Sen. Ron Johnson (R-Wis.) said Thursday that the Washington, D.C., health board has taken the healthcare mandate in the Affordable Care Act too far.

In a letter to D.C. Mayor Vincent Gray, Johnson asks the mayor and the D.C. Health Benefit Exchange Authority (HBX) Executive Board to explain its decision to require all D.C. small businesses to purchase healthcare through exchanges created under the Affordable Care Act.

Johnson argues the decision would prevent people in the District from keeping their current doctors and health plans. 

"This decision pushes far beyond any other implementation of the law,” Johnson said in a statement Thursday. “Contrary to promises made by President Obama and reiterated by [Health and Human Services] Secretary [Kathleen] Sebelius that the American public can keep their current doctors and insurance plans, this decision denies those in the District that very freedom."

D.C.'s exchange board approved a plan earlier this month that would require small businesses (those with fewer than 50 employees) and people who purchase insurance on their own, rather than through an employer, to buy their coverage through the exchange.

States have the power under the Affordable Care Act to eliminate the individual and small-group insurance markets outside their exchanges. The move could help keep the exchanges alive, by preventing insurance companies from offering cheaper plans with fewer benefits outside of the exchange, leaving only sicker and more expensive patients inside the exchange.

But the approach comes with risks, especially in large states with many plans for individuals and small businesses to choose from. The D.C. exchange justified its decision by citing the city's especially small market for individual and small-group policies. Most insured people in D.C. get their benefits through their employer, and most employers have more than 50 workers. Those firms can't use exchanges even if they want to.

But the move by the Executive Board is proving controversial with Republicans in Congress, which has a role in D.C. government. 

Johnson serves as ranking member of the subcommittee on Oversight of Government Management, the Federal Workforce and the District of Columbia, which has jurisdiction over federal policy and the District.

In the letter, Johnson pointed out that Obama has repeatedly said that under his plan, “if you like your doctor, you keep your doctor” and “if you like your current insurance, you keep that insurance.” But Johnson said HBX’s October decision isn’t consistent with Obama’s statements.

"The Executive Board's decision not only tramples on the ability to negotiate an insurance contract, but also eliminates choice by forcing individuals and small businesses to purchase standardized coverage through a monopoly of government-selected and approved health plans,” the letter stated. “This action will greatly increase costs and significantly reduce competition."

Johnson said the executive board has mandated that individuals and small-business owners in D.C. purchase health insurance through the Health Benefit Exchange it oversees.

"The decision to force individuals and small groups into a government-run exchange violates their freedom to negotiate, contract and retain their current health insurance plan,” Johnson wrote. “I am very concerned that individuals and small businesses in the District will face restrictions on healthcare choice and freedom that exceed even those limitations established in the flawed healthcare law itself.”

Johnson said the board was thinking more about the sustainability of the exchange itself, rather than the consumer.

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