Congress ObamaCare: ObamaCare Exemption for Congress

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.

First here are a few updates on changes and attempted change to the law made by Congress and other branches of government.

UPDATES ON OBAMACARE AND CONGRESS: On July 25, 2017 Congress voted for a “motion to proceed” with voting on an ObamaCare repeal and replace plan. With that in mind, no repeal and replace bill was passed (all measured failed to get the 51 votes needed outside of the initial measure to proceed). Get updates on the ObamaCare Repeal and Replace Vote in Congress.

UPDATE ON THE MANDATE AND CHANGES TO THE ACA UNDER TRUMP: Some changes were made to the ACA under the Trump administration. Most notably the fee for not having health insurance was reduced to $0 in most states. You can see a full list of changes by Congress and the Executive branch on our page on “TrumpCare.”

IMPORTANT UPDATE ON LAWSUITS: A Texas federal judge ruled the Affordable Care Act (Obamacare) unconstitutional on December 14, 2018. The Justice Department then affirmed its support for the ruling in late March 2019. For now nothing changes as the appeals process play out. However, there could be real consequences down the road. Learn more about the 2018 ObamaCare ruling.

NOTE: See also our page on ObamaCare’s Supreme Court Cases for past changes to the ACA.

Is Congress Exempt From ObamaCare?

The ObamaCare exemption for congress is essentially a myth… but the TrumpCare exemption isn’t (although that could change).

Here is how this rather complex story works:

Congress and ObamaCare

In the early days of the push to get the ACA passed, Democrats were criticized for exempting Congress and their staffers from the exchanges.

At that time, the claims that members of Congress were exempt from ObamaCare weren’t totally without merit, as an early version of the ACA exempted Congress. However, the final bill did not.

The result of the final version of ObamaCare (the Affordable Care Act) is that members of Congress, and their staffers, have to buy their health insurance on the exchanges along with millions of other Americans… more or less. In reality, they got to follow some special rules.

Congress and their staffers use SHOP plans under the ACA (ObamaCare plans for employers). This allows them to retain their tax-payer provided “employer” contribution while still technically being on “the exchanges.”

TIP: The SHOP exchange is an exchange that other normal working Americans are on, so they are on “ObamaCare” in that sense. However, allowing Congress to be on SHOP plans (rather than the individual exchanges used by non-employees) required a few special rules.

In other words, Congress and their staffers 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 normal working-class Americans.

Congress and TrumpCare

With the above said said, things have gotten complex again under “TrumpCare” (the house and senate’s still unpassed repeal and replace bills)… as both the House and Senate bill have attempted to exempt Congress from their changes.

The MacArthur Amendment, an Amendment to the House Republican repeal and replace plan (the AHCA) noted below, originally let Congress opt-out of the Republican repeal and replace plan and stay on ObamaCare!

That would have meant Congress could have kept ObamaCare but been exempt from TrumpCare 1.0. However, that provision was changed before the bill passed the House.

But wait, it gets even more bizarre…

…Not only did the ACA and AHCA both originally exempt congress and then changed the rule to appease people. The most recent Senate healthcare plan, the BCRA, actually stuck an exemption back in.

So as it stands now, under the ACA congress and their staffers use the SHOP. Meanwhile, keeping in mind the plan has so far failed to pass, under the latest version of TrumpCare congress and their staffers would be exempt from the new rule that allows insurers to not follow ACA standards and sell “junk plans.”

In other words, the reason people think congress is exempt has a lot to do with the fact that they keep trying to exempt themselves…

With that fact about congress and healthcare reform cover. We cover other important aspects of Congress and ObamaCare below.

TIP: We discuss more myths 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 the first time, but it did after having the MacArthur Amendment attached.

Then, after those changes, the House passed their bill.

The bill was then revised by the Senate, making substantial changes. Then, when it didn’t look like Republicans had enough votes, the bill was revised again.

Learn more about the Senate health bill, now called Better Care Reconciliation Act of 2017, by clicking the link.

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 (this plan is only phase 1 of 3).

Can Congress Repeal ObamaCare in full? Congress can, technically speaking repeal ObamaCare in full, but the path is difficult. This is why Republicans have opted for a budget reconciliation bill that only requires 51 votes to pass. That along with the changes the Trump administration make mean we will see many changes, but the ACA won’t likely be repealed in full. With that in mind, again as noted above, this part of the process is unofficially only phase 1 of 3.

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.

See: Do 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