Source: Ada S. Cornell, Congressional Research Service, CRS Report, R43194, June 17, 2015
The federal government, as an employer, offers health benefits to its employees, including Members of Congress and congressional staff. Prior to 2014, Members and staff had access to many of the same health benefits as other federal employees. For example, Members and staff were eligible to voluntarily enroll in employer-sponsored health insurance through the Federal Employees Health Benefits (FEHB) Program, and they could choose to participate in other health benefit programs, such as the Federal Flex ible Spending Account Program (FSAFEDS).
Section 1312(d)(3)(D) of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) generally specifies that the only health plans that the federal government may make available to Members and designated congressional staff (with respect to their service as Members or staff) are either created under the ACA or offered through an exchange established under the ACA. A final rule issued by the Office of Personnel Management (OPM) amends FEHB eligibility regulations to comply with Section 1312(d)(3)(D) of the ACA. Under the final rule, beginning January 1, 2014, Members and designated congressional staff are no longer able to purchase FEHB plans as active employees; however, if they enroll in a health plan offered through a small business health options program (SHOP) exchange, they remain eligible for an employer contribution toward coverage. Additionally, the final rule allows Members and designated congressional staff who are eligible for retirement to enroll in a FEHB plan upon retirement.
This report summarizes the provisions of the final rule and describes how it affects current and retired Members and congressional staff. OPM has indicated that Members and congressional staff are still eligible for other health benefits related to federal employment, and these additional health benefits are outlined in this report. These health benefits include FSAFEDS, the Federal Employees Dental and Vision Insurance Program (FEDVIP), the Federal Long Term Care Insurance Program (FLTCIP), the Office of the Attending Physician, and treatment in military facilities. This report also discusses Members’ and staff’s eligibility for Medicare, which does not appear to be affected by the final rule.
For information about the health benefits received by other federal employees (i.e., those who are not affected by the aforementioned final rule), see CRS Report R43922, Federal Employees Health Benefits (FEHB) Program: An Overview.