Complaint: Congressional Staffers Committed Fraud When Applying for Obamacare

Anti-waste groups claim staffers improperly obtained Obamacare subsidies by claiming to be employed by a ‘small business’

July 17, 2015

A coalition of 10 organizations has filed an ethics complaint calling for an investigation into whether senators and their staff committed fraud when they submitted applications to the health insurance exchange in Washington, D.C.

The Council for Citizens Against Government Waste, the lobbying arm of the nonpartisan watchdog group Citizens Against Government Waste, led the coalition in filing the complaint to the Senate Select Committee on Ethics. The organizations involved are calling for an investigation into whether members of Congress and their staff violated laws by claiming to be a "small business" in order to buy their insurance and qualify for taxpayer-funded subsidies.

"The Affordable Care Act (ACA), better known as Obamacare, required that members of Congress and their staff enroll in individual plans through the healthcare exchanges created by the law," the group said in a press release. "As open enrollment approached in 2014, members and staff realized that by enrolling as individuals, they would no longer receive generous taxpayer-funded contributions to help pay their insurance premiums as they had for decades under the Federal Employees Health Benefits Program. They would instead only qualify for subsidies if their household income was less than 400 percent of the federal poverty level, just like millions of other Americans that had to purchase insurance in the individual market."

The group notes that senators worked with the White House and the Office of Personnel Management for guidance on how to enroll in the Small Business Health Options Program in order to skirt any obstacles.

On October 2, 2013, the Office of Personnel and Management (OPM) used a federal regulation to deem Congress a small business despite its having more than 12,000 employees and dependents. Additionally, individual congressional offices do not directly pay salaries—their payment comes from the House of Representatives and Senate.

The group says this was done in order to allow members of Congress and their staff to have access to the taxpayer-funded subsidies.

"The purpose of this rather arbitrary and capricious action was to enable members of Congress, their staff, and families to gain access to taxpayer-funded subsidies for health insurance under the Affordable Care Act (ACA). This special exemption was cooked up by members of Congress, with help from the White House, to get something that no other individual or business can obtain."

As the first Obamacare enrollment period was underway in February 2014, one individual filed an application to the Washington D.C. Small Business Health Options Program acting on behalf of the entire Senate.

Under the Affordable Care Act, the Small Business Health Options Exchange allows businesses that employ 50 or fewer full-time workers to shop around for health insurance and gives employers greater control of the coverage, such as how much they wish to contribute to their employees’ premiums

Judicial Watch, a government watchdog group, filed a Freedom of Information Act request for the application submitted on behalf of the Senate.  The FOIA request was granted in part and denied in part.

The unredacted information they obtained showed that the individual who submitted the application said that he or she employed 50 or fewer full-time employees and had used the first name "Twenty" and the last name "Congress." The individual also used the address of the Senate Dispersing Office. This was also done for the House of Representatives.

"By pushing for OPM to issue the regulation that ostensibly allows them to "be a small business" and participate in the D.C. SHOP, members of Congress and their staff have found a clever, but potentially illegal way to get access to government financial assistance to help pay for their health insurance premiums," CCAGW said.

"Members of Congress have tried to keep this special carve-out for themselves quiet. After all, they are supposed to participate in Obamacare like any other citizen who purchases their health insurance in the individual market."