Holding Congress Accountable on the Health Care Bill


Although Congress’s pending health care bill has been overshadowed by other headlines, the Senate and the President are moving forward with efforts to undo the Affordable Care Act (ACA). According to recent press reports, Senate Majority Leader Mitch McConnell plans to have a vote by July 4 on the Affordable Health Care Act (AHCA). And meanwhile, the Administration is taking regulatory actions to undermine the ACA. All of this is happening even though the AHCA and the Administration’s actions will likely cause millions of people to lose health insurance and benefits

The District has a role to play in addressing all this. Here’s why.

A critical provision of the AHCA would allow states to seek waivers from federal standards for health insurance plans. The waivers are one reason so many people would lose insurance, or find their premiums increased or their benefits reduced.

Fortunately, the House passed an amendment to the ACHA providing that Members of Congress must be subject to the same insurance rules as their constituents. But unfortunately, as the Washington Post reported, this amendment may not be implemented because Members who get their insurance through an exchange currently use the D.C. exchange, and the District is unlikely to seek any waivers. The upshot will be that Members of Congress will be shielded from harmful waivers that apply to their constituents.

However, as I explained in a HuffPost column last week, it shouldn’t be this way, especially since the District has a special obligation under the Constitution to make sure that Congress’s intent is carried out in the District of Columbia. Once Congress passes a provision making clear that the District should not allow its Members to receive special treatment compared with Members’ constituents, the District has an obligation to implement that provision. In fact, the District has a constitutional obligation to do so, since under the District Clause of the Constitution, Congress makes the rules for the District “in all cases whatsoever.”

As a result, If the AHCA is enacted, either the federal Office of Personal Management or the District government will have to carry out Congress’s intent that its Members not receive preferential treatment. OPM could do this by requiring Members to buy insurance through their home states, as opposed to the District. If OPM doesn’t do this, the District would have to do it, by redirecting Members from the District’s exchange to the exchanges in their home states.

This would be a good outcome for Congress because it would effectuate Members’ intent. It would be good for the District because it would avoid the District being involved in preferential treatment for Members of Congress. And it would be good for the country because it would require Members to think about the pending health care law not only in terms of how it would affect their constituents, but also in terms of how it would affect them personally.

We hope that D.C. officials will make clear that they are willing take steps to make sure that all these good outcomes will occur.

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