Fixing the ‘bug’ offers relief on the cost of health care

Opinion editor’s note: Editorials represent the views of the Star Tribune Editorial Board, which operates independently of the editorial board.

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As inflation continues to take a toll on family budgets, there’s a bright spot this fall for those who buy health insurance on their own instead of getting it through work or a government program:

Thanks to a timely fix to the Affordable Care Act’s “family problem,” more Minnesotans will be eligible this fall for financial assistance that immediately — and in some cases significantly — lowers the monthly premium cost of plans purchased through MNsure.

The administrative remedy the Biden administration finalized this week would go into effect for “open enrollment” in 2023. That’s the annual window of time to buy coverage for the following year.

This critical shopping period begins in Minnesota on November 1st and runs through January 15th. About 169,000 people (roughly 3 percent of Minnesotans) buy their health insurance in the so-called individual market, according to the state Department of Commerce. Many are self-employed or early retirees, too young to qualify for Medicare, the federal health insurance program that typically serves Americans 65 and older.

The Affordable Care Act (ACA) provides subsidies to eligible individual market consumers to offset monthly insurance bills. The correction of the family problem expands the group of people who can benefit from this financial assistance. Specifically, the change will help working families purchase quality coverage for everyone in the household, not just the family breadwinner.

“This is really good news,” said Lynn Blewett, a professor at the University of Minnesota School of Public Health who has long tracked health insurance across the country.

The political battles surrounding the passage and implementation of the ACA in 2010 created a situation where errors in drafting or interpreting the law persisted rather than being corrected. The family mistake is a high-class example.

This includes how eligibility for ACA financial assistance is determined. These considerations take into account whether an individual in the household has access to an employer-provided plan, as well as the cost of coverage.

The problem unfortunately limited the affordability calculation to whether the cost of an employee-only policy was manageable. Rather than determining whether a plan covering spouse and dependents fits comfortably within a family’s budget, the criteria is whether the household can manage a less expensive employee-only policy.

This is important because there is a huge price difference between the two. According to a recent analysis by the journal Health Affairs, average premiums for an employee-only plan averaged $7,739 in 2021. The average price for a family plan: $22,221.

Before the fix, families who couldn’t afford to cover more than one person weren’t eligible to use ACA help to buy a different plan for the rest of the family. Some families may have shouldered the higher costs and sacrificed elsewhere. Or some spouses or children may have been left without coverage.

About 5.1 million Americans were caught by the loophole. “The people affected … are mostly children and low-income women,” according to Community Catalyst, a health care advocacy group.

Fixing the problem means that families in this situation now have access to ACA subsidies, which is a logical solution. MNsure, the state’s online health insurance marketplace, is ready to help those newly eligible for help during the upcoming open enrollment.

Letters have been sent to 2,100 households in Minnesota to alert them that they may now be eligible for assistance, MNsure Executive Director Nate Clark said this week. Marketing the market will also include this important information.

In addition, MNsure’s network of assistants and navigators are ready to help. For more information on how to find this assistance near you, go to tinyurl.com/MNsureAssister.

Assistance is also available by phone at 651-539-2099 or 855-366-7873 outside the Twin Cities.

Going without insurance is risky. Even one hospital stay can lead to catastrophic bills. Minnesotans should take advantage of this new family-friendly option for quality, affordable coverage.

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