Canard Watch: ‘Exempting’ Congress from the Affordable Care Act

by Mark Wilson

“Wait a minute,” I thought, listening to this Affordable Care Act talk on the radio this week, “What is the deal with this ‘exempting’ members of Congress from the law? Aren’t they already within the scope of the individual mandate?”

The Affordable Care Act requires Americans to have any health insurance, whether it’s from an employer, a spouse, or a parent. If a person doesn’t have health insurance, that’s what the new state exchanges are for: a place to go get health insurance. As federal employees, members of Congress and their staffers already have health insurance, so “exempting” them from the ACA requirements doesn’t make sense because there’s nothing to exempt them from.

It turns out that this “exemption” talk comes from a bad faith amendment to the Affordable Care Act, inserted by Republicans, that would have required members of Congress to obtain their health insurance from a state exchange. The amendment ended up being part of the law, but now that’s creating a problem:

Large employers — defined in the law as employers with more than 100 employees — aren’t allowed onto the insurance exchanges until 2017, and only then if a state makes an affirmative decision to let them in.

But the federal government is the largest employer in the country. So Grassley’s amendment means that the largest employer in the country is required to put some of its employees — the ones working for Congress — on the exchanges. But the exchanges don’t have any procedures for handling premium contributions for large employers.

That’s where the problem comes in. This was an offhand amendment that was supposed to be rejected. It’s not clear that the federal government has the authority to pay for congressional staffers on the exchanges, the way it pays for them now in the federal benefits program. That could lead to a lot of staffers quitting Congress because they can’t afford to shoulder 100 percent of their premiums. (There’s also a smaller issue related to how retiree benefits might be calculated. But I’m only willing to go so far into the weeds here.)

So, is Congress trying to “exempt” itself from the Affordable Care Act? No: Congress is trying to undo a bad faith amendment that will result in, at the least, confusion as to what health care members of Congress actually have, and at worst, make health insurance way more expensive than it has to be, all while failing to address the purpose of the law, which was to get everyone insured (which members of Congress already are, anyway).

The article linked above notes that there is no special plan just for members of Congress; they have access to the same health insurance plans that all federal employees have. However, by virtue of their being members of Congress, they have—separate and apart from their health insurance plans—perks that other federal employees don’t (again, regardless of which insurance plan they choose):

In addition, members of Congress also qualify for some medical benefits that ordinary federal workers do not. They (but not their families) are eligible to receive limited medical services from the Office of the Attending Physician of the U.S. Capitol, after payment of an annual fee ($491 in 2007). But services don’t include surgery, dental care or eyeglasses, and any prescriptions must be filled at the member’s expense.

House and Senate members (but not their families) also are eligible to receive care at military hospitals. For outpatient care, there is no charge at the Washington, D.C., area hospitals (Walter Reed Army Medical Center and National Naval Medical Center). Inpatient care is billed at rates set by the Department of Defense.

So, no, Congress doesn’t have any special plan just for itself. And any perks that a member has come as a result of that person’s status as a member of Congress, not as a result of an insurance plan that person has chosen. No non-Congressman could have access to those perks under any insurance plan because only a member of Congress can have them.