U.S. fixes ACA ‘family glitch’ as insurers start key open enrollment season

coinstack-150x150The Biden Administration has tackled the “family glitch” in Obamacare, issuing new eligibility rules that will open up more affordable health insurance for many more poor, working poor, and middle-class Americans who otherwise might struggle to pay for coverage, even as provided by their employers.

This change in health care regulation is taking effect, even as tens of millions of people roll into an important period to protect their well-being — the annual “open enrollment” months for health coverage under the Affordable Care Act, by many employers, as well as for those eligible for Medicare.

The Treasury Department’s new regulations on the “family glitch” affects as many as 5 million people, more than half of them children, according to the nonpartisan, independent Commonwealth Fund. Here is how the Associated Press described what federal regulators are doing to make health coverage more affordable to many more people under the Affordable Care Act or Obamacare:

“Since the law was enacted more than a decade ago, people who have access to health insurance plans through their employers are supposed to get price breaks on the Affordable Care Act marketplace [coverage, instead], if they pay more than 9.5% of their income toward monthly premiums. But for years, the Internal Revenue Service arrived at that calculation based on the cost of a work-sponsored health insurance plan for a single individual, instead of a more expensive family plan. That meant many families didn’t qualify for the tax breaks offered through the ACA …”

Commonwealth Fund experts reported this forecast with the new ACA rules:

“One study estimates that under the [new] rule, about 710,000 more people would enroll in marketplace coverage with premium tax credits and 90,000 more children would be enrolled in Medicaid and the Children’s Health Insurance Program when their parents sought marketplace coverage because the system will automatically check for eligibility. The administration estimates that the number of uninsured would be reduced by about 200,000. The proposal would be more beneficial to lower-income enrollees than those with higher incomes because they receive fewer tax subsidies for employer coverage and higher tax credits for marketplace coverage. One study estimated that it would save families about $400 per person annually, but families with incomes below 200% of the federal poverty level (just under $28,000 for a family of four) would save $580 per person annually. The administration estimates that a million people would save money.”

Health insurance, just to remind, offers a crucial way for regular folks to spread the bankrupting burdens of paying for unanticipated, and regular medical services across a broader group, rather than seeing these nosebleed costs just crush individuals. It can still leave patients exposed to sky-high costs in the U.S. health care system, the world’s most expensive. But employers and insurers also negotiate with doctors, hospitals, and others in the system for typically better prices. And the poor and uninsured too often find themselves paying the highest and astronomic costs for care.

Because of the economic shocks of the coronavirus pandemic, doctors, hospitals, and other service providers in the health care system have seen their business recover slowly, and their federal emergency aid ebb. They have forecast higher prices for the days ahead — and insurers also see cost hikes in their immediate future, too. This will pose big challenges for employers, who provide most Americans with their health coverage in a long, cost-sharing arrangement.

Employers for some time have sought to shove ever-increasing portions of the cost of health coverage onto their workers, notably with spiking deductibles meant to off-set ever more expensive monthly premiums. But too many workers have found that they must forgo prescription drugs and medical services because they cannot meet high deductibles and afford skyrocketing out of pocket expenses. The already fraught relationship between companies and their workers has grown even more so, as employers confront labor shortages, higher materials and compensation costs, fears of a recession, and painful inflation.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by bankrupting and dangerous drugs. Too many patients struggle these days to access and afford safe, efficient, and excellent health care. This has become an ordeal with the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications.

Most of us, to be honest, would just as soon have a molar drilled or sit in the front row of a heavy-metal concert, rather than spending time in our employers’ annual, Human Resources-run sessions on the options for work-provided health insurance. Buck up, read the materials, and go to the programs with lots of smart questions, please. This is important stuff for your health and for those you love.

People who get their coverage under Obamacare public exchanges can find information online. And, with Democrats in power, they also will find ACA outreach programs that include expanded efforts to provide them information about Obamacare coverage.

Seniors should take care to check on their Medicare options at this time of year, too, especially as concerns grow about booming Advantage plans and whether insurers are pushing for excessive profits and problematic care through this coverage.

By the way, as regular folks scrutinize where they and the nation stand as far as health insurance go, here’s hoping they also tuck their findings into their thinking about how they will vote in the watershed midterm elections just weeks away. Health care is always an important political issue. But it is interesting to note that the furious Republican opposition to any federal role in health care has faded after more than a decade of ferocious attacks on Obamacare. As the AP reported about the ACA:

“The number of uninsured Americans has dipped to a historic low of 8% this year, with an estimated 26 million people in the U.S. still without health insurance.”

We have much work to do still to ensure that health care is not a privilege but a right in the wealthiest nation in the world and that reciprocal altruism prevails so we all, as they say now, have each other’s backs with appropriate insurance coverage in times of costly medical crises.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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