'Glitch' fix offers health care price relief

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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While inflation continues to batter family budgets, there's a bright spot this fall for those who buy health insurance on their own instead of getting it through a job or a government program:

Thanks to a timely fix to the Affordable Care Act's "family glitch," more Minnesotans will be eligible this fall for financial assistance that instantly — and in some cases, significantly — discounts monthly premium costs on plans bought through MNsure.

The administrative remedy, which the Biden administration finalized this week, will go into effect for 2023 "open enrollment." That's the annual window of time to buy coverage for the upcoming year.

This critical shopping period begins in Minnesota on Nov. 1 and runs through Jan. 15. About 169,000 people (roughly 3% of Minnesotans) buy their health insurance on 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 generally serves Americans 65 and older.

The Affordable Care Act (ACA) provides subsidies to eligible individual market consumers to offset monthly insurance bills. The family glitch fix broadens the pool of people who can tap into this financial assistance. Specifically, the change will help working families buy quality coverage for everyone in the household, not just the breadwinner.

"This is really good news," said Lynn Blewett, a University of Minnesota School of Public Health professor who has long tracked health insurance coverage across the nation.

The political battles over the ACA's 2010 passage and implementation created a situation where errors in the law's drafting or interpretation persisted rather than being addressed. The family glitch is a high-profile example.

It involves how eligibility for the ACA's financial assistance is determined. These considerations consider whether an individual in the household has access to an employer-provided plan as well as the cost of the coverage.

The glitch regrettably restricted the affordability calculation to whether the cost of an employee-only policy was manageable. Instead of determining whether a plan covering a spouse and dependents fit comfortably into a family's budget, the criteria has been whether a household could manage a less expensive employee-only policy.

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

Before the glitch fix, families that couldn't afford to cover more than a single person weren't eligible to tap ACA aid 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 kids may have gone without coverage.

About 5.1 million Americans were caught up in the glitch gap. "People impacted ... are primarily low-income children and women," according to Community Catalyst, a health care advocacy group.

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

Letters have been sent to 2,100 Minnesota households to alert them that they may now qualify for aid, said MNsure CEO Nate Clark this week. The marketplace's marketing will also include this important information.

In addition, MNsure's network of assisters and navigators is standing by 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 have catastrophic bills. Minnesotans should take advantage of this new family-friendly opportunity for quality, affordable coverage.