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Amends subparagraph (D) of 42 U.S.C. 18032(d)(3) to (1) change the subparagraph heading to reference Members of Congress, congressional staff, and political appointees in the Exchange; (2) expand clause (i) language to include the President, the Vice President, and political appointees; (3) add a definition for 'political appointee' in clause (ii); (4) add a new clause prohibiting Government contributions under 5 U.S.C. 8906 on behalf of specified individuals for coverage under this paragraph; (5) limit tax credits or reduced cost sharing so an enrolling individual does not receive greater benefits than a similarly situated non-enrolled individual (citing 26 U.S.C. 36B and section 1402 of this Act); (6) prohibit Members of Congress from having discretion to determine which office employees are eligible to enroll through an Exchange; and (7) clarify that the terms 'small employer' and 'qualified employers' do not include Congress with respect to Exchange and SHOP Exchange enrollments.
Adds new paragraph (6) to subsection (e) creating an exemption from the requirement to maintain health coverage for any period during a calendar year when fewer than 2 health insurance issuers offer qualified health plans on an Exchange in the county where the individual resides; includes aggregation rules treating certain related issuers as a single issuer.
Adds a new tax-code exemption for people who live in counties where fewer than two health insurance companies offer qualified plans on an Exchange, counting certain affiliated issuers as one for that test. Also changes Exchange enrollment and subsidy rules for senior officials and some congressional personnel: it extends coverage-rule limits to the President, Vice President, and political appointees, forbids a government contribution for their Exchange coverage, limits extra tax credits or cost‑sharing reductions, and restricts Members of Congress from selecting which of their staff may enroll through the Exchange.
Adds a new paragraph (6) to section 5000A(e) of the Internal Revenue Code of 1986 titled 'Individuals in areas with fewer than 2 issuers offering plans on an exchange.'
Exempts any applicable individual for any period during a calendar year from the requirement to maintain health coverage if there are fewer than 2 health insurance issuers offering qualified health plans on an Exchange for that period in the county where the individual resides.
Aggregation rule: for purposes of counting issuers under the exemption, all health insurance issuers that are treated as a single employer under subsection (a) or (b) of section 52, or subsection (m) or (o) of section 414, are to be treated as a single health insurance issuer.
The amendments apply to months beginning after the date of enactment of this Act.
Amends 42 U.S.C. 18032(d)(3)(D) by replacing the subparagraph heading with: “(D) Members of Congress, congressional staff, and political appointees in the exchange;”.
Who is affected and how:
Residents in low-issuer counties: Individuals who live in counties where fewer than two issuers offer qualified health plans on an Exchange gain an explicit exemption in the Internal Revenue Code. That exemption changes how eligibility for any individual coverage requirement or associated tax treatment is determined for months after enactment. The rule for counting issuers treats certain related carriers (affiliated issuers counted as a single employer) as a single issuer, which can change whether a county qualifies for the exemption.
Health insurance issuers/carriers: Insurers that are affiliated or part of the same corporate family will be aggregated for the issuer‑count test. That aggregation could increase the number of counties that qualify (if multiple related carriers are treated as one) or, conversely, reduce perceived competition in some analyses.
Federal officials and political appointees (President, Vice President, political appointees), Members of Congress, and congressional staff: The bill adds high‑level officials to the cohort subject to special Exchange enrollment rules, bars any government premium contribution for their Exchange coverage, and limits extra tax credits or CSR benefits for them. It also removes Members’ discretion to pick which staff may enroll under the particular enrollment scheme described, changing personnel and benefits administration in congressional offices.
Exchanges, CMS/HHS, and tax administrators: Implementation will require administrative action by agencies that administer Exchange enrollment and premium tax credits (HHS/CMS, and Treasury/IRS for the tax-code exemption). Exchanges and agencies may need to update enrollment forms, eligibility checks, subsidy calculations, and internal guidance to enforce the new prohibitions and limits.
Employer/benefits administrators in Congress and the Executive: Office HR and benefits staff will need to change enrollment procedures and communications to impacted employees and appointees. Congressional payroll and benefits processes may require modification to enforce the prohibition on government contributions and the rule that limits which staff can enroll.
Net effect: The bill creates a narrow tax-code exemption aimed at residents in very low‑competition insurance markets, while tightening rules and reducing government financial support for Exchange coverage for certain senior federal officials, political appointees, Members of Congress, and some congressional staff enrollment processes. Administrative workload will shift to tax and Exchange administrators and congressional/Executive branch benefits offices to implement the new tests and restrictions.
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Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, House Administration, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced January 3, 2025 by Andrew S. Biggs · Last progress January 3, 2025
Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, House Administration, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House