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It's hard to see any logic behind a provision in the health care reform law that offers an affordability-based federal premium subsidy for individual coverage but not family coverage. The law says if the premium an employer charges for individual health care coverage exceeds 9.5% of household income, the coverage is unaffordable. That makes the employee eligible for premium subsidies to purchase coverage in public health insurance exchanges.
But the law is silent on an affordability test for family coverage. And that has big consequences for lower-income employees whose employers require them to pay most of the premium if they want to receive family coverage. Those employees may not be able to afford coverage provided by their employers, yet will not be eligible for premium subsidies from the government.
Lawmakers' central goal in drafting the health care reform legislation was to reduce the number of uninsured, so why they chose to exclude family coverage from the affordability test is perplexing.
Unfortunately, because of the way the bill was passed, there are no clues for that decision. Normally, when the House and Senate pass different versions of a bill, a conference committee is set up, differences are ironed out, and a final report detailing the changes is prepared before the House and Senate vote for a final time.
In the case of the health care reform law, there was no conference report and, for that matter, no conference committee. As a result, the landmark measure did not get the scrutiny it deserved.
And that is only one big problem. A much bigger one was that Republican members stayed out of the drafting process, due in part to a decision by the GOP leadership to stay on the sidelines and in part because Democrats weren't much interested in GOP input.
Regardless of the reasons, we know the public is the loser when major pieces of legislation are put together by only one party. No one party has a monopoly on good ideas, and the Patient Protection and Affordable Care Act would have been a much better measure had both parties worked together in crafting it.
We hope that lesson is not lost on lawmakers and that bipartisanship will again become the order of the day.