Finally fixed the “Family Glitch”

The Biden administration this week announced regulations aimed at fixing a “family glitch” in the Affordable Care Act.The Obama administration has decided that only Congress can fix the glitch.

Meanwhile, Medicare open enrollment will begin on October 15, allowing beneficiaries to enroll in or change to a private Medicare Advantage Plan or an independent prescription drug plan. For the first time, Medicare Advantage Plans are poised to enroll more than half of the Medicare population, despite claims that many of the largest insurers have been overpaid by the federal government.

This week’s panelists are KHN’s Julie Rovner, The New York Times’ Margot Sanger-Katz, Johns Hopkins Bloomberg School of Public Health and Politico’s Joanne Kenen, and Stat’s Rachel Cohrs.

This week’s episode takeaways:

  • “Family malpractice” occurs because under ACA rules, people who were provided insurance through their workplace generally are not eligible for subsidies if they purchase insurance on the market instead. That decision was based on individual worker premiums, not family insurance costs. Family insurance is often out of reach for workers as it is considerably more expensive than individual insurance. A new federal rule takes into account the cost of family insurance.

  • Democrats recognized this problem even when they passed the ACA. But this was a costly change, and they were desperate to keep the cost of the bill below $1 trillion. They promised to fix the “family glitch”, but they didn’t.

  • Many health policy experts believed the amendment needed to be made by Congress, but the Biden administration chose to do it through regulation. It’s not clear if they will face the allegations, but opponents could have a tough time proving that they are harmed by the new rules and that they are entitled to sue.

  • Many seniors are happy with their Medicare Advantage plans. This plan often offers more benefits at a lower cost than traditional Medicare. However, subscribers typically must remain within the plan’s provider network.

  • Questions were raised about federal payments for the plan. It was initially envisioned as a way to save money, as legislators considered it more efficient than government-run plans. But the plan’s benchmark formula gives her more than 100% of what the government pays the average person in conventional Medicare, and the government pays the plan bonuses for taking on sick patients.

  • These bonuses have been the subject of numerous government investigations, whistleblower claims, and fraud lawsuits alleging that the plan misidentified enrollees’ medical conditions in order to receive higher reimbursements from the government. Although some watchdog groups have expressed concern, Medicare Advantage has high patient satisfaction and bipartisan support on the Capitol, leading the Centers for Medicare and Medicaid Services to No major changes have been made to the redemption formula.

  • As lawmakers approach next month’s election day, Democrats thundered their support for abortion rights and lashed out at Republicans who backed the decision to overturn the Supreme Court’s ruling. Law vs. Wade, guaranteed access to the whole country. But Democrats have not vigorously advocated passage of the Inflation Reduction Act, which proposed several general changes, including a cap on out-of-pocket drug costs for Medicare recipients. This will allow Medicare to start negotiating higher prices for some drugs, as well as an extended increase in subsidies for people who buy insurance through the ACA Marketplace.

  • Democratic Senator John Fetterman’s campaign from Pennsylvania has slowed down a bit as he recovered from a stroke earlier this year. I’m using a computer device to help translate the conversation into written language because I say I’m not cured. Critics say he should be more transparent about his medical records. Disability advocates have hit back at Fetterman’s criticisms.

Plus, as extra credit, panelists recommend their favorite health policy stories of the week that they think you should read.

Julie Robner: “If you care about the environment, consider composting when you die” by Bernard J. Wolfson at KHN

Margot Sanger-Kutz: KHN’s “Baby, That Bill Is High: Private Equity ‘Gambits’ Squeeze Excessive ER Fees From Regular Births,” by Rae Ellen Bichell

Joanne Kennen: “Historically Black California Towns Denied Access to Water for 100 Years,” by Teresa Cotsirilos, The Food & Environmental Reporting Network

Rachel Corres: Stat’s “A Few New HHS Offices Have Big Goals: Committed to Environmental Justice” by Sarah Owermohle

Also mentioned in this week’s episode:

This article is reprinted from with permission from the Henry J. Kaiser Family Foundation. An editorially independent news service, Kaiser Health News is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization independent of Kaiser Permanente.

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