{"id":638427,"date":"2018-10-24T07:00:40","date_gmt":"2018-10-24T13:00:40","guid":{"rendered":"http:\/\/nmpolitics.net\/index\/?p=638427"},"modified":"2018-10-24T07:42:25","modified_gmt":"2018-10-24T13:42:25","slug":"fixing-obamacares-family-glitch-hinges-on-outcome-of-midterm-elections","status":"publish","type":"post","link":"https:\/\/nmpolitics.net\/index\/2018\/10\/fixing-obamacares-family-glitch-hinges-on-outcome-of-midterm-elections\/","title":{"rendered":"Fixing Obamacare\u2019s \u2018family glitch\u2019 hinges on outcome of midterm elections"},"content":{"rendered":"<div id=\"attachment_72046\"  class=\"wp-caption module image alignnone\" style=\"max-width: 771px;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-72046\" src=\"http:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2015\/08\/CapitolBuilding-771x455.jpg\" alt=\"The U.S. Capitol Building\" width=\"771\" height=\"455\" srcset=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2015\/08\/CapitolBuilding-771x455.jpg 771w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2015\/08\/CapitolBuilding-336x198.jpg 336w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2015\/08\/CapitolBuilding-768x453.jpg 768w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2015\/08\/CapitolBuilding-1170x690.jpg 1170w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2015\/08\/CapitolBuilding.jpg 1500w\" sizes=\"auto, (max-width: 771px) 100vw, 771px\" \/><p class=\"wp-media-credit\">Heath Haussamen \/ NMPolitics.net<\/p><p class=\"wp-caption-text\">The U.S. Capitol Building in Washington, D.C.<\/p><\/div>\n<p>Last Christmas Eve, Justine Bradford-Trent slipped on ice, slamming to the ground. Her elbow swelled. Was it broken? She couldn\u2019t tell.<\/p>\n<p>Because Bradford-Trent was uninsured, she weighed her options. She could go to the emergency room, the immediate but more costly option. The urgent care center cost less, but it was closed for the holiday. The Idaho resident decided to wait and, once the swelling subsided, she concluded it was just a bad bruise.<\/p>\n<p>Bradford-Trent, 54, knows she was lucky this time. But, because her family can\u2019t afford health insurance, she worries about the next time something happens.<\/p>\n<p>\u201cWhat if \u2026 I end up with cancer or [something] like that,\u201d she said. \u201cI don\u2019t want to be faced with a decision of having to make a choice: to live or die? Or do we go into debt so deeply that it\u2019s thousands and thousands of dollars just to save me, and we\u2019re stuck in debt for the rest of our lives?\u201d<\/p>\n<p>Although the Affordable Care Act is credited with expanding health insurance to about 20 million Americans, a small segment of the population \u2014 including Bradford-Trent \u2014 has been left behind.<\/p>\n<aside class=\"module align-left half type-aside\">\n<h3>About this article<\/h3>\n<p>This articles comes from\u00a0<a href=\"https:\/\/khn.org\/news\/fixing-obamacares-family-glitch-hinges-on-outcome-of-november-elections\/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News<\/a>,\u00a0is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation and not affiliated with Kaiser Permanente.<\/p>\n<\/aside>\n<p>The problem is called the \u201cfamily glitch.\u201d It\u2019s deeply rooted in the health law\u2019s weeds. And fixing it would cost taxpayers a bundle.<\/p>\n<p>In the current Republican-controlled Congress \u2014 which has been more interested in dismantling the health law than building on it \u2014 such a fix is unlikely. Unlikely, that is, unless the Democrats, who have been campaigning hard for the congressional elections on health care issues, pick up enough seats to control the legislative agenda.<\/p>\n<p>Under the ACA, people who meet a particular income threshold can get a federal subsidy to help buy insurance on the marketplace. One of the conditions of eligibility is that the consumer doesn\u2019t have access to \u201caffordable\u201d coverage through work \u2014 that is, the employee\u2019s share of the insurance would cost no more than 9.86 percent of the employee\u2019s household income.<\/p>\n<p>The sticky part: calculating affordability considers only the cost of insuring one family member, even if the person\u2019s spouse and children also would be covered through that health plan. So while the cost of individual coverage might sound feasible, adding the rest of the family would quickly cause financial strain.<\/p>\n<p>For Bradford-Trent, it\u2019s a real problem. Her husband, who works in commercial construction, makes $66,000 per year and is the family\u2019s primary breadwinner. She\u2019s a part-time notary public, earning \u201ca few hundred dollars a month \u2014 not enough to pay for insurance,\u201d she said.<\/p>\n<p>His employer-based coverage alone would be a doable $172 a month. That\u2019s well within the 9.86 percent \u201caffordability\u201d threshold. But to add their daughter to the plan is another $270. To add Bradford-Trent as well would add $718 more, she says \u2014 a total of $1,060. \u201cThat\u2019s 25 percent of his take-home pay \u2014 25 percent,\u201d she said. \u201cThat\u2019s astronomical.\u201d And that doesn\u2019t include out-of-pocket costs for any medications or procedures.<\/p>\n<p>For now, they\u2019ve chosen to buy insurance for her husband and daughter. She goes without and hopes to stay healthy.<!--more--><\/p>\n<p>They\u2019ve explored other health coverage options. She is looking for a full-time job with benefits. She and her husband have considered divorcing, or moving to another state, to see if she could qualify for health coverage. They\u2019ve even turned to the ACA marketplace in search of an individual plan for her, but those generally have a price tag north of $400 a month.