Healthcare Fix in Action: Taking on the Family Glitch

This past week former President Barack Obama made his first trip to the White House since leaving in 2017. The former president came to support the announcement of an administrative rule change or government clarification of policy to fix the so-called 'family glitch' in Obamacare. In writing the very popular and expansive law that created several significant changes to healthcare in the United States, areas that needed additional work have come into focus. In this case, a piece of the law was found acting in the spirit of the law. This is why we have to review laws, their effects, and the legislation's intentions we should be continuously improving. And when those don't match up with where the law was supposed to be, we can make changes that help get to the heart of the matter. This is the situation with the family gitch within the Affordable Care Act.

●      The "family glitch" is the ACA rule that bases eligibility for a family's premium subsidies on whether available employer-sponsored insurance is affordable for the employee only, even if it's not actually affordable for the whole family.

●      In 2022, the Biden administration is working on a rule change to address the family glitch.

●      Large employers have to offer coverage to dependents, but they don't have to pay for that coverage.

●      Many kids who would otherwise be caught by the family glitch are eligible for CHIP. But that doesn't help spouses, and there are still about 2.8 million kids caught by the glitch and ineligible for Medicaid or CHIP.

The Biden administration is proposing a rule to fix the family glitch; fixing the glitch would bring down costs for family premiums. Currently, an employer-sponsored plan is unaffordable if premiums top 10 percent of an employee's household income. This affordability piece only looks at individuals and does not account for adding spouses or children to their employer's health plans. The law is intended to make coverage affordable. Still, this gap allowed for a group of people to be pulled into having to pay more than 10 percent of their income which is against the law's intention.

The Biden administration finally proposed interpreting the law more sensibly, providing subsidies to families. It would ensure that a family would pay more than 10 percent of their income to cover every member on an employer-sponsored plan.

As a community that deals with the challenges around care and coverage. This clarification can be beneficial to make sure that coverage is available to one's whole family. Plugging people into the range to get much-needed support to cover certain familial relations. The proposed rule change is relatively simple: Instead of basing the affordability determination for a family's employer-sponsored health insurance on just the cost to cover the employee. If applicable, the determination would be based on the cost to cover the employee plus family members. Here are the essential points to understand about this:

●      The expectation is that the family glitch fix will be in effect as of 2023.

●      If a family has to pay more than a certain percentage of household income for the employer-sponsored plan, they would potentially be eligible for premium tax credits in the marketplace.

●      There are roughly 5 million people affected by the family glitch. The White House published a statement indicating that they expect about 200,000 uninsured people to gain coverage due to the proposed family glitch. And they anticipate that "nearly 1 million Americans would see their coverage become more affordable" under the new rules. (As described below, fixing the family glitch will not result in subsidies for everyone currently caught by the family glitch; some will still find coverage unaffordable.)

It's important to remember some stats about our community and the reality we are trying to change each year. LGBTQ people are more than twice as likely to be uninsured as non-LGBTQ people. 15% of LGBTQ are uninsured, compared to 7 % of non-LGBTQ people. And they're given the gaps in our data collection. We have to look at the rates for the black community as well. Since the ACA's coverage provisions, the uninsured rate among Black Americans under age 65 decreased by 8 percentage points, from 20 percent in 2011 to 12 percent in 2019. The uninsured rate for Black Americans is still higher than that for White Americans: 12 percent compared to 9 percent. Then we have to tie the two together because we know how this goes. We know how to connect the stories of our lived experiences with the numbers to know the whole story of our community. But we need to make sure that we can use every resource available to help people ensure that they have the coverage they need for their families.