Proposed Rule to Implement PPACA Health Care Requirements for Congress, Staff

The Office of Personnel Management (OPM) issued a proposed rule intended to clarify and streamline changes to health insurance coverage for members of Congress and congressional staff under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). On January 1, 2014, members of Congress and their official staff will lose their eligibility for the Federal Employee Health Benefits program (FEHB) and must obtain coverage from health plans created under PPACA or offered via the health insurance exchange in the state in which the individual resides.

The proposed rule also clarifies who will lose FEHB eligibility upon PPACA implementation. Members of Congress are members of the Senate or House of Representatives, delegates to the House of Representatives, and the Resident Commissioner of Puerto Rico. Staff members are all full-time and part-time employees of an official office of a member of Congress; the OPM proposes that each member of Congress determine which staffers work in his or her official office, and therefore meet the PPACA requirement. Designations must be made by the October prior to the coverage year to give staff time to enroll in a state exchange or FEHB as applicable.

Those individuals who are no longer eligible for FEHB will maintain the same government contributory stipend as they had prior to PPACA implementation. Otherwise, they will be subject to the same rules as other individuals obtaining coverage through the exchanges. Upon retirement, individuals enrolled through the exchanges can retain that coverage, and are not eligible for FEHB coverage in retirement.