HR 127119th CongressIn Committee

Protection from Obamacare Mandates and Congressional Equity Act

Introduced: Jan 3, 2025

Standard Summary

Comprehensive overview in 1-2 paragraphs

H.R. 127, the Protection from Obamacare Mandates and Congressional Equity Act, would (1) create an exemption from the ACA’s requirement to maintain health insurance for individuals living in counties with fewer than two health insurance issuers offering plans on an Exchange, (2) expand ACA coverage rules to Members of Congress, congressional staff, the President, the Vice President, and political appointees while limiting government contributions and subsidies for their coverage, and (3) impose several restrictions intended to equalize treatment between federal officeholders and other individuals regarding Exchange enrollment. The bill also places limits on how staff eligibility is determined and clarifies that Congress is not treated as a small employer for SHOP/Exchange purposes. The changes would take effect for months after enactment.

Key Points

1Exemption from the individual mandate for people in counties with fewer than 2 issuers offering Exchange plans. The exemption applies for the entire calendar year and treats issuers within a county as a single issuer for aggregation purposes.
2Effective date: these changes apply to months beginning after enactment.
3Expanded ACA coverage participation for federal officeholders. Members of Congress, congressional staff, the President, the Vice President, and political appointees would be eligible to enroll in health insurance coverage through an Exchange.
4Government contributions for these individuals would be eliminated. No government contribution under 5 U.S.C. 8906 would be provided for their Exchange coverage.
5Subsidy and cost-sharing restrictions. Any premium tax credits or reduced cost-sharing for these enrollees cannot exceed what a similarly situated individual not enrolled in this program would receive.
6Staffing enrollment restrictions. Members of Congress would not have discretion to decide which of their staff are eligible to enroll through an Exchange.
7Definitions clarified to exclude Congress from small-employer and qualified-employer status for purposes of SHOP/Exchange enrollments.

Impact Areas

Primary group/area affected:- Individuals living in counties with fewer than 2 health insurance issuers offering Exchange plans (they would be exempt from the federal individual mandate).- Members of Congress, congressional staff, the President, the Vice President, and political appointees (they would participate in Exchange coverage but without government subsidies and with limited subsidies eligibility).Secondary group/area affected:- The broader health insurance market and Exchange dynamics, because more federal employees would be enrolled through Exchanges and not through standard employer contributions.Additional impacts:- Federal expenditure on government contributions for subsidized coverage would be reduced for the affected federal employees.- Subsidy structures would be aligned so that federal enrollees cannot receive more in tax credits or cost-sharing reductions than similarly situated non-enrolled individuals, potentially reducing benefits for some high-need enrollees.- Administrative and governance changes would limit the ability of Members of Congress to unilaterally determine staff eligibility for Exchange enrollment.- Clearer separation between Congress and small-employer SHOP treatment to avoid treating Congress as a small employer for these purposes.

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