referring to the protection for people with preexisting conditions. “[Congress] would still be protected in that way.”
Dan Mendelson, president of consulting and research firm Avalere Health, agreed.
“Ironically, since D.C. will likely always be a community rating state, members and their staffs are unlikely to have to worry about any personal disruption,” he wrote in an email.
There are a handful of scenarios in which the opt-outs might apply to lawmakers. For example, members of Congress could choose to buy health insurance on the individual market in their home state, or the Trump administration could write rules kicking them off the D.C. exchange. Experts said neither situation is likely to happen.
Kelsey Snell contributed to this report.