Help! I found a huge software error on the Obamacare Affordable Care Act (ACA) Healthcare Marketplace. This error falls on all families using the Marketplace to determine their ACA subsidy where one member has insurance through their job and only some of the family are seeking insurance through the Marketplace.
I believe this is system-wide and nationwide programming glitch. Even families well above the poverty line would have their subsidy minimized when they only seek coverage for one member of the family because other members have health care coverage through work.
Follow me through the squiggle for background.
I discovered this error while helping my daughter's family apply for health insurance online. I expected they'd qualify for free insurance through the governor's recent expansion of Medicaid in the state of Pennsylvania. Still in school and with a new baby, their annual income is less than one and a half times the poverty rate for a family of three. We were excited to qualify for the newly expanded Medicaid coverage but were hurt to discover that even with the ACA subsidy they were unable to afford healthcare coverage.
One of the many ACA Helpline representatives I spoke with told me that the family should apply for Medicaid rather than the ACA Marketplace, but isn't expanded Medicaid available through the Marketplace?
I think this is a programming mistake because expanded Medicaid coverage should mean 100% subsidized coverage. Yes, they were offered a subsidy, but it was for less than half of the monthly insurance expense. People on Medicaid are not asked to pay, so neither should people under Medicaid expansion.
I believe the problem is a simple software error. When a family of two or more applies for insurance coverage for only some members of the family, the software takes the entirety of their annual family income and determines the subsidy based solely on the number of people requesting insurance. So, as currently programmed in the Marketplace, a single person making as much as a family receives the exact same subsidy as an individual from a family with the same income even though the family has additional dependents. The single person is well above the poverty line while the family with the exact same income is not. The ACA Marketplace should take into account family size when calculating the subsidy regardless of how many members of the family are requesting coverage.
Perhaps this error is the reason why the ACA is costing the government less than originally anticipated. This might also be why I've read that some families are already falling behind on their insurance premiums.
The ACA imagined that the family I was trying to help could come up with $140 a month to cover insurance for just one member even though that family is living on less than one and a half times the poverty level. Granted $140 a month is substantially less than adding this family member to the working member's work insurance policy, but it's still unaffordable. Extended Medicaid coverage should mean free coverage.
I imagine this error is system-wide and nationwide and that it affects families well above the poverty line too, minimizing their subsidy when they only need coverage for one member of the family when other members are able to get insurance through their work.
When I asked the ACA Helpline at the 1-800-318-2596 number about what to do, they said my daughter's family needed to file an appeal in order to request a higher subsidy. The supervisor encouraged me by saying that most people who file an appeal get the higher subsidy.
I think overworked people shouldn't have to find the forms and file the letter since this error affects so many. I've looked to see whether anyone else is reporting on this and I haven't seen it reported. I asked the ACA Helpline supervisor where I should send my comment on my experience with the Marketplace and he indicated there was no formal process to let the government know about this huge mistake. I think this mistake would be relatively easy for a programmer to correct.
I hope the activists here know how to verify my find and can direct my concern to the proper government office. I want the error to be corrected not buried under the idea that "the computer is always right." I thought we as a human race had grown past that dictum.