Policy

GOP Plan Doesn’t Address Members, Staff Health Care

Unanswered questions on fate of 11,000 people

A sign from 2013 alerts Senate employees that representatives from DC Health Link are in the Hart Senate Office Building to help them with health insurance enrollment. (Bill Clark/CQ Roll Call File Photo)

As lawmakers delve into questions about the Republican health care plan, one big one will remain unanswered for the time being: What happens to health care for members of Congress and their staffs?

The 2010 health care law required members and their staff to enroll in health care programs created by the law. But it’s not clear if that requirement will continue, or whether lawmakers and staff will return to the coverage plans they had prior to the law taking effect.

The requirement was intended to have lawmakers and staff experience the effects of the law. But logistical questions arose over whether staffers and lawmakers could migrate to the exchanges and maintain employers’ contribution to mitigate health care costs. 

So the Office of Personnel Management ruled that lawmakers and congressional staffers could enroll in the District of Columbia’s small business exchange and keep the contribution.

That decision sparked legal challenges and critiques that members and staff were receiving special treatment.

Others argued that maintaining employer contributions prevented an exodus of staffers from Capitol Hill for far better compensation and benefits packages. They also pointed out that the exchanges were meant to provide insurance avenues for people who were self-employed or whose employers did not provide insurance plans, and decried the requirement as putative and unnecessary, because Congress already provided insurance coverage to its employees.

Roughly 11,000 people are currently designated as congressional enrollees in the D.C. Small Business Health Options Program, or SHOP, according to a spokesman for the D.C. Health Benefit Exchange Authority. Congressional enrollees account for nearly 17 percent of total SHOP enrollees. 

But as Republicans move forward with their new health care plan, unveiled Monday evening, the question of how to handle congressional health care does not seem to be part of the discussion.

“That has not,” said Sen. Bill Cassidy when asked if congressional health care had been discussed.

“Obviously, that is a detail that’s not unimportant,” the Louisiana Republican said. “But really in the whole macro level, that can be sorted out.”

The GOP plan to undo the health care law does not make any mention of congressional staff, so it is not clear if staffers will have to remain on the exchange or return to federal employee health coverage plans managed by the OPM. An OPM spokesman said the agency did not have any information on how congressional staff might be affected by pending legislation.

Congressional health care was not included in the GOP plan due to procedural constraints, since Republicans are moving their bill through a process known as budget reconciliation. In order for the bill to pass muster in the Senate, the bill must adhere to the so-called Byrd Rule, which stipulates that the bill cannot include provisions that do not affect spending or revenues.

A section on congressional staffers would have created a problem under the Byrd Rule, according to a GOP aide, so it was not included. The aide said that the issue would have to be resolved in separate legislation. 

“I am concerned,” said Democratic Rep Gerald E. Connolly, whose northern Virginia district is home to a number of federal workers and congressional staffers.

“I make the assumption that if you essentially repeal Obamacare, that we then revert back to FEHBP,” Connolly said, referring to the federal employee health benefits program by its acronym. Connolly said that would result in an increase in costs for his younger staffers, and a cost decrease for members like himself who are also enrolled in the exchange.

“Because the exchanges are age-based, age-weighted, so the younger you are, the less your premium is. So a lot of my staff has had 30, 40 percent savings in their premiums when we went to the exchange,” Connolly said. 

Iowa GOP Sen. Charles E. Grassley, who introduced the amendment requiring staffers and lawmakers to enroll in Obamacare programs, said he expected the issue to be addressed in another health care bill.

Republican leaders have described additional legislation as a third phase of their repeal and replace plan, with the first two phases covering the budget reconciliation bill and administrative actions.

“If it isn’t done in reconciliation, at some point there’s going to be another health care bill,” Grassley said. “And somebody’s going to try to put it back to exactly where it was.”

The Iowa lawmaker said he originally offered the amendment during the 2010 health care law debate after hearing from constituents, “‘Well, it’s good enough for us, why isn’t it good enough for you?’”

That sentiment persists as lawmakers once again seek to overhaul the health care system.

Sen. Jeff Flake, who is enrolled in the D.C. exchange, said he has experienced a cost increase in the program, but has not considered how lawmaker and staffer coverage should be addressed. 

But, the Arizona Republican noted, “We want to be covered by whatever we pass.”

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