Everything You Need to Know About Congress and ObamaCare

We cover everything you need to know about ObamaCare and Congress, including updates on votes to repeal and replace ObamaCare and the Congress exemption.

TIP: See also our page on ObamaCare’s Supreme Court Cases.

Is Congress Exempt From ObamaCare?

The ObamaCare Exemption for Congress is essentially a myth.

It turns out that reports that members of Congress were exempt from ObamaCare were mostly without merit.

Members of Congress, and their staffers, have to buy their health insurance on the exchanges along with millions of other Americans, although they do follow some special rules.

Congress and their staffers are on a SHOP plan (an ObamaCare plan for employers). This allows them to retain their tax-payer provided “employer” contribution while still technically being on the exchange.

In other words, they certainly do get special treatment, but the grand result is they still have to pay a portion of their premiums and they are still on the same ObamaCare plans as the rest of us.

With that said, the MacArthur Amendment, the Republican plan noted below, actually lets Congress opt-out of the Republican repeal and replace plan and stay on ObamaCare!

So, yes Congress and their staffers have been on ObamaCare since January 1st 2014, and it seems like they will still be on it under TrumpCare as it stands now.

Speaking of which, the other important “ObamaCare and Congress” item on everyone’s mind is addressed here too. So let’s get to that.

TIP: We discuss the myth more below, first let’s discuss the ongoing (and related) repeal and replace effort.

An Update on the Repeal and Replace Voting in Congress

The last repeal and replace effort the American Health Care Act (AHCA) didn’t pass the House, but that doesn’t mean we won’t see another repeal and replace attempt.

In fact, there is now talk of voting for the same bill again this time with different Amendments (see: The MacArthur Amendment: the Latest ObamaCare Replacement Plan Explained).

Meanwhile, the Trump administration just passed a set of new regulations in April that shorten 2018 open enrollment, allow for higher out-of-pocket costs, and allow for narrower networks.

See Trump’s previous January Executive Order and the new April Regulations for what is changing, or see the Difference Between ObamaCare and TrumpCare to get an idea of what else could change in the future.

What Has Happened With the ObamaCare Repeal So Far?

With the above in mind, lets start at the beginning of the repeal and replace process and walk through it.

True to their campaign promises, Republicans moved forward with an Obamacare repeal almost immediately after Trump took office, but the details are complex.

Republicans began the process of repeal via what is known as “budget reconciliation“.

So far, votes have passed the House and Senate that pave the way for Republicans to use special budget procedures to repeal major parts of the law without cooperation from Democrats. However, that alone didn’t’ change anything, it just set things in motion (motion that then resulted in the AHCA noted above).

While the strategy to start a repeal and replace plan by defunding and delaying is frustrating in some ways, it is a boon to those covered (as it doesn’t result in an immediate repeal of provisions like cost assistance).

Since this process involves voting to write legislation that begins to repeal ObamaCare at a later date, and because there is no passed plan yet (and the AHCA was phase 1 of 3 with the intent to piecemeal everything over time), it is often summarized as “a repeal and delay” plan.

All this to say, the repeal process has begun after a budget resolution passed the House and Senate, but for the time being, the Affordable Care Act (ObamaCare) is still in effect and open enrollment 2018 is still on.

Get more ObamaCare 2017 Repeal and Replace Updates or see another perspective at Washington Post’s “It will only get harder for Republicans aiming to repeal Obamacare”.

Can Congress Repeal ObamaCare? Congress can repeal ObamaCare, but the path is difficult. They are starting by defunding, then they will have to write a repeal bill, and then they will need a replace bill. Even then, some parts are harder to get rid of than others. Right now Republicans are depending on bills they can get through without the votes of Democrats, and are trying to repeal and replace in phases. It is likely only key provisions will actually be repealed and replaced due to logistics. But, for now, we still don’t know!

ObamaCare Congress Shutdown

Now that we have a few key points covered, let’s take a look at yet another “ObamaCare Congress” item, why Republican members of congress forced a Government shut down over ObamaCare back in 2013.

On October 1st, 2013 Republican members of congress forced a Government shut down in protest of ObamaCare and some of its key provisions by not signing off on the budget needed in order to move forward.

The shutdown didn’t actually stop ObamaCare, but it did shut down congress for 17 days costing tax payers about $24 billion. Most of the funding for ObamaCare is mandatory and has nothing to do with the appropriation bills Congress was protesting.

UPDATE: For 2017 something like this could have happened, but Democrats lost power in the 2016 election and don’t have the votes to filibuster the Republican budget plan. So for now 20 million lives are on the line over this.


Congress Health Insurance Exchange Catch

As noted above, it is essentially a the myth that Congress and their staff are exempt from buying their health insurance through the health insurance marketplace.

Just like everyone else, members of congress and their staff must purchase their coverage through the exchanges.

Unlike most everyone else, they use the small businesses part of the health insurance marketplace and a loophole to retain robust benefits.

It works like this,

Prior to the passage of the ACA members of Congress and their staffers were covered through the Federal Employees Health Benefits Program, or FEHBP.

However, the ACA required members of Congress and congressional staff members to obtain their health insurance through ACA exchanges.

After debates, a final rule allowed Congress and Congressional staff purchase their insurance through the District of Columbia’s small business health options program (SHOP) exchange.

This doesn’t mean they get free healthcare or anything, instead the federal government provides a subsidy equivalent to 72% of the weighted average of all FEHBP premiums (or75% of the cost of the chosen plan, whichever is less; up to about $12,000).

Private employers on average pay more than 80% of the cost of health benefits.

In other words, Congress and their staffers are “on ObamaCare” and “use the exchanges” and they don’t get free healthcare, but the details are complex.

SeeDo Members of Congress Enjoy Free Health Care? from Snopes.

Grassley’s Amendment

Grassley’s amendment, the one that made Congress have to use the exchanges, created some problems as the exchanges don’t have any procedures for handling premium contributions for large employers.

Grassley’s amendment was an offhand amendment that was supposed to be rejected, but was passed.

It was never clear if the federal government had the authority to pay for congressional staffers on the exchanges, the way it used to pay for them with the federal benefits program.

However, the loophole noted above, where they use the SHOP, was created to avoid staffers quitting Congress over not being able to afford their health premiums.

Is the ObamaCare Loop Hole for Congress Fair

The health insurance purchasing system set up under ObamaCare may not be fair, as it doesn’t provide equal treatment to all Americans, however it is fair in that Congress is on the same plans anyone else has access to.

Whether or not Congress is really getting “the same” insurance as most Americans, everything considered, may be a point of argument, but they are generally “on ObamaCare.”

Keep coming back for the truth on ObamaCare and Congress.


ObamaCare Exemption for Congress