Summary: The PPACA has a provision which requires Congress to receive insurance coverage through the new exchanges. However, there aren’t any provisions as to how the premiums will be paid. Congress is scurrying to resolve.
The Patient Protection Affordable Care Act became effective in 2010. Part of the act requires Congress to become part of the healthcare exchanges in terms of insurance coverage. Not until recently has this become a big issue – with the exchanges open enrollment beginning October 1, 2013. It is one of the many provisions of the legislation that was enacted and basically forgotten until the provisional effective date is right around the corner – that is when panic sets in.
Under the legislation, members of Congress and many of their aides are required to be covered through the new state-based exchanges. One of the main issues is there wasn’t anything written into the provision that the government would continue to pay its share of the premiums once Congress falls under the exchange umbrella. So, Congress is scurrying about trying to figure out a way to skirt around paying a $5,000 individual premium or an $11,000 family premium. Representative Billy Long has gone so far as to say Congress is “freaked out” at the prospect of paying the full premium.
Many Congressman do not live luxuriously and in fact many live in group houses or cramped apartments just to survive. So, this premium issue could have some Congressman flocking to other sources of income and in some cases threatening to leave Congress al together.
So, once again Congress is scrambling at last minute to try to resolve the issue and permit the federal government to anti-up at least a portion of the premiums while trying to avoid any perception of “special treatment”. It is a very fine line. The PPACA was designed for all and not just “non-Congress” Americans and that is the basis for Congress participating in the exchanges. The PPACA explicitly requires Congress to join the exchanges but no wording was added to either authorize the government to pay the premiums or for the government to reimburse for the premiums paid.
Behind the scenes, the personnel agency is working on proposed legislation to address the issue but the proposal isn’t due until October, the same time as the exchanges open for business. Where this goes is anyone’s guess, but the next month and a half should prove to be very interesting.
What are your thoughts? Do you think Congress should be forced to obtain insurance through the exchanges? Do you think the government has an obligation to subsidize? If they do, where will the funding originate? What additional healthcare services and agencies will have to be further cut in order to fund such an expense?
About BHM Healthcare Solutions – www.bhmpc.com
BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.
Contact Us : firstname.lastname@example.org, 1-888-831-1171
To receive our blogs delivered to your mailbox weekly, sign up for our newsletter, by clicking the newspaper below. We deliver cutting edge information on healthcare news and events.