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Healthcare Law Could Leave Families With High Insurance Costs
A major provision of the healthcare reform law designed to prevent businesses from dropping coverage for their workers could inadvertently leave families without access to subsidized health insurance.
The problem is a huge headache for the Obama administration and congressional Democrats, because it could leave families unable to buy affordable health insurance when the healthcare law requires that everyone be insured starting in 2014.
Some of the administration’s closest allies on healthcare reform warn this situation could dramatically undercut support for the law, which already is unpopular with many voters and contributed to Democrats losing the House in the 2010 midterm elections.
“It’s going to be a massive problem if it comes out that families have to buy really expensive employer-based coverage,” said Jocelyn Guyer, deputy executive director at Georgetown University’s Center for Children and Families.
“If they don’t fix this — and by 'they' I mean either the administration or Congress — we’re going to have middle-class families extremely unhappy with [healthcare] reform in 2014, because they’ll basically be facing financial penalties for not buying coverage when they don’t have access to any affordable options.”
At issue is a so-called “firewall” in the law that denies subsidies to workers whose employers offer quality, affordable coverage.
The firewall applies to plans with premiums that cost less than 9.5 percent of a worker’s income. If a worker has to dole out more than that amount to buy coverage, the employer coverage is considered unaffordable and the worker is eligible for subsidies to buy coverage on the new exchanges.
Initially, advocates thought the threshold also applied to family coverage. If premium costs paid to cover a worker’s family cost 20 percent of a worker’s income, for example, the worker and his or her family should be eligible for subsidies.
But in calculating the bill’s cost last year, Congress’s Joint Committee on Taxation (JCT) took the law to mean that employers and their families aren’t eligible for subsidies as long as the individual plan is affordable — regardless of the price of the family plan.
This means the costs to an employee for covering his or her family could be too high to afford for many working families.
“If you’ve got employer-based coverage that’s affordable for the employee only,” Guyer said, “the family is expected to take the employer coverage even if it's totally unaffordable and no one in the family is eligible for the exchange subsidies.”
The glitch is causing heartburn for advocates who worry that it could leave thousands of children and spouses uninsured and subject to penalties for not having insurance.
“The JCT read of the language is disturbing and we hope the administration doesn’t read the language that way,” said Bruce Lesley, president of the children’s advocacy group First Focus. “It would put dependent coverage, children and spouses at grave risk.”
The Obama administration is expected to clarify shortly — through Treasury Department regulations — who’s eligible for subsidies.
An administration official told The Hill, “These matters will be considered in future regulations.”
Healthcare reform proponents say they’ve quietly been talking to the administration for months about the issue.
“We’ve talked to them — a lot — about this,” said Judith Solomon, vice president for health policy at the liberal Center on Budget and Policy Priorities. “We’ve made our views known.”
While advocates say changing the policy is a no-brainer, the costs could be a hurdle.
One new study, by the Employment Policies Institute, estimates that changing the policy could cost taxpayers $50 billion per year. But if the administration leaves the policy as is, “millions of families will be stuck in a no-man’s-land without affordable coverage through their employer or the exchange.”
“Whichever interpretation holds,” the study concludes, “the consequences are significant.”
Others dispute those figures. They argue that employers will offer affordable coverage for whole families and point out that many children who aren’t covered by employer family plans are eligible for Medicaid or the Children’s Health Insurance Program.
“It’s really not clear to me how much of an impact it would be [to change the policy],” Solomon said. The $50 billion-per-year figure “seems very high to me.”
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66 Comments so far
Show AllUS Americans like social programs that are for everyone. They like medicare & social security, but dislike "welfare" and food stamps primarily because those latter programs are limited to people with very low incomes.
Also, the level of subsidy will perpetually be the subject of political wrangling in relation to budget authorization, and so will always be inadequate.
This slimy nonsense would not be necessary under single payer health care. The subsidy problem is part and parcel of an authoritarian government apparoach in the service of corporate healthcare profits.
