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Closing ‘family glitch’ will expand affordable health care coverage

December 1, 2022

The open enrollment period for health insurance within the Affordable Care Act (ACA), which began Nov. 1 and ends Jan. 15, reflects a long sought-after administrative fix that will mean affordable health care coverage for more families.

After years of advocacy by the Academy and its partners, the Biden administration finalized a rule to close a loophole in the ACA, known as the “family glitch,” which kept millions of people from qualifying for subsidized health plans.

The AAP has long been calling for the change as part of its advocacy focused on issues impacting children’s health care coverage and reiterated the call to eliminate the glitch in its transition plan for the Biden administration.

Before the fix, an employer-sponsored health insurance plan was considered “affordable” based on the cost of an individual plan, not a more costly family plan.

Specifically, if individuals had to spend more than 9% of their household income on employer-sponsored insurance premiums, then they qualified for subsidized coverage through the ACA. The problem was that the 9% threshold and calculation did not take into account the cost of covering an employee’s family.

This loophole meant that families were locked out of subsidized health coