WASHINGTON — Older members of Congress and those who smoke, like Speaker John A. Boehner, could be facing much higher health insurance premiums under a new official interpretation of President Obama's health care law.
The administration said Wednesday that the government would continue contributing to the cost of health benefits for lawmakers and thousands of Congressional employees, but that they would have to buy coverage as individuals through new state-based markets known as insurance exchanges.
Federal workers, including lawmakers, now generally get coverage through the Federal Employees Health Benefits Program, the nation's largest employer-sponsored health insurance program. Under some of the most popular health plans, the government contributes $5,000 a year for individual coverage and $11,000 for family coverage.
The 2010 health care law generally requires members of Congress and employees in their "official offices" to get coverage through the exchanges. The purpose was to make sure lawmakers understood the benefits and burdens of the law, as experienced by many of their constituents.
In the federal employee program, people in the same health plan generally pay the same premiums, regardless of their age or place of residence.
However, for health plans sold on the exchanges, premiums can vary, based on a person's age, tobacco use and place of residence. A person like Mr. Boehner, who turns 64 in November, might be charged three times as much as a 23-year-old. And as a smoker, he could be charged up to 50 percent more than a nonsmoker of the same age.
Even before the implications of this provision became clear, Mr. Boehner strenuously opposed the law, on the ground that it was driving up costs for consumers and employers, and he has led efforts to repeal it.
The United States Office of Personnel Management issued a proposed rule on Wednesday that would end coverage under the federal employee program for lawmakers and many of their aides on Dec. 31.
"These proposed regulations implement the administrative aspects of switching members of Congress and Congressional staff to their new insurance plans — the same plans available to millions of Americans through the new exchanges," said Jonathan Foley, director of planning and policy at the personnel agency.
In 2009, Mr. Obama said: "If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what."
But that assurance does not apply to Congress. The law requires members of Congress and many of their aides to get their employer-based coverage through exchanges. The administration said this means the exchange where a lawmaker or an aide resides.
Thus, a caseworker in the district office of a House member from Chicago might enroll in a health plan offered on the Illinois exchange, while the chief of staff in the lawmaker's Washington office might sign up for a plan in Virginia, and the scheduler in the same office might enroll in a plan in Maryland.
The proposed rule includes a surprise for lawmakers. They will generally not be able to get into or return to the Federal Employees Health Benefits Program when they retire.
"Members of Congress and their staff who purchase health insurance coverage on the exchange will be eligible to carry that coverage, with the government contribution, into retirement," the personnel agency said. But, it said, lawmakers and aides "who retire with exchange plan coverage are not eligible for Federal Employees Health Benefits plan coverage in retirement."
Congressional aides said they would urge the administration to change this provision before it takes effect. The federal employee program has decades of experience providing benefits to retirees, but the new exchange plans were conceived mainly for people under 65 and have no experience coordinating benefits with Medicare.
The proposed rule allows lawmakers to decide which aides work in the "official office" of a member of Congress and must therefore go into the exchanges.
The nonpartisan Congressional Research Service has said that the law appears to exempt people who work for Congressional committees and in leadership offices, like those of the speaker and the majority and minority leaders of the Senate and the House.
But the administration said "there is not an existing statutory or regulatory definition" of a lawmaker's official office. And it noted that some aides split their time between a lawmaker's personal office and committee offices.
Unwilling to make these delicate decisions, the administration said that lawmakers were best equipped to determine "whether particular individuals are employed by the official office" and must go into the exchanges. The personnel agency said it "will not review or overturn these determinations."
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