Frustrated by the ACA's 'family glitch'
Susan Rubinstein's optimism dissolved into tears when she learned the Affordable Care Act marketplace wouldn't help her. The Brookhaven woman recently received the annual rate for the health insurance policy her husband's job offers the family, which includes the couple and two young adult daughters: $17,500 for 2014.
Susan Rubinstein's optimism dissolved into tears when she learned the Affordable Care Act marketplace wouldn't help her.
The Brookhaven woman recently received the annual rate for the health insurance policy her husband's job offers the family, which includes the couple and two young adult daughters: $17,500 for 2014.
"I was in utter, complete shock at how much it had gone up," Rubinstein said.
The monthly payment of nearly $1,500 exceeds the cost of her mortgage. Unlike most large employers, her husband's company doesn't contribute toward the premiums.
Rubinstein, full of hope, turned to the marketplace in search of alternatives.
With the help of a trained navigator, Rubinstein started searching plans. She found she and her husband, 54 and 58, could be charged premiums up to three times higher than their 21- and 24-year-old daughters'. Experts point out that's actually an improvement. Older adults were charged up to six times more under old individual plans.
For Rubinstein's Delaware County family, the cheapest silver HMO plan would cost $1,338 a month, about $16,000 a year.
Rubinstein thought she might be eligible for subsidies to help defray the costs. She wasn't.
She is stuck in what is called the family glitch. Because she is offered insurance through her husband's company, despite the high cost, she is ineligible for discounts on the marketplace. "I'm disgusted, angry, and upset with this entire situation," Rubinstein said.
The health law defines affordable coverage as costing no more than 9.5 percent of household income for families well above the poverty level. But affordability is based on the cost of an individual policy offered to the employee, not the cost of a family plan.
"To pay over $17,000 a year makes a huge dent in our budget," said Rubinstein, "especially with a child in college."
On top of that, the family's company plan has a $3,000 individual deductible, or a $6,000 family deductible, which must be paid before coverage starts.
Last year, Rubinstein injured her foot, and the doctor, suspecting a stress fracture, wanted to order an MRI. At $1,000 out of pocket, Rubinstein opted to forgo the procedure, assuming she had the injury.
She wore a walking brace - which cost her several hundred dollars - until she was pain-free.
If she could get a subsidy, Rubinstein said, her health insurance would likely be affordable.
In 2011, the Kaiser Family Foundation estimated 3.9 million Americans could be snared in the family glitch. There are no current plans to fix it.
New federal rules finalized in August could make Rubinstein and her daughters exempt from the requirement to be insured. But that's not good enough for Rubinstein, who was hoping to see the glitch fixed. "I'm just really angry that we're in this catch-22," she said. "We can't go without insurance."
This article was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.