KHN’s ‘What the Health?’: Finally, a fix for the ‘family glitch’

Reviewed by Emily Henderson, B.Sc.Apr 7 2022

The Biden administration this week moved to fix the so-called family glitch in the Affordable Care Act, which has prevented dependents from getting federal subsidies to buy health insurance even if the insurance offered by the employer is unaffordable. It remains unclear, however, whether this is something that can be done by regulation or instead requires congressional action.

Meanwhile, Congress struggled to find a compromise that would keep federal funding flowing for covid-19 testing, treatment, and vaccines. A $10 billion bipartisan bill negotiated in the Senate failed to advance when Republicans insisted on a vote on a separate public health immigration policy. That proposed spending was still less than half the amount the Biden administration had requested to continue to address the pandemic.

This week's panelists are Julie Rovner of Kaiser Health News, Tami Luhby of CNN, Shefali Luthra of The 19th, and Jessie Hellmann of CQ Roll Call.

Among the takeaways from this week's episode:

• The Biden administration's proposal to fix the "family glitch" in the Affordable Care Act addresses a problem that Democrats and ACA advocates have complained about for years. The issue is that people who are offered insurance through their work but would rather get a policy through the ACA exchanges are eligible for premium subsidies only if their work-based insurance is considered unaffordable. That determination is based on the cost of a policy for a single person and does not take into account the higher costs for a family.
• Most people thought it would be up to Congress to remedy the family glitch. But since getting modifications through Congress has proved nearly impossible, advocates have pushed for executive action. That is not as foolproof as passing a law and is subject to a challenge through lawsuits. It's not clear who might be able to prove they have standing because they are being harmed by regulation and mount a successful suit.
• The federal government is setting up a special enrollment period for low-income people to buy ACA insurance plans, but insurers are cutting back on commissions to brokers who might help consumers find a plan during this period. Insurers have long been wary of efforts to extend enrollment beyond the usual sign-up periods because they fear that those special enrollment options attract people with health problems who are more costly to cover.
• If brokers can't or won't help customers in the special enrollment period, the federal government has increased its funding for navigators and other assistance groups in the past year that can help consumers.
• Lawmakers in Oklahoma this week passed a bill outlawing abortion in nearly all circumstances. That bill, expected to be signed by the governor, could go into effect in the fall after, supporters hope, the Supreme Court has revised the landmark Roe v. Wade decision that made abortion legal throughout the country. But the legislature is also seeking a more immediate way to end abortions and is expected to pass a bill that bans abortions after six weeks and calls on private individuals to sue anyone helping someone secure an abortion. That measure, modeled after a Texas law that has so far not been struck down by the Supreme Court, could go into effect immediately after it's signed by the governor.
• Lawmakers in Colorado have moved in a different direction. The governor this week signed a bill that guarantees the right to abortion. With so many nearby states moving to ban abortions, Colorado could become a hub for women seeking the procedure. But that option, may not be affordable for many people.
• Reducing the cost of insulin is a popular bipartisan goal on Capitol Hill, yet lawmakers have not been able to agree on a way to do it. The House passed a bill last week that would hold the out-of-pocket cost for insured patients to $35 a month. But Republican senators have balked at the measure, at least in part because it is being pushed by Sen. Raphael Warnock (D-Ga.), who is up for reelection in a seat the GOP would very much like to recapture.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: KHN's "Losing Sleep Over the Pandemic? Work Flexibility May Be a Boon for Night Owls' Health," by Krishna Sharma

Shefali Luthra: The Washington Post's "With Roe Endangered, Democrats Divide on Saying the Word 'Abortion,'" by Caroline Kitchener

Tami Luhby: Health Affairs' "Health Care Is Now Healthcare," by Alan Weil

Jessie Hellmann: KHN's "$11M for North Carolina Work-Based Rehab Raises Concerns," by Aneri Pattani and NC Health News' Taylor Knopf

Also discussed on this week's podcast:

KHN's "Doctors Trying to Prescribe Abortion Pills Across State Lines Stymied by Legislation," by Rachel Bluth

KHN's "ACA Sign-Ups for Low-Income People Roll Out Amid Brokers' Concerns About Losing Their Cut," by Julie Appleby