The Glitch That Got Fixed: Felicia's Story
A year ago, Felicia of Dickson, Tenn., was spending 25 percent of her income for health coverage for herself, her spouse, and their two children. On top of that, Felicia was paying out-of-pocket costs for medical essentials like prescriptions for asthma medications and co-pays for doctor and specialist visits.
At the time, Felicia’s payments amounted to about three times the national average for health insurance expenses. All because she and her family fell into the “family glitch.” They were among the more than 5 million people, mostly women and children, who were stuck without a pathway to more affordable coverage.
This year, however, is different, thanks to a new rule by the Biden administration that went into effect in 2023. The work it took to get here, however, has been years in the making.
The family glitch, a misinterpretation of the Affordable Health Care Act (ACA), occurred when an individual received what was deemed “affordable” health coverage through an employer. However, the “glitch” stemmed from a 2013 rule by the Internal Revenue Service (IRS), which determined that an individual is ineligible for premium tax credits (also known as subsidies) if their employee offers affordable employee-only coverage. That single rule created a major barrier for people like Felicia because affordable family coverage was not considered a factor in affordability, which is what the tax subsidies were based upon.
“If this issue is not fixed before open enrollment, that’s what we’ll be stuck with for the entire year,” said Felicia in 2022. She shared her story with the Biden administration. Together with partners and individuals like Felicia across the country, Community Catalyst advocated for the glitch to be fixed over the last 10 years. This past summer, Executive Director Emily Stewart testified in support of the Biden administration’s move to fix it. The Biden administration delivered.
Today, Felicia — and countless others across the country — are grateful to the Biden administration for fixing this longstanding problem.