<\/p>\n<p>This year, Obamacare <a href=\"https:\/\/www.healthcare.gov\/blog\/when-is-2019-open-enrollment\/\" target=\"_blank\" rel=\"noopener\">open enrollment<\/a> runs from Nov. 1 to Dec. 15. The Centers for Medicare &amp; Medicaid Services announced Oct. 11 that the cost of premiums for plans available on the federal marketplace have, for the first time, trended <a href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/data-2019-individual-health-insurance-market-conditions\" target=\"_blank\" rel=\"noopener\">downward<\/a>. In 2018, by contrast, the national average rate of premium hikes ran well into the double digits. (Idaho\u2019s average 2019 increase is <a href=\"https:\/\/doi.idaho.gov\/DisplayPDF?Id=5675\" target=\"_blank\" rel=\"noopener\">5 percent<\/a>, far below last year\u2019s 27 percent hike.)<\/p>\n<p>Policy analysts say there is no obvious solution to the family glitch. It\u2019s a widely recognized problem that has gotten lost in the shuffle, as it affects a relatively small number of Americans \u2014 up to about 1.8 percent of the population, or 6 million people.<\/p>\n<p>\u201cLast year there was essentially one issue, and that was all of the repeal-and-replace attempts,\u201d said Matthew Buettgens, a senior research analyst at the Urban Institute\u2019s Health Policy Center, who has studied the glitch. \u201cProposals to expand federal spending have not been active in the public debate.\u201d<\/p>\n<p>Any fix, for instance, would likely involve changing the eligibility calculation for marketplace subsidies \u2014 pegging the affordability standard to the coverage cost of the whole family rather than just an individual\u2019s coverage. Doing so would increase federal spending by <a href=\"https:\/\/www.rand.org\/pubs\/research_reports\/RR1296.html\" target=\"_blank\" rel=\"noopener\">about $9 billion<\/a>\u00a0or <a href=\"https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2016\/sep\/hillary-clintons-health-care-reform-proposals-anticipated\" target=\"_blank\" rel=\"noopener\">$10 billion<\/a>, according to estimates by the Rand Corp., a nonprofit think tank, since many more people would qualify for subsidies.<\/p>\n<p>Such a change was proposed by Hillary Clinton during her presidential campaign and is now part of bills put forth by <a href=\"https:\/\/www.congress.gov\/bill\/115th-congress\/senate-bill\/2582\/text\" target=\"_blank\" rel=\"noopener\">Sen. Elizabeth Warren (D-Mass.)<\/a>\u00a0and <a href=\"https:\/\/www.congress.gov\/bill\/115th-congress\/house-bill\/5155\/text?q=%7B%22search%22%3A%5B%22Restricting+First+Use+of+Nuclear+Weapons+Act%22%5D%7D\" target=\"_blank\" rel=\"noopener\">Rep. Frank Pallone (D-N.J.)<\/a>, though both bills have stalled on Capitol Hill.<\/p>\n<p>But the idea could gain traction if Democrats \u2014 who are already campaigning on health care and slogans like \u201cMedicare-for-all\u201d \u2014 take one or both chambers of Congress.<\/p>\n<p>\u201cIf you talk about what might be realistically possible if the election produces strong shocks to the system, then maybe you think, \u2018Well, the Democrats have the majority in the House. Maybe Democrats and Republicans could come together on some affordability reforms,\u201d said Jonathan Oberlander, a professor of social medicine and health policy at the University of North Carolina at Chapel Hill. \u201cThis would be an enticing part of that agenda.\u201d<\/p>\n<p>The White House says it\u2019s taking steps to address health care unaffordability \u2014 rolling out plans such as \u201cassociation health plans\u201d and \u201cshort-term limited-duration plans\u201d \u2014 skimpier, less regulated coverage that also cost less. That could be an option for people priced out of both employer and marketplace plans, some experts say.<\/p>\n<p>\u201cIf your alternative is less affordable coverage \u2014 or none at all \u2014 they look more attractive,\u201d said Thomas Miller, a resident fellow at the conservative American Enterprise Institute, a Washington think tank.<\/p>\n<p>But other experts caution that those options leave patients vulnerable, since they can charge higher rates to people with preexisting conditions, cover fewer benefits and often have higher out-of-pocket costs. For Bradford-Trent, such plans cover too little to merit the price, she said.<\/p>\n<p>For now, she feels forgotten. And hopes she won\u2019t get sick.<\/p>\n<p>\u201cThere are choices you don\u2019t want to have to make for yourself in life because affordable health care is not available,\u201d Bradford-Trent said.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Although the Affordable Care Act is credited with expanding health insurance to about 20 million Americans, a small segment of the population has been left behind.<\/p>\n","protected":false},"author":1,"featured_media":72046,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[2238,117,116],"class_list":["post-638427","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news-and-analysis","tag-2018-election","tag-health-care","tag-washington"],"_links":{"self":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/638427","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/comments?post=638427"}],"version-history":[{"count":3,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/638427\/revisions"}],"predecessor-version":[{"id":638431,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/638427\/revisions\/638431"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media\/72046"}],"wp:attachment":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media?parent=638427"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/categories?post=638427"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/tags?post=638427"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}