OPM final rule: Lawmakers, staff eligible for gov't contribution in exchanges

Wednesday - 10/2/2013, 4:47pm EDT

The Office of Personnel Management has made it official: Lawmakers and their staff members are required to purchase health insurance from one of the Affordable Care Act's exchanges — but the government will still contribute toward their premiums.

OPM issued the final rule, which goes into effect immediately, Wednesday.

When the new health care law goes fully into effect in January, members of Congress and official congressional staff will no longer be eligible for coverage under the Federal Employees Health Benefits Program (FEHBP).

Instead, according to the final rule, they will purchase insurance through the exchange's small-group market, known as the Small Business Health Options Program (SHOP).

The issue of whether the government would still contribute the employer share to lawmakers' and their staff members' premiums has roiled through Capitol Hill in recent days.

Currently, the government pays about three-fourths of federal employees' premiums — including congressional staff. In the legislative back-and-forth that preceded the first government shutdown in more than 17 years, the House approved a measure that would have stripped those contributions out, resulting in a pay cut of about $11,000 congressional employees. The Senate rejected that measure.

OPM's finalized regulations state that members of Congress and their official staff members must enroll in the small-business exchanges — or SHOPs — in order to continue to receive the 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," the rule states. "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."

Members of Congress and their staff members should sign up for insurance through the D.C. Health Link Small Business Market, which is administered by the D.C. Health Benefit Exchange Authority in Washington.

OPM issued interim regulations in early August after some members of Congress stepped up pressure on the agency to clarify how the ACA would affect lawmakers and their staff. Sen. Tom Coburn (R-Okla.) put a hold on President Barack Obama's nomination to head OPM, which was lifted after the agency issued the draft rules.

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