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Monday, Nov 24, 2014
Healthcare Exchange Q&A

Who is exempt from Obamacare? Members of Congress?

Published:

Q: Who is exempt from Obamacare? And am I correct in understanding that Congress has exempted itself? By the way, I contacted and spoke with an aide to Rep. Kathy Castor in Washington, D.C., on this issue earlier this year. She advised me to address this question in an email to her office citing the answer would require some research. I did so immediately but have not had the courtesy of a reply. — Cathy from Brandon

A: A lot of people wonder if the mandate requiring all Americans to get health insurance applies to them. And for most of us, the answer is yes.

People who have employer-based insurance plans, Medicare or Medicaid, or buy their own individual health insurance are good to go if they sign up for 2014 coverage. It’s the people without insurance — about 20 percent of Floridians — who need to start shopping.

But you can apply for an exemption if you:

* cite a religious objection to the requirement;

* are a member of a Native American tribe, an undocumented immigrant, a prison inmate or a member of a health care sharing ministry;

* are uninsured for less than three months of the year, such as someone in between jobs;

* make an income low enough that health coverage is considered unaffordable or low enough that you don’t file federal income taxes;

* would qualify for the expanded Medicaid program for poor Americans, but the state where you live isn’t broadening its requirements. (Florida is one of 16 such states.)

Now, about members of Congress and their staff.

The Affordable Care Act requires these lawmakers and staff to leave the Federal Employee Health Benefits Program and get health insurance on the federal Healthcare Marketplace, according to FactCheck.org, a project of the Annenberg Public Policy Center.

This requirement to leave their employer-based insurance applies only to this group, and not all federal employees.

Confusion cropped up this summer, when Congress did change a loophole. The government will provide members of Congress and their staff cash to buy a health plan, but it’s not a subsidy like the one poor- and middle-class Americans will get for shopping on the exchange. The money Congress and staff will get is equal to what these workers would have received as employer contributions for the federal employee benefits plan.

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