Affordable Care and Congress
April 30, 2017 9:46 AM Subscribe
Why is The United States Congress exempt from the health care law that they are trying to pass?
The technical answer has to do with how the ACA (aka ObamaCare) and the "repeal" attempt is structured.
The ACA set up state exchanges for health insurance, including an exchange for Washington, D.C. It also included a bunch of rules about what insurance could be offered on the exchanges, and which would be considered valid insurance for the purposes of avoiding the tax penalty for failing to have insurance (known as "The Mandate"). This is where things like the prohibition on refusing to cover pre-existing conditions, and the requirement that reproductive and mental health care be covered come in. Also, in a bit of political showmanship, the ACA requires Congress members and their staffers to buy health insurance on the Washington, D.C. exchange.
The Republican "repeal" bill (I use scare-quotes because it's really much more complicated than simply repealing the ACA) doesn't actually remove those protections, instead, it allows states to request an exemption from these rules. But DC isn't a state, its government is entirely under the control of Congress. There's no way for DC to request an exemption. So Congress members by definition won't have to participate in a health insurance marketplace that is exempt from these rules.
posted by firechicago at 10:02 AM on April 30, 2017 [3 favorites]
The ACA set up state exchanges for health insurance, including an exchange for Washington, D.C. It also included a bunch of rules about what insurance could be offered on the exchanges, and which would be considered valid insurance for the purposes of avoiding the tax penalty for failing to have insurance (known as "The Mandate"). This is where things like the prohibition on refusing to cover pre-existing conditions, and the requirement that reproductive and mental health care be covered come in. Also, in a bit of political showmanship, the ACA requires Congress members and their staffers to buy health insurance on the Washington, D.C. exchange.
The Republican "repeal" bill (I use scare-quotes because it's really much more complicated than simply repealing the ACA) doesn't actually remove those protections, instead, it allows states to request an exemption from these rules. But DC isn't a state, its government is entirely under the control of Congress. There's no way for DC to request an exemption. So Congress members by definition won't have to participate in a health insurance marketplace that is exempt from these rules.
posted by firechicago at 10:02 AM on April 30, 2017 [3 favorites]
Before the latest effort to pass the health care bill fell apart last week, House Republicans were working to make sure they were *not* exempt b/c Paul Ryan decided the optics were awful.
posted by mlis at 10:06 AM on April 30, 2017
posted by mlis at 10:06 AM on April 30, 2017
It's not just healthcare. Do a google search on "laws congress exempt from"
Some animals are more equal than others.
posted by IndigoJones at 11:36 AM on April 30, 2017 [3 favorites]
Some animals are more equal than others.
posted by IndigoJones at 11:36 AM on April 30, 2017 [3 favorites]
they get free health care for life, so they don't care it does not affect their lives, they will never fix health care till that stops,
& i think firechicago misunderstood the question.........
posted by patnok at 6:17 PM on April 30, 2017
& i think firechicago misunderstood the question.........
posted by patnok at 6:17 PM on April 30, 2017
But DC isn't a state, its government is entirely under the control of Congress. There's no way for DC to request an exemption. So Congress members by definition won't have to participate in a health insurance marketplace that is exempt from these rules.
This isn't exactly correct. It is more complicated than that.
First off, the idea that DC is different because it isn't a state is not true. For the purposes of the ACA, DC is treated just like a state. DC is governed by a mayor and 13-member council that functions similarly to a state government with governor and legislature. Congress can overrule the decisions of the DC government, but otherwise they operate like a state government. So there is nothing preventing DC from seeking an waiver just like any other state, just that it is unlikely for the Democrat dominated council to do so.
As examples of this local power, the DC council voted to implement their own ACA exchange and also to implement Medicaid expansion just like many other states.
Members of congress and their staff can buy their insurance on the DC Health Link exchange. However, they don't buy from the individual exchange like ordinary citizens of DC. They buy their insurance from the Small Business Health Options Program (SHOP) which was designed by ACA to help small businesses buy insurance for their employees. So they are treating Congress as a small business for ACA purposes. This was so they they could keep their federal "employer contribution" which pays up to 75% of their premiums.
Congress and staff buy their insurance from the DC exchange but from a different portion of the exchange from ordinary folks in DC, their "employer's" small business menu of plans.
