There has been a lot of hubbub surrounding alleged exemptions for members of Congress where Obamacare, or the Affordable Care Act (ACA) is concerned. Some claim that Congress enjoys unfair advantages that other Americans do not; while others say that such exemptions are nothing more than a myth. The truth is that members of Congress and their staffers are not exempt from Obamacare. Every American, including senators and representatives, must carry health insurance or pay associated penalties for failure to meet the mandatory minimum for coverage. That said they are not necessarily required to purchase insurance through their state’s health exchanges. And some may receive what many Americans would believe to be special considerations.
So what is this debate all about? First and foremost, it is important to understand that federal employees, including members of Congress, are not exempt from Obamacare, per se. They must meet minimum standards for individual health insurance coverage like everyone else. However, like all Americans, they enjoy the right to decide whether they purchase insurance through the Obamacare insurance exchanges or they buy policies from private companies. In this regard, members of Congress are no different from any other consumer.
However, the government has typically covered a large portion of the cost of healthcare for federal employees. Under Obamacare, those who receive coverage for their family through an employer-sponsored plan are not eligible for marketplace assistance. Further complicating the issue is the fact that amendments to Obamacare require members of Congress and their staffers to use the health insurance marketplace. In essence, this means that members of Congress who formerly enjoyed extremely affordable healthcare would probably wind up paying more under Obamacare.
This is where the alleged exemptions come into play. Because members of Congress and their staff have been unable to claim assistance, the government, as their employer, has been allowed to cover a portion of their healthcare costs, thus creating a sort of subsidy that only government employees enjoy. They did this by allowing Congressional members to purchase health insurance through SHOP, the Small Business Health Options Program. The debate lies in the fact that the U.S. government and its many federal employees hardly constitute a small business.
The argument in favor of this plan revolves around the fact that many members of Congress employ small staffs, making them like small businesses. However, they gain all the advantages of a small business, as well as those associated with working for a large employer. This is the complex crux of the exemption debate. While members of Congress are not technically exempt from purchasing health insurance and they are required to use ACA exchanges, they are also granted perks that other Americans don’t enjoy when it comes to selecting affordable healthcare plans and receiving subsidies to help pay for them.
The question is: is it legal? The debate continues, with some members of Congress opting out completely by purchasing private health insurance rather than using exchanges and/or taking subsidies. Several members of Congress have made it their personal crusade to put an end to exemptions and make certain that everyone, even Congress, is held to the same standards when it comes to selecting and paying for health insurance. So is Congress exempt from Obamacare? Technically, no. Are they receiving special considerations? In some cases, yes.
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