The public exchange that serves members of Congress and their aides wants the flexibility to treat Congress as if it were generous small employer rather than just another cheap one.
Mila Kofman, executive director of the District of Columbia Health Benefit Exchange Authority, says her understanding is that Centers for Medicare & Medicaid Services wants to treat Congress as if it had failed to give much support to its health plan, or had failed to get many employees to participate.
By putting Congress in the "employer with a bad health plan" category, CMS would require the district's DC Health Link exchange to start 2015 coverage open enrollment for members of Congress and their aides on Nov. 15, rather than Oct. 1, Kofman says.
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"We strongly oppose this proposed change," Kofman writes in a comment on the CMS draft regulations that describe the open enrollment calendar proposal.
The congressional health plan enrollment proposal would cause big headaches both for congressional employee benefits programs and for the DC Health Link staff, Kofman says.
Drafters of the Patient Protection and Affordable Care Act tried to give members of Congress a taste of their own medicine by requiring them to get their coverage through the exchange system, rather than through the Federal Employees' Health Benefit program.
Officials at the U.S. Office of Personnel Management decided members of Congress and their aides should get their exchange coverage through the DC Health Link Small Business Health Options Program division, even though PPACA bars larger employers from the public exchanges until at least 2017.
DC Health Link has helped 43,000 people sign up for qualified health plan coverage, and Congress has about 12,000 lawmakers and staff employees who are eligible to buy through the exchange, Kofman says.
The open enrollment period for most federal benefits programs, including congressional plans other than the health plan, starts Oct. 1.
Forcing Congress to start open enrollment Nov. 15 would create a conflict with the enrollment periods for the other benefit plans, and it would force the DC Health Link staff to run two open enrollments for very different market segments at the same time, Kofman says.
Kofman says the SHOP exchanges will be able to work with carriers and small employers to decide when to hold open enrollment.
Normally, the Nov. 15 open enrollment calendar start date would apply to an employer only if they failed to pay a minimum percentage of employee premiums, or if participation rate fell below a minimum level, Kofman says.
Congress does meet the normal D.C. SHOP plan participation and contribution requirements, Kofman says.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
