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True or False: Members of Congress Have Better Benefits

Benefits through government are better than those available in the Marketplace.

If you said true, you are correct, if you’re talking about years prior to 2014. If you said false, you are also correct, if you’re talking about years 2014 to present.

The fact of the matter is that Congressional members enjoyed health insurance in the Federal Employee Health Benefit Plan (FEHBP), a very robust large group plan up until 2014. In an interesting addition to a piece of legislation in late 2013, Congressmen and their staffers found they were legally no longer able to participate in the FEHBP and had to turn to other means for health care coverage, namely the District of Columbia-DC Exchange’s small business health options program (SHOP).

At least 12,359 members of Congress, congressional staffers, and their spouses and dependents obtained health insurance through the Small Business Exchange as of February 9, 2014. These 12,359 persons represent approximately 86 percent of the 14,289 persons enrolled in the Small Business Exchange between October 1, 2013 and September 9, 2014. Some of these individuals also received subsidies. – Mila Kaufman, Director, DC Exchange

A subsequent lawsuit stated that the group application for participation of members of Congress, their staffers, and their spouses and dependents in the SHOP was inaccurate and the group was ineligible for coverage since Congress is not a small business, i.e. a business with 50 or fewer employees. To assuage the compliance issue and provide the needed coverage, President Obama signed an executive order allowing for coverage for this group in the DC Exchange. Consequently, the lawsuit was dismissed since federal regulations now allowed the participation.

Fast forward to 2017 with the potential of a new health care law. The American Health Care Act (AHCA), the bill that passed through the House at the beginning of May, is now with the Senate who will determine its future. In one of the newest amendments to the bill, States will have permission to use waivers to modify certain portions of the Affordable Care Act (ACA) dealing with premium rating, coverage requirements, and risk sharing. They may not, however, modify this mandatory exclusion of Congressional members from the FEHBP.

In response to this prohibition, House bill 2192 was introduced. This bill amends “…the Public Health Service Act to eliminate the non-application of certain State waiver provisions to Members of Congress and congressional staff”. With the House’s unanimous passage of the bill, 429-0, further action now rests with the Senate. So, now we wait for this week’s activities to see what transpires with bill H.R. 2192 and the AHCA.

Bill # Title Description Date Introduced Sponsor Party/ State # of Co-sponsors Current status
2192 To amend the Public Health Service Act to eliminate the non-application of certain State waiver provisions to Members of Congress and congressional staff. To amend the Public Health Service Act to eliminate the non-application of certain State waiver provisions to Members of Congress and congressional staff. 4/27/2017 Martha McSally R-AZ 86 4/27 - Referred to Energy and Commerce and Admin

4/28 - Referred to Health Committee

5/3 - Rules committee resolution

5/4 - Passed House 429-0

 

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