NPR : News

Filed Under:

Why Some Families Won't Qualify For Subsidized Health Insurance

Quite a few families with expensive job-based health insurance may be ineligible for federal subsidies to help them buy cheaper coverage through new online insurance markets, under final rules released Wednesday by the Internal Revenue Service.

The two rules, published by the Treasury Department here and here, uphold earlier proposals outlining what is considered affordable, employer-sponsored coverage.

Under the federal health law, low- and moderate-income workers with job-based coverage that is deemed unaffordable can opt out of it and turn to new marketplaces, called exchanges, to buy subsidized insurance.

But the rule defines the standard for affordability more narrowly than most consumer groups had hoped. The threshold is defined as less than 9.5 percent of household income to cover the employee's share of premium costs — not on what he or she must pay to cover the entire family, which is generally more expensive.

Consumer groups had hoped to sway the IRS to base the affordability threshold on the cost of a family plan, saying the rules could prevent some children and spouses from getting coverage. A July report from the Government Accountability Office estimated that a small percentage of uninsured children — 6.6 percent of the total, or at least 460,000 — may be shut out because of how the government proposed to define affordable coverage.

"It doesn't make sense to test the affordability of children's coverage by looking at the cost of covering one person, the employee," said Joe Touschner, senior health policy analyst at Georgetown University's Center for Children and Families. More than 100 groups, including the March of Dimes, the American Academy of Family Physicians and the Children's Defense Fund, had signed a letter to the Treasury Department making that argument.

Touschner acknowledged that if the IRS had used the cost of family coverage as the threshold it would have boosted the cost of the law because more people would become eligible for subsidies.

Supporters of the rule, among them employer groups and insurance brokers, say it closely follows the wording in the law and will be easier to administer.

The final rules also outline exemptions to the federal law's requirement that most Americans carry health insurance coverage, including not being able to afford coverage.

The exchanges and subsidies, as well as the requirement that most Americans carry insurance, go into effect on Jan. 1, 2014.

Copyright 2013 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

WAMU 88.5

Remains In Jamestown Linked To Early Colonial Leaders

Scientists from the Smithsonian's National Museum of Natural History and The Jamestown Rediscovery Foundation say they've identified four men buried in the earliest English church in America.
WAMU 88.5

The Democracy Of The Diner

Whether the decor is faux '50s silver and neon or authentic greasy spoon, diners are classic Americana, down to the familiar menu items. Rich, poor, black, white--all rub shoulders in the vinyl booths and at formica counters. We explore the enduring appeal and nostalgia of the diner.

WAMU 88.5

D.C. Council Member David Grosso

D.C. Council Member and Chair of the Committee on Education David Grosso joins us to discuss local public policy issues, including the challenges facing D.C. Public Schools.

NPR

Twitter Faces Challenges As It tries To Balance Profitability, Popularity

The social network Twitter is popular with users, but that's not enough. It also needs to be profitable, and by its 140-character nature that's a challenge.

Leave a Comment

Help keep the conversation civil. Please refer to our Terms of Use and Code of Conduct before posting your comments.