Medicare for all (kids)

By J. Thomas

November 15 marked the start of the open enrollment period for the nation’s health law which means millions of Americans once again have the opportunity to purchase private health plans on the Affordable Care Act’s (ACA) health insurance marketplaces.

An op-ed in Salon by Public Citizen’s health care advocate, Vijay Das, reveals a glitch in the ACA that adds barriers to coverage for working families. The ACA’s “family glitch” is a drafting error with big effects. As it stands, employers must offer affordable coverage to their employees – but not their employees’ families. So, if an individual plan is “affordable” (i.e., it costs less than 9.5% of what the employee earns), the employee is ineligible for subsidies, even if the cost of family coverage is exorbitant and unaffordable.

Even worse, the ones who are most affected tend to be children from low income households– 460,000 of them, according to the nonpartisan U.S. Government Accountability Office. Meanwhile, parents are faced with a difficult choice – maintain their own too costly family insurance or drop it and enroll their kids in Medicaid or the Children’s Health Insurance Program (CHIP). One more hitch during this post-election “lame-duck” Congress: CHIP expires next October. Nobody knows if Congress will reauthorize it by the end of year, and, if so, at what level the program will be funded.

The family glitch points to a larger problem in American health care. The U.S. stands as the only wealthy nation in the world with uninsured kids and no universal health care. The civil rights movement expanded rights on many fronts: for LGBT individuals, environmental protections and international human rights, to name a few. But when it comes to children’s health, our nation remains far behind the curve. The concept of “American exceptionalism” was meant to symbolize hopes and dreams, not sick kids.

The U.S. must meet the challenge of insuring families by guaranteeing health insurance for all Americans by expanding Medicare. Not only would that move save us money and be far more efficient, it would ensure universal health care coverage. About 45,000 lives would be saved. Every year.

While I hope that Congress fixes the ACA’s drafting mistakes (including the federal subsidies typo that will be now decided by the U.S. Supreme Court) and renews CHIP, I really want to see America do more by expanding coverage so we don’t have these glitches and enrollment challenges in the first place. We can and must do better.

J. Thomas is a health policy fellow for Public Citizen’s Congress Watch division

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