Congressman Beto O'Rourke

Representing the 16th District of Texas

How the Affordable Care Act Pertains to Members of Congress & their Staff

Many of you have asked if Members of Congress and their staff are exempt from the ACA or if we get some type of sweet-heart deal on health care and I want to respond to your concerns. It is a myth that Members and their staf...f are exempt from the ACA and receive special health insurance. (see link below) has thoroughly debunked the myth and said: “In other words, the Affordable Care Act places on lawmakers and their staffs additional requirements that don’t pertain to other Americans with work-based insurance.”

Currently, my staff and I are offered health insurance through the Federal Employees Health Benefits Program (FEHBP). This is the program that provides health insurance to all federal employees. We have the exact same insurance options that other federal employees have and nothing else. Under the FEHBP, the federal government (the employer) can pay 72% of the total health insurance premium and the employee pays the rest, including any co-pays or deductibles. Depending on your employer and what plans are offered to you, the FEHBP may seem like a good deal. Many of my staff are covered by FEHBP, but many others find it more cost effective to obtain insurance through a spouse or through other means. I did not decide to get coverage under FEHBP because it was less expensive for my family and I to maintain the coverage we had before I was elected to Congress.

The ACA contains a provision (Section 1312) that actually forbids Members of Congress and their staff from continuing to receive health coverage through the FEHBP. Under Section 1312, beginning on January 1, the only plans that will be available to Members and their staff will be those offered through the new health care exchanges. Members and staff are the only group of federal employees who will lose their current coverage and have to sign up for new plans through the exchanges. Although I was not around when the law passed, my understanding of the provision is that it was designed to ensure that lawmakers get a personal sense of how the new exchanges function because they will be covered through them. Members and staff will still be able to receive assistance from their employer (the federal government) in paying for part of the insurance premium. There are no plans to change the law to exempt Members of Congress or their staff or allow them to maintain their current coverage.

Here’s a quote from Congressman Dennis Ross, a conservative Republican from Florida who voted against the ACA and wants it repealed:

“There is a common misconception that members of Congress do not have to pay for health insurance,” Ross said. “Members of Congress and their staff are covered under the Federal Employees Health Benefits Program. My staff and I are able to choose among several different plans also available to Americans across the country, and we all must pay premiums, deductibles, and co-pays, just like constituents like you, while choosing from the same list of providers as everyone else in the plan. Additionally, as the Affordable Care Act (ACA) – also known as Obamacare – is implemented, my staff and I will be absorbed into the insurance exchanges. There is no exemption for members of Congress or their staff, and in fact, the ACA specifically states we must be included.”

There are legitimate problems with the ACA that Congress should work together to fix. The recurring myth that Congress is exempt is distraction that keeps us from examining and improving other parts of the law.