Congress Leaders Try to Keep Health Subsidy With New Law

Congressional leaders are discussing how to mitigate the potential effects of a section of the 2010 health-care law that could cost lawmakers and their employees subsidies for health insurance, an aide said.

The health-care law, the Affordable Care Act, included a provision requiring members of Congress and their staffs to obtain insurance from online marketplaces set to open in 2014. The exchanges will sell insurance to Americans who don’t have health-care coverage from their employers.

The congressional requirement was an amendment from a Republican, Senator Charles Grassley of Iowa, who opposed the law and wanted Congress to experience its effects. Michael Steel, a spokesman for House Speaker John Boehner, said today that the Ohio Republican “will not sneak any language into bills” to lift the requirement.

“The speaker would like to see resolution of this problem, along with the other nightmares created by Washington Democrats’ health law, which is why he supports full repeal,” Steel said in an e-mail.

Talks are continuing between Boehner’s office and the office of Senate Majority Leader Harry Reid on the issue, said a congressional aide who requested anonymity because the discussions weren’t public. The talks were first reported by Politico.

Same Benefits

The Office of Personnel Management, which administers health plans for members of Congress and their staffs, must interpret the provision applying to Congress and issue regulations to enact it. That hasn’t happened, and spokesmen for OPM didn’t immediately respond to an e-mail today asking about the status of the regulations.

One question is whether lawmakers and their staff will continue to receive a subsidy from their employer -- the federal government -- if they have to enroll in exchange plans. The aide said Reid and Boehner haven’t decided what to do if OPM decides that Congress won’t continue to receive a federal subsidy.

“Senator Reid is committed to ensuring that all members of Congress and congressional staff experience the benefits of the Affordable Care Act in exactly the same way as every other American,” Reid spokesman Adam Jentleson, said in an e-mail. “He believes that this is the effect of the legislation as written, and that therefore no legislative fix is necessary.”

Congressional Staff

The law doesn’t give specifics on coverage of congressmen and their staffs. A 145-word passage says “the only health plans that the federal government may make available to members of Congress and congressional staff” are those created by the law, or offered in “an exchange” created by the law.

The provision defines “congressional staff” as people “employed by the official office of a member of Congress,” which may exclude employees of congressional committees and other workers at the U.S. Capitol who aren’t directly employed by lawmakers.

The law’s language leaves plenty of room for interpretation, said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute in Washington.

“You’ve got to see the regulations. What does that mean, that a member of Congress has to be covered by the exchange in his home district? What about employees that live and work” in Washington, he said in a phone interview.

Preliminary Talks

The unidentified congressional aide said the talks were preliminary. Discussions are confined, for now, to identifying ways to ensure congressional staffers aren’t put at a disadvantage compared with other members of the public if OPM rules that they must enroll in a health exchange, the aide said.

“Members of Congress will not receive anything that is not available to the public,” said a White House spokesman, Eric Schultz, in an e-mail. “They are going to get insurance on the marketplace, just like individuals uninsured and small businesses.”

Much like other Americans who have health coverage through their jobs, congressional staff receive a subsidy for their premiums, paid by their employer -- the federal government. If they had to enter the exchanges they may have to give up that employer subsidy, although low- and middle-income staff could be eligible for tax credits administered by the exchanges.

The federal government’s subsidy for its employees’ health plans amounts to as much as 75 percent of the monthly premium. That’s comparable to the subsidies received by employees of large U.S. companies that offer health insurance, according to a February report by the Congressional Research Service.

Senate Republican Leader Mitch McConnell of Kentucky isn’t involved in the talks and won’t support legislation to change the law for Congress, said his spokesman, Don Stewart.

‘Special Favors’

McConnell “does not support, and is not involved in drafting, legislation that would do special favors for Congress when his constituents are still facing the increased premiums and taxes, the mountains of red tape, the loss of health care plans they like and want to keep,” Stewart said in an e-mail.

Fronstin said that if Congress and its staff have to shop for insurance in the exchange, the federal government could simply give them money toward the purchase of a policy.

“There’s devil in the details that have to be worked out, but for the most part I think it’s workable,” he said.

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