The Trump administration should end Congress’ special treatment for Obamacare subsidies, which would give lawmakers an incentive to repeal the law, Sen. Ron Johnson (R-Wis.) and Rep. Ron DeSantis (R-Fla). said July 31.

They spoke on a conference call with reporters about requiring members of Congress to sign up for exchange plans without subsidies, which they said is required under the Affordable Care Act. Until members of Congress “are put in that exact same position” as people who are required by the law to buy coverage but who aren't eligible for much financial support, “we are not going to address the root cause of this problem. We're not going to bring down premiums,” Johnson said.

The Obama administration Office of Personnel Management published a final rule in October 2013 allowing members of Congress and their approximately 12,000 staff members to enroll in the District of Columbia's small business exchange even though small business exchanges are normally reserved for companies with fewer than 50 employees.

The rule also allowed members of Congress and staff to receive subsidies to cover the cost of their care, which other businesses are not allowed to provide pre-tax funds for exchange enrollees’ premium payments. Some members of Congress have fought the rule, arguing it is illegal under the ACA and it provides special advantages to Congress and staff members that the public doesn't enjoy.

Repealing the OPM regulation “means that Congress itself won't get relief until and unless, and to the same extent as, voters do,” Heather Higgins, president and chief executive officer of Independent Women's Voice, said on the call. IWV supports free-market economic solutions and it hosted the call.


Trump Tweets

President Donald Trump tweeted July 29 and July 31, suggesting that “bailouts” for insurance companies and members of Congress “will end very soon” if a health care bill isn't approved quickly, and Congress should be “paying what public pays.”

But those threats are “not enough,” because they could result in “the worst of all possible worlds,” Higgins said.

That could result in “some sort of a lousy, partial repeal-replace that leaves voters very unsatisfied, and yet an obligation to continue this double-standard for Congress,” Higgins said.

“He should be very clear that he is instructing the Office of Personnel Management that Congress is not a small business—whether or not they vote for repeal—and that Congress will be treated under the Affordable Care Act as the law intended like everyone who is on the exchanges, and to the extent that the American people get relief, Congress will get relief,” she said.

That would tell Congress “that they will be eating their own cooking, which will radically improve what's on that menu,” Higgins said.

Both Democrats and Republicans in Congress “desperately do not want to be on the exchanges,” which will guarantee that the administration can get the votes they need to change the ACA, she said.

The OPM didn't respond to Bloomberg BNA's request for comment.

During debate over the ACA Sen. Charles Grassley (R-Iowa) won approval of an amendment that required members of Congress and their staffs to enroll in the exchanges, Hadley Heath Manning, director of policy for the Independent Women's Voice, told Bloomberg BNA. “If they passed it, it's a law and they ought to follow it,” she said.

Prior to the ACA, members of Congress and staff were covered by the Federal Employees Health Benefits Program, and the government paid most of their premiums in the same way that most employers pay workers’ premiums.

The attempt to rescind government payments for exchange coverage for congressional employees is “an obviously vindictive thing to do to give Congress a pay cut if they don't pass this legislation,” Andy Slavitt, former acting administrator of the Centers for Medicare & Medicaid Services, told Bloomberg BNA. Slavitt is now a senior adviser with the Bipartisan Policy Center.

“We're only going to be able to go so far based on threats,” he said of Trump's tweets.


‘Different Ball Game’

If congressional staff members didn't receive subsidies to help pay their health insurance premiums, “we can raise our staff's pay,” DeSantis said. But congressional members can't change their own pay without voting on it, “and a lot of members don't want to have to pay more. They don't want to be in that same boat” as people who must buy covering through the exchanges without subsidies, he said.

The House approved legislation in September 2013 attached to a budget continuing resolution striking the OPM rule, but the measure was killed in the Senate, which was then controlled by Democrats, DeSantis said. “It really was a bailout, because they're getting around what the statute ultimately provides for.”

However, “it's very unpopular inside of Congress” to repeal the OPM rule, DeSantis said. “But once it's teed up and you've got to go on record, it's a little bit different ball game at that point. So I'm hoping that this could maybe help us get back to the table and actually do what we promised the voters we would do.”