OPM provision defines how Congress, staff receive health benefits in 2014

Wednesday - 8/7/2013, 4:07pm EDT

The Office of Personnel Management proposed a new rule today to make it clearer how members of Congress and some of their staff would receive their health benefits under to The Affordable Care Act (ACA).

OPM's proposal comes a week after Sen. Tom Coburn (R-Okla.) put a hold on the nomination of Katherine Archuleta as the director of the Office of Personnel Management. He demanded that OPM and the White House provide an answer as to how ACA would apply to lawmakers and their staff.

Coburn said at the Homeland Security and Governmental Affairs markup and vote of Archuleta's nomination that he was unhappy with the administration's delay in getting the final rule out with only a few months before it's supposed to take effect.

"That decision has been decided and has gone to (the Office of Management and Budget) and back. There is no reason we should vote on this position until we know what the administration's position is on our employees' health insurance starting Oct. 1," he said. "I plan on holding that nomination until we get an answer so we can legislate or do something for the very valuable staff that we have and the stupidity for which we have in the present law a gutting of our own staff because someone was trying to make a political point."

A Coburn spokesman reached by email confirmed Coburn would lift the hold on Acrhuleta's nomination now that OPM had issued its proposal.

Congress and staff no longer eligible for FEHB

With its proposed rule, OPM is seeking to clear up language in ACA that would limit members of Congress and their staff's ability to access health benefits plans.

"Notwithstanding any other provision of law ... 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 (Health Insurance Marketplace) established under this Act (or an amendment made by this Act), " ACA states.

When ACA goes into effect on Jan. 1, 2014, members of Congress and some of their staff will no longer be eligible for the Federal Employees Health Benefits (FEHB) Program. OPM proposed the new rule to ensure that when that happens, they will be eligible for the Affordable Insurance Exchange (exchanges) put in place by ACA.

"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," OPM Director of Planning and Policy Jon Foley said, in a statement.

OPM released a fact sheet and a Q&A sheet to explain the mechanics of the proposed rule and how ACA will affect congressional staff.

Under the rule, participants would still receive an employer contribution toward their health insurance premiums, even though they may no longer be eligible for premium tax credits for Exchange plans. Those contributions would be no more than what they would make to the FEHB program.

The rule also empowers Congress to determine who in their office is an "official" staff member and, therefore, no longer eligible for FEHB.

"Under the proposed rule, Congress designates which employees are eligible for FEHB coverage by October of the year before the coverage year so individuals know whether, during open enrollment, to participate in the appropriate state Exchange or the FEHB Program for the following year. For this year (2013) only, the deadline may be extended for up to 30 days," an OPM sheet said.

OPM also issued a Benefits Administration Letter to the congressional administrative offices to provide guidance on the coverage of individuals under the Exchange plans.

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