During the debate over the Affordable Care Act, critics in Congress warned that the law would mean that many Americans would lose their existing employer-provided insurance coverage.
But when a key part of the law takes effect in January, the ones who will be forced to drop their insurance and find coverage through a health exchange will be those who work in Congress.
In an already controversial law, the treatment of members of Congress and their staffs is yet another point of contention, drawing fire from supporters and opponents alike. And the mandate is raising questions about worker retention on Capitol Hill and the impact on other federal workers' insurance costs.
"The intent [of the Affordable Care Act] was to provide health insurance coverage options to the uninsured," one commenter said after the Office of Personnel Management proposed the rule this summer. "It was never intended to rescind coverage from those already insured by a group- or employer-provided health plan."
After Dec. 31, members of Congress and their office staffs will no longer be insured under the Federal Employees Health Benefits Program.
On Jan. 1, they will be required to purchase plans though the District of Columbia exchange, one of the online marketplaces created to give the uninsured a place to shop for coverage. The congressional employees will not be eligible for the subsidies offered to other exchange participants but will receive an employer contribution.
The provision was inserted into the law by an opponent of the legislation. Sen. Charles E. Grassley, an Iowa Republican, who intended his requirement that lawmakers use the same exchanges as their constituents to serve as a poison pill. But Democrats embraced the idea.
Some who commented online argued that those affected should be allowed to keep their coverage. But many objected primarily to the government contributing roughly 70 percent of the employees' premiums.
"This is outrageous," one said. "No subsidy for members of Congress and staff. They should be in the same boat as everyone else in the exchanges. ... The fear of these people leaving for other jobs is unfounded and should have no impact on this decision."
"They will stay forever if they see themselves as a privileged class with benefits that cannot be enjoyed elsewhere."
In its final rule, the Office of Personnel Management said members of Congress will receive the employer contribution only if they choose a gold-level plan.
Rep. Andy Harris, Maryland's only Republican in Congress, took to the House floor to call for a repeal of a rule he said is contrary to law.
"Under Obamacare, members of Congress and staff will receive special treatment unavailable to the American public," the Baltimore County lawmaker said. "Members of Congress will receive subsidized health insurance coverage on the exchanges established by Obamacare, even though employer subsidies are specifically banned for everyone else."
Congress is not getting special treatment, a spokeswoman for Rep. C.A. Dutch Ruppersberger said.
"We're still getting calls from people every day who think Congress is exempt from this law," spokeswoman Jaime Lennon said. "We're not being given anything better. We must go to the exchange and purchase [insurance] if we want to keep our federal benefits."
Ruppersberger said he does not want to see lawmakers and their aides treated differently from the public.
The rule "means that members and their staff are the only individuals under the law who are explicitly removed from their current health care plan, and are also the only group ineligible for tax credits, even those whose income levels qualify them."
After the rule was proposed, David Farber, a blogger for The Hill, urged congressional staffers to ask to stay in the current health plan based on a grandfather clause in the Affordable Care Act.
Farber, a partner in the Washington law firm King & Spalding, contended that the clause prevents the law from forcing someone to end existing coverage. But the Office of Personnel Management disagreed.
Farber, a longtime lobbyist, said he has heard from congressional staffers who are concerned about the uncertainty of trading their coverage for new insurance.
"I have talked to Hill staffers who say, 'It's not about me, it's about my wife and kids,'" he said. "Everyone has cast this as a special deal to congressional staff. It's just the reverse. It's a much worse deal than for any other American. The only people in America who are forced to change their coverage are congressional staff."
"Any time you pull a group of people out of an existing insurance plan, that plan is going to be adversely affected," said Jessica Klement, a lobbyist for the National Active and Retired Federal Employees Association. "You decrease the size of the risk pool, and your premiums will increase."
But now that workers will be moving to the exchange, Klement said, they should get the same level of contribution from their employer as in the federal employees health program.
The organization is satisfied with the final rule, she said, because it allows for the premium contribution and lets those in an exchange plan return to the federal employee program upon retirement.
"It's standard among businesses," Klement said of the premium contribution. "It's not like something they haven't been getting before."