Tag Archive: congressional staff

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 fpilot@pilothealthstrategies.com or call 530-295-1473. 

Congressional staff headed for enrollment in state exchange marketplace; some state and local government retirees could be next

Two types of government workers could end up getting health coverage through the state health benefit exchange marketplace.  The first is members of Congress and their staffs as mandated by the Patient Protection and Affordable Care Act.  The federal Office of Personnel Management issued a proposed rule this week that implements the requirement under which these individuals would use their existing employer contributions from the Federal Employees Health Benefits program to purchase exchange plans for coverage beginning in January 2014.

The other category is state and local government retirees who have not yet become eligible for Medicare. These early retirees could also end up in the exchanges as state and local governments struggle with ballooning deficits in retiree health funds that threaten their solvency.  The prospect is the topic of recent articles by Bloomberg and Governing magazine. The apparent thinking is a fair number of these pensioners on relatively modest fixed incomes would qualify for advance income tax credits to help them purchase an exchange plan and wouldn’t have to undergo medical underwriting under individual market reforms that take effect in 2014.

 


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 fpilot@pilothealthstrategies.com or call 530-295-1473. 

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