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In Praise of Congress

Posted by John McDonough  August 10, 2013 02:00 PM

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Most of this past week's coverage of the Obama Administration's "fix" to the section of the Affordable Care Act requiring Members of Congress and their personal staffs to obtain employer sponsored health insurance coverage through an official ACA health insurance marketplace/exchange missed the essential point.

This section of the ACA is a bona fide cynicism buster. Let's consider. Here is the specific text of subsection D of ACA section 1312 (click here to read on pages 157-158). 

(D) MEMBERS OF CONGRESS IN THE EXCHANGE.
(i) REQUIREMENT. Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are:
(I) created under this Act (or an amendment made by this Act); or
(II) offered through an Exchange established under this Act (or an amendment made by this Act).
(ii) DEFINITIONS. In this section:
(I) MEMBER OF CONGRESS. The term "Member of Congress" means any member of the House of Representatives or the Senate.
(II) CONGRESSIONAL STAFF. The term "congressional staff" means all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.

This language was adopted by the Senate Finance Committee in the fall of 2009 as proposed by Sen. Charles Grassley (R-Iowa). Other Congressional committees included a similar requirement, different wording. No public opposition from either side. The intent was that Members and their staffs who wanted employer-sponsored health insurance coverage through the federal government, once the ACA was fully launched, would only be able to get it through their available health insurance exchange (now called "marketplace" by the Obama Administration), so that high-level federal officials would have to live with the same new program being made available to tens of millions of Americans. No longer would these folks be able to obtain coverage through the Federal Employees Health Benefits Program as all other federal employers can and will still be able to do.

Good thing.  I recall highlighting this section in talks I would give in 2010 and 2011 about the ACA, much to most audience members' surprise, often accompanied by someone's confident prediction: "They'll repeal it the first chance they have."

Over the past year, some have questioned whether section 1312 permits the federal government to continue paying its share of premiums for these affected Members and staff, or whether the ACA requires Members and staff to pay the entire premium themselves (losing not just the federal premium share, but also the federal tax benefits from employer sponsored coverage, a huge financial loss). A large share of these employees would also be eligible for no or minimal ACA premium subsidies.

This past week, the Obama Administration, through a new proposed regulation, clarified that the ACA does permit the federal government to continuing paying the employer share of premiums currently available to federal workers in the FEHBP. Click here to read the proposed rule. 

Across the media landscape, commentators decried Congress creating a special deal for themselves, ignoring others' pleas for special fixes, and acting like self-interested pigs.

Bull.

Here's the real message to consider. When the state and federal health insurance exchanges/marketplaces open next January 1, among the participants will be Members of Congress and members of their personal staffs. When an Exchange screws up, and they will,  Members and Congressional staff will be among those directly affected. When an Exchange works well, and most will, Members and their staff will see it and know it.

No, they didn't repeal section 1312. No, they didn't alter the intent behind the Grassley amendment.  You didn't hear or read Senator Grassley complain (no mention on his Senate website or Twitter feed.) Members are keeping true to this commitment made in the ACA.
 
That's a good thing, and they deserve praise for doing so.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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