By Kathleen Stoll
April 9, 2022
A lot of news recently has featured the health care “family glitch.” In my family, when you say something is just a glitch, it means a small problem and probably easily fixable.
In this case, the “family glitch” in the news has to do with families qualifying for premium subsidies when they purchase health insurance on the state health marketplace. This glitch isn’t a small matter. It impacts more than 5 million Americans – many of whom are women and children. While not small, this glitch is fixable. And President Biden has proposed a new rule to do just that.
A new Commonwealth Fund report looked at women’s health (ages 18-49) in the United States and 10 other “developed” countries and found:
-- Rates of death from avoidable causes, including pregnancy-related complications, are highest in the U.S.
-- The U.S. had the highest maternal mortality rate by far at 23.8 maternal deaths per 100,000 live births.
-- U.S. women have among the highest rates of multiple chronic conditions and the highest rate of mental health needs.
-- U.S. women are significantly more likely to have problems paying their medical bills or to skip or delay needed care because of costs.
Like many similar reports, I am frustrated that the media coverage doesn’t always connect the dots on how policy changes could alter the next report’s findings.
Big picture, these findings drive home that our U.S. health system leaves many lower and middle-income Americans without affordable basic health care. It is yet another a call for our nation to look at how we can take huge profits (that flow to pharmaceutical, insurance, and large health care system corporations) out of our health care system. Fundamental health care system reform is needed.
Families can’t afford the care they need and the result can be tragic.
Unfortunately, Congress seemingly is unable to move even small proposals to lower health insurance and care costs. I haven’t given up on Congress totally but partisan politics keep standing in the way of even popular, commonsense proposals.
Therefore, it seems imperative that the Biden administration to do what they can where they can to make quality, comprehensive (not barebones) health insurance and care more affordable via federal rules and regulations.
That brings me back to the “family glitch.” The thing about regulatory change is that it can be complicated and boring. So now I hope I don’t lose you or bore the hell out of you. Hang with me. This really is important.
People can qualify to buy health insurance with robust premium subsidies (and sometimes lower out-of-pocket costs) if their offer of job-based insurance premiums cost more than 9.83% of their income – a federal definition of unaffordable premiums.
This definition of unaffordable is based on the job-based premium charged for just the worker’s coverage — not the cost of family coverage. Of course, the premiums for a single worker are lower than premiums for family coverage. That flaw in the definition is the family glitch.
Example: Jane’s premiums for her own job-based health insurance are less than 9.83% of her income so no premium subsidy. If Jane includes her spouse and/or child on her job-based plan, the premiums rise above 9.83%. But it doesn’t matter. Jane can’t choose to go to the marketplace and get a premium subsidy for family coverage.
Of the 5 million-plus hurt by this glitch, more than half are female. More than half are children. The vast majority would pay less for a quality marketplace family plan (often with lower copays and deductibles) than for family coverage through their employer. And this fix reduces overall marketplace premiums by, on average, 1% as new younger, healthier people enroll.
What stands in the way of fixing this family glitch? Now just a few months.
President Biden recently announced a federal proposed rule that will fix this crazy definition of affordable family coverage. There are opportunities for the public to express support as described in the proposed rule.
We can all bring our voices to this rule-making process so that struggling working families will have one less hurdle in the way of securing quality affordable health insurance coverage.
Kathleen Stoll serves as the Policy Director for West Virginians for Affordable Health Care (wvahc.org) and operates a policy and economic consulting business, Kat Consulting.
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