Wrinkle in Health Law Vexes Lawmakers’ Aides
nytimes.com
By ROBERT PEARPublished: July 29, 2013 510 Comments
WASHINGTON — As President Obama barnstorms the country promoting his health care law, one audience very close to home is growing increasingly anxious about the financial implications of the new coverage: members of Congress and their personal staffs.
Under a wrinkle that dates back to enactment of the law, members of Congress and thousands of their aides are required to get their coverage through new state-based markets known as insurance exchanges.
But the law does not provide any obvious way for the federal government to continue paying its share of the premiums for the comprehensive coverage.
If the government cannot do so, it could mean an additional expense of $5,000 a year for individuals and $11,000 for families under some of the most popular plans.
Not surprisingly, that idea is unpopular on Capitol Hill.
“It’s a very serious concern,” said Representative Billy Long, a Missouri Republican who said staff members were “freaked out” at the prospect of paying the full cost of insurance out of their own pockets.
“They’re thinking about leaving government service,” said Mr. Long, noting that some staff members already lived in group houses and cramped apartments to make ends meet on Capitol Hill salaries. “They’re thinking about taking jobs other places. We have tried, and tried, and tried to get the answer on what they’re going to be paying. The Office of Personnel Management cannot tell us.”
The personnel office arranges health insurance benefits for federal employees.
The nonpartisan Congressional Research Service pinpointed the problem 10 days after President Obama signed the health care law in March 2010. Since then neither Congress nor the administration has addressed it.
With the exchanges scheduled to open in just nine weeks, the Obama administration is struggling to come up with a creative interpretation of the health care law that would allow the federal government to kick in for insurance as private employers do, but so far an answer has proved elusive.
The issue is politically charged because the White House and Congress are highly sensitive to any suggestion that lawmakers or their aides are getting special treatment under the health law. The administration is already under fire from Republicans for delaying a requirement that larger businesses offer insurance to their full-time employees.
The Federal Employees Health Benefits Program, the nation’s largest employer-sponsored health insurance program, covers more than eight million people, including government employees and their family members. It offers dozens of competing plans and has been cited as a model by members of both parties.
In battles over the health care law in 2009-10, Republicans proposed a requirement for lawmakers and aides to join the exchanges, and Democrats accepted it.
Senator Charles E. Grassley, Republican of Iowa, who proposed an early version of the idea, said he wanted to make sure that “members of Congress and Congressional staff get their employer-based health insurance through the same exchanges as our constituents.”
It has been a headache for many in Congress ever since.
Democrats and some Republicans wish the issue would simply disappear.
The 2010 law generally requires lawmakers and aides who work in their personal offices to get coverage through the exchanges. That implies that they would no longer receive coverage through the Federal Employees Health Benefits Program.
The law is silent on the question. It does not clearly authorize the government to pay premiums for federal employees who obtain insurance through the exchanges. Nor does it authorize the government to reimburse federal employees who buy health insurance on their own.
David M. Ermer, a lawyer who has represented insurers in the federal employee program for 30 years, said, “I do not think members of Congress and their staff can get funds for coverage in the exchanges under existing law.”
“Perhaps,” he said, “they could buy coverage on an exchange, pay for it on their own and be reimbursed later by the government. You would need a law to appropriate money for that.”
At a Congressional hearing in April, House members pressed the administration to say what would happen to their health insurance if they went into exchanges.
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