California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

OPM Clarifies ACA Exchange Rules for Federal Lawmakers, Staffers

On Wednesday, the Office of Personnel Management issued a proposed rule that would allow congressional lawmakers and their staff members to keep their employer contribution toward health insurance coverage under the Affordable Care Act, the AP/Sacramento Bee reports (Alonso-Zaldivar, AP/Sacramento Bee, 8/7).


The ACA calls for all House and Senate lawmakers and their aides to enroll in the law's health insurance exchanges. However, OPM until recently had not clarified whether they would still receive the employer contribution to help them purchase coverage. Currently, the federal government covers about 75% of Congress' health insurance costs through the Federal Employees Health Benefits Program.

The potential loss of the employer contribution prompted concern among lawmakers and congressional staffers about potentially high health insurance premiums. Last week, OPM announced a directive stating that the government will continue to contribute to lawmakers' and their staffers' premiums. However, they will not be eligible for the subsidies available to other U.S. residents under the ACA to help purchase coverage (California Healthline, 8/2).

Details of the Proposed Rule

Under the proposed rule, lawmakers and their staffers still would have to move from the FEHBP to the exchanges in January (Lawder, Reuters, 8/7). OPM said that while the government would continue to contribute to their premiums, the contributions likely would not exceed what they would have received under their current benefits plan (Hattem, "RegWatch," The Hill, 8/7). OPM reiterated that lawmakers and staffers would not qualify for the ACA subsidies available to other U.S. residents (Reuters, 8/7).

The proposed rule also clarifies several other issues related to the coverage requirement, including retiree coverage, definitions of residency and identifying staffers who would be required to move into the exchanges, the New York Times reports.

OPM said lawmakers are best equipped to determine which staffers work in their "official office" and should be moved into the exchanges. Further, lawmakers and staffers who receive coverage through an exchange would do so through the marketplace where the lawmaker or aide resides. For example, a caseworker in the home district office of a House member from Chicago could enroll in a health plan offered through Illinois's exchange, but a scheduler in the Washington, D.C., office could sign up for a plan in Maryland or Virginia (Pear, New York Times, 8/7).

However, a senior congressional staffer said questions remain over the residency issue because a staffer enrolled in their state's exchange could face difficulties finding an in-network provider while working in D.C. (AP/Sacramento Bee, 8/7).

Meanwhile, OPM noted, "Members of Congress and their staff who purchase health insurance coverage on the exchange will be eligible to carry that coverage, with the government contribution, into retirement." However, the office said that lawmakers and aides "who retire with exchange plan coverage are not eligible for [FEHBP] coverage in retirement."

Congressional aides said they would urge the Obama administration to change this provision before it goes into effect, noting that the FEHBP has decades of experience providing retiree benefits, while the new exchanges -- which were built primarily to serve individuals under age 65 -- have no comparable experience coordinating with Medicare (New York Times, 8/7).

In a statement, Jon Foley -- OPM's planning and policy director -- said, "These proposed regulations implement the administrative aspects of switching members of Congress and congressional staff to their new insurance plans -- the same plans available to millions of Americans through the new Exchanges."

According to "RegWatch," the proposed rule does not need congressional approval, but it will have to go through a regulatory process that could take months before it is enacted ("RegWatch, The Hill, 8/7).

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