Affordable Care Act changes proposed

To the Editor:

As part of the Covid Relief Bill in Congress, there are changes being proposed to the Affordable Care Act that would increase access to affordable health plans.

Point One: Provide subsidies to families whose premiums for the benchmark plan would be more than 8.5% of their income, regardless of income level or employment status.

The ACA currently only provides subsidies to people between 100 and 400 percent of poverty. We have many people in their 50’s and 60’s who cannot afford health insurance under this rule. For example: a couple, both 60 years old, earning $67000 pays about $200 a month for a Bronze plan and $550 a month for a Silver Plan. The same couple earning $70,000 pays $1300 more per month for the same plans. Can we agree that this is insane?

This enormous cost difference is creating an incentive for workers past 55 to work less in order to stay under the threshold and afford health insurance. In other situations, it is causing these workers to forgo health insurance altogether.

By limiting premiums to no more than 8.5% of income (regardless of total income), the couple in my example earning $70000 pays just $33 dollars more per month for a Silver plan instead of $1300 more.

Point Two: The current test for affordability of an employer sponsored plan only looks at the employee’s cost to purchase health insurance from their employer, not the cost for the entire family’s enrollment.

Many employers will pay a portion of the employee’s premium, making it technically affordable, but opt NOT to pay a portion of the dependent premium. This means that many families can only afford to purchase insurance for the employee receiving benefits, not the spouse and children.

Let’s change the employer plan affordability test. Let’s say that any time the family premium for an employer sponsored plan is over 8.5% of the family income, the family can opt out of employer coverage and purchase coverage on-exchange with a subsidy, even if the employer offers an HRA.

These two changes would have a dramatic impact on two key groups: Older workers not yet eligible for Medicare and working families who have unaffordable dependent coverage at work.