Now, the MacArthur amendment allows states to get waivers for Obamacare requirements such as pre-existing conditions and essential benefits. For congress and staff in DC, this isn't an issue because there is no way that Democrat DC officials are going to ask for a waiver. But some members of congress and their staff get their Obamacare insurance through exchanges in their home states which in many cases, that is Republican states, might ask for a waiver.
The MacArthur amendment exempted congress and staff from these possible waivers in their home states. Republicans wanted to make sure that they could keep Obamacare exactly as passed in 2010 but only for themselves.
In other words, in reality, Republicans think Obamacare is just great for themselves at the very same time they say it is terrible and want to repeal it for everyone else.
Republicans have said they will be removing their special exemption now that it has been exposed to the public, but that remains to be seen.
posted by JackFlash at 6:50 PM on April 30, 2017 [4 favorites]
This isn't exactly correct. It is more complicated than that.
First off, the idea that DC is different because it isn't a state is not true. For the purposes of the ACA, DC is treated just like a state. DC is governed by a mayor and 13-member council that functions similarly to a state government with governor and legislature. Congress can overrule the decisions of the DC government, but otherwise they operate like a state government. So there is nothing preventing DC from seeking an waiver just like any other state, just that it is unlikely for the Democrat dominated council to do so.
As examples of this local power, the DC council voted to implement their own ACA exchange and also to implement Medicaid expansion just like many other states.
Members of congress and their staff can buy their insurance on the DC Health Link exchange. However, they don't buy from the individual exchange like ordinary citizens of DC. They buy their insurance from the Small Business Health Options Program (SHOP) which was designed by ACA to help small businesses buy insurance for their employees. So they are treating Congress as a small business for ACA purposes. This was so they they could keep their federal "employer contribution" which pays up to 75% of their premiums.
Congress and staff buy their insurance from the DC exchange but from a different portion of the exchange from ordinary folks in DC, their "employer's" small business menu of plans.
Now, the MacArthur amendment allows states to get waivers for Obamacare requirements such as pre-existing conditions and essential benefits. For congress and staff in DC, this isn't an issue because there is no way that Democrat DC officials are going to ask for a waiver. But some members of congress and their staff get their Obamacare insurance through exchanges in their home states which in many cases, that is Republican states, might ask for a waiver.
The MacArthur amendment exempted congress and staff from these possible waivers in their home states. Republicans wanted to make sure that they could keep Obamacare exactly as passed in 2010 but only for themselves.
In other words, in reality, Republicans think Obamacare is just great for themselves at the very same time they say it is terrible and want to repeal it for everyone else.
Republicans have said they will be removing their special exemption now that it has been exposed to the public, but that remains to be seen.
posted by JackFlash at 6:50 PM on April 30, 2017 [4 favorites]
they get free health care for life, so they don't care it does not affect their lives, they will never fix health care till that stops
No, this is false. It was false back in 2009 and it is still false today. Congress has to pay for their healthcare under the current law.
posted by soelo at 7:43 AM on May 1, 2017
No, this is false. It was false back in 2009 and it is still false today. Congress has to pay for their healthcare under the current law.
posted by soelo at 7:43 AM on May 1, 2017
Not exactly false but incomplete. The government pays for a generous 75% of health insurance for congress members and staff. They only pay 25% out of pocket. And this 25% comes out of their paycheck tax-free -- no social security tax, no medicare tax, no federal income tax and no state income tax. This is similar to the insurance plans for most federal employees and similar to many of the best insurance plans at large corporations.
Where Republican hypocrisy shows up is in the MacArthur amendment to their AHCA. They want an exemption to the state waivers that they are trying to push on the public. What this is saying is that they are quite delighted with all of the benefits of Obamacare and they don't want Obamacare taken away from themselves at the same time they are trying to repeal it for the public.
posted by JackFlash at 8:38 AM on May 1, 2017
Where Republican hypocrisy shows up is in the MacArthur amendment to their AHCA. They want an exemption to the state waivers that they are trying to push on the public. What this is saying is that they are quite delighted with all of the benefits of Obamacare and they don't want Obamacare taken away from themselves at the same time they are trying to repeal it for the public.
posted by JackFlash at 8:38 AM on May 1, 2017
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posted by Automocar at 9:50 AM on April 30, 2017 [8 favorites]