Biden Admin Plots To Fix Obamacare’s ‘Family Glitch,’ Expand Coverage

About That ObamaCare 'Glitch' - WSJ

Source: Politico, by Adam Cancryn

The Biden administration is planning on Tuesday to propose a long-sought change to the Affordable Care Act aimed at lowering health insurance costs for millions of Americans, four people with knowledge of the matter told POLITICO.

The new policy is designed to close a loophole in the ACA known as the “family glitch” that’s prevented an estimated 5 million people from qualifying for subsidized health plans — even when they can’t find affordable coverage elsewhere.

Biden administration officials are expected to unveil the proposed regulation ahead of a celebration of the landmark 2010 health law that will also mark former President Barack Obama’s return to the White House for the first time since he left office.

Obama, alongside President Joe Biden and Vice President Kamala Harris, is slated to tout the ACA’s coverage gains and the administration’s broader efforts to slash health costs.

In its rollout on Tuesday, the administration will highlight its new bid to fix the family glitch as the largest administrative action to expand ACA coverage since the law’s enactment, one person with knowledge of the matter said. Still, the proposed regulation could take months to finalize.

Democrats last year also expanded ACA subsidy eligibility as part of the passage of the American Rescue Plan, and enrollment through the law’s insurance exchanges reached 14.5 million last year, a record high. Those expanded subsidies are due to expire later this year, raising concerns within the party about the potential for millions of people to get hit with higher health costs right around the midterm elections.

The White House declined to comment.

Democrats and health advocacy groups have long pushed for a fix to the family glitch, which locked certain Americans out of subsidized coverage due to the complex way the federal government determines eligibility for family members of workers who have access to employer-based health plans.

Under the ACA, people can qualify for subsidized health insurance if the cost of their employer-based coverage rises above a set percentage of their household income.

But the Obama administration originally interpreted that provision as applying to the premium charged to one individual — even if that person’s spouse and children would be covered under the plan, driving up its overall cost.

Health law experts have since argued that the statute could be reinterpreted to incorporate the added cost of additional family members. The administration began work last year on changes to the law, resulting in the proposed rule that cleared OMB’s regulatory review in late March.

The vast majority of people affected by the glitch would pay less for ACA coverage than their employer-based plan if the loophole were closed, the Kaiser Family Foundation estimates.

“Fixing the family glitch is the most consequential thing they can do without Congress to improve the affordability of ACA coverage,” said Larry Levitt, KFF’s executive vice president for health policy.

Medicare Legislation Would Prevent Drastic Payment Cuts

President Barack Obama signed into law the Protecting Access to Medicare Act (H.R. 4302). The bill will halt a 24% reimbursement cut to Medicare providers. It will also eliminate the $2,000 deductible cap on small group health plans. Janet Trautwein, CEO of NAHU explains that many carriers have pulled out of Medicare, leaving thousands of beneficiaries in limbo. Addressing the physician payment will avert a similar crisis by ensuring continued access to physician services. The bill also includes bipartisan legislation to repeal the Affordable Care Act’s statutory cap on deductibles for health plans in the small group market; a provision that Trautwein says the ACA’s inflexible deductible caps would force a majority of small group plans to put employees through significant and often higher premium plan re-design, including raising premiums, increasing copays, or stripping benefits to comply with the cap. She said that H.R. 4302 ensures stable and affordable private insurance coverage options and generates significant taxpayer savings.

Obama press secretary hints at extended enrollment deadline

The open enrollment period for health insurance policies bought through an Affordable Care Act exchange runs through March 31, but tax experts have said that consumers will need to begin the process of enrolling in a plan by mid-February in order to have coverage in place and avoid being assessed a tax penalty. HHS officials “are working to align the policies — the disconnect — between the open-enrollment period and the individual responsibility timeframe,” said administration Press Secretary Jay Carney. National Underwriter Life & Health (10/21)

Administration Issues Proposed Rules Implementing the ACA

The Obama administration issued a proposed rule that, beginning in 2014, prohibits health insurance companies from discriminating against individuals because of a pre-existing or chronic condition. Under the rule, insurance companies would be allowed to vary premiums within limits,  based only on age, tobacco use, family size, and geography. Health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry. The rule would ensure that people for whom coverage would otherwise be unaffordable and young adults have access to a catastrophic coverage plan in the individual market. For more information regarding this rule, visit

The administration also issued proposed rule outlining policies and standards for coverage of essential health benefits while giving states more flexibility to implement the Affordable Care Act. Essential health benefits make up a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states. For more information regarding this rule, visit

In addition, the administration issued a proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status. For more information regarding this rule, visit

Medicare Coverage of Home Health Care

The Obama administration has proposed a settlement in a nationwide Medicare class-action lawsuit. It would allow thousands of U.S. residents with chronic conditions or disabilities to qualify for Medicare coverage of home health care services, reports The New York Times. The administration agreed to change Medicare rules to cover skilled nursing and therapy services when they are needed to maintain the patient’s current condition or prevent or slow further deterioration. The changes would apply to the traditional Medicare program as well as private Medicare Advantage plans. More than 10,000 beneficiaries whose claims were denied before Jan. 18, 2011 when the lawsuit was filed are expected to benefit as their claims would be re-examined under the new standards, the Times reports. The changes are expected to generate savings because fewer patients would need to depend on hospitals and nursing homes for physical therapy and similar services.

Romney and Obama Seen As Even in Dealing With Healthcare

Mitt Romney no longer trails Barack Obama in the Pew Research Center’s presidential election polling. By about three-to-one, voters say Romney did a better job than Obama in the Oct. 3 debate, and the Republican is now better regarded on most personal dimensions and on most issues than he was in September. Romney is seen as the candidate who has new ideas and is viewed as better able than Obama to improve the jobs situation and reduce the budget deficit.

Romney and Obama now run about even on dealing with health care, Medicare, foreign policy, and taxes. Obama led on most of these issues by significant margins in September. Romney also holds a significant 49% to 41% advantage on improving the job situation, despite the fact that most of the interviewing was conducted after the October jobs report, which showed the unemployment rate falling below 8%. For more information, visit


How the Obama and Romney Health Plans Stack Up

The following is a summary of a report by the Commonwealth Fund

With the U.S. presidential election just weeks away, health care is in the spotlight. President Obama and Governor Romney have proposed distinctly different approaches to health care problems. If reelected, the president has pledged to continue implementing the Affordable Care Act with major provisions are to be rolled out in the next 15 months. President Obama supports the goal of near-universal health insurance coverage by maintaining existing private insurance markets while instituting tighter and more standardized regulations. In addition, federal tax credits would make individually purchased health plans more affordable. The Medicaid program would cover more families with low or moderate incomes.

To contain growth in health care costs and improve the quality of care, Obama supports the health law’s reforms that target how insurance markets operate, how providers are paid, and how care is delivered.

Governor Romney says that more limited regulation would ensure that consumers have a broad choice of health plans. To encourage more people to buy health plans in the individual market, he would make the tax treatment of individually purchased coverage similar to what is accorded to employer-based plans.

Romney would reduce federal funding to Medicaid by establishing state block grants and loosening federal requirements. He would scale back the federal/state public insurance program substantially for people with low incomes.

Romney wants to drive down health care costs by providing fixed budgets and looser standards to state Medicaid programs, on the theory that doing so will allow states to innovate and save money.

Romney would introduce competition between private plans and traditional Medicare by giving premium support to beneficiaries to buy the plan they choose. If such competition fails to bring down costs, he would also place limits on annual spending, starting in 2023. To get the full report,

Last Updated 06/29/2022

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