Final rule directs members of Congress, staffers to DC SHOP exchange

The Office of Personnel Management (OPM) has issued a final rulemaking to be published in the Federal Register this week that directs members of Congress and designated staffers who avail themselves of government funded premium contributions to obtain coverage through the District of Columbia health benefit exchange’s Small Business Health Options Program (SHOP).  The Patient Protection and Affordable Care Act requires each state exchange marketplace to establish a SHOP to offer employers of 50 or fewer employees qualified small group health plans.

OPM explained its reasoning in the preamble to the final rule:

The proposed rule was silent on whether eligible individuals would select qualified health plans through an Exchange in the individual or small group market by way of the SHOP. Because a Government contribution is, in essence, an employer contribution, the final rule clarifies that Members of Congress and designated congressional staff must enroll in an appropriate SHOP as determined by the Director in order to receive a Government contribution. SHOPs are designed to provide employer-sponsored group health benefits and are, therefore, the appropriate environment in which to provide an employer contribution to Members of Congress and congressional staff. Further, this ensures that Members of Congress and congressional staff do not have additional choices in the individual Exchanges with a Government contribution that other individuals lack. Given the location of Congress in the District of Columbia, OPM has determined that the DC SHOP, known as the DC Health Link Small Business Market administered by the DC Health Benefit Exchange Authority, is the appropriate SHOP from which Members of Congress and designated congressional staff will purchase health insurance in order to receive a Government contribution. OPM intends to work with the DC Health Benefits Exchange to implement this rule.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email or call 530-295-1473. 

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Frederick Pilot

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