The 2012 election will be a trip to the woodshed.
Bill in Dubuque
Obama's mandatory defective-insurance purchases will be enforced by the IRS but there are no penalties for insurance company bad faith, so it's just more of the same old "delay, deny and hope you die." But as of 2014, we'll be required to buy these ripoff policies or be fined by the IRS.
"the law, which already is unpopular with many voters ... contributed to Democrats losing the House in the 2010 midterm elections."
That's right! And Obama's newest plan to steal from Social Security to pay for tax cuts for billionaires and absurd levels of military spending, waste and fraud will guarantee defeat for Dems in 2012.
We'd better get behind some third-party candidate or we'll have some Republican dumbass president by default.
The market forces are exactly what created Obamacare. Government by the "Free Market" (which is neither "free", nor a "market" .. but let's not worry our poor heads on that right now.) .... Services and legislation for sale! .... Congress, the president, the courts; all working together (behind closed doors) in an efficient, effective, harmonious manner to serve the their most important clients and constituency; the monied elites. To enable them to make even more money, of course!
And what capitalist would turn down the opportunity to use government to his advantage? One who wasn't doing his job!
I would say that the 10's millions of people on medicare would disagree with you on that. And the 10s of millions of people shut out of the for-profit system would also disagree with you.
"which is why govt intervention in the economy can't work."
Can't work for whom? Gvmnt captured by international corporations and the investor class works great for them! It works so good that they want more and more control. They want the whole thing for themselves. The "free market" run amok.
We don't need more "free markets", what we need is more democracy.
Gvmnt has been around for 10,000 years ... the "free market" on the other hand, well, we might just as well put our faith in letting some sky fairy run our economy.
This is a very ignorant statement. Haven't you ever heard of capitalist imperialism?
Haven't you heard of the brutal capitalist suppression of striking workers?
Under capitalism, the wealthy classes control the State and utilize state violence in order to protect and expand their wealth and power. This is an inextricable part of the capitlaist system. Capitalism cannot exist without statist violence.
You free market pipe dream is completely out of touch with reality.
So again I say that your equating capitalism and "the free market" with peace and prosperity is utter nonsense and flies boldly and insanely in the face of the history of the past 300 years.
Capitalism inevitably devolves into corporatism, militarism and imperialism.
Your libertarian underpinnings are showing when you lump together "taxation, regulation, confiscations, & expropriations"
The utter violence and mayhem of capitalist imperialism is on display daily for anyone who cares to take a look. Stalin doesn't have much to do with that darrenlobo.
As for your ridiculous theory that free markets ='d peace after Napoleon & prior to WW I,in the US, some of the most blatant imperial wars took place during that period: The Mexican War & the Spanish American War. Numerous smaller scale imperialist actions also took place in Latin America at that time, some of which were free-booter affairs that took place without any government sanction - just a bunch of militarist "adventures" heading to, say, Nicaragua, and busting some heads. True free market imperialism.
I'm glad to argue history with you, but I'm afraid that you appear to be a delusional libertarian, and I'm not certain facts will have much effect here.
There is no place on earth where the healthcare industry is unregulated and also provides quality care to all. Your comment is a pure ideological pipe dream.
Your ridiculous plan would lead to a dire healthcare situation for at least half the population, while the rich get the very best care. But then that's what libertarianism is really all about.
Single Payer socilaized health care is the best way to guarantee access to quality healthcare for all.
Unregulated "free market" healthcare is a sick joke that would doom the poor to an early death.
You state, "Actually, what you describe above is the direction that all these govt health care plans are taking us in. The people that can afford it getting the best care while the rest get to use the system the govt ruined. "
This statement is nonsense. Ask the Canadians. Ask the Brits. The only threat to quality healthcare under a socialized paln is that in an otherwise capitalist society, the rich constantly attempt to undermine public healthcare by using their disproportionate political power to cut revenues.
Libertarianism is, on a fundemental level, an enemy of the masses.