Summary
Summary: Many Californians struggle to afford job-based coverage, especially family coverage. Under the original Affordable Care Act (ACA) regulations, workers whose coverage for themselves only cost more than 9.61% of household income (in 2022) could receive subsidies to enroll in Marketplace coverage, along with their family members. However, if coverage for the worker only was affordable no one in the family was eligible for subsidies, even if the cost of family coverage was unaffordable. The spouse and children of the worker are said to fall in the “family glitch” — unable to access subsidies in the individual market, and offered family coverage through an employer that was unaffordable.
Authors use the California Simulations of Insurance Markets (CalSIM) model to project for 2023 how many people would fall into the family glitch in California, how many would be newly eligible for a positive dollar subsidy, and how many would enroll in Covered California with subsidies under the family glitch fix.
Findings: Some of the findings for this study include:
- 615,000 would be in the family glitch, meaning they are spouses or children of workers with an affordable offer of single coverage but the offer of job-based coverage that includes them is unaffordable; they are not otherwise eligible for or enrolled in Medi-Cal or other public health insurance; they are not undocumented; and they do not have their own offer of affordable single job-based coverage (i.e., from their own employer).
- 391,000 would be eligible for a positive dollar subsidy because they would require a subsidy to keep their premium below the maximum contribution as a percentage of income, taking into account how age, household composition, and region factor into premiums.
- 149,000 would enroll in Covered California with subsidies.
Of the 149,000, researchers project to newly enroll in Covered California with subsidies if the family glitch is fixed, 97,000 are otherwise enrolled in employer sponsored insurance, 38,000 are otherwise uninsured, and 14,000 are otherwise enrolled in the individual market without subsidies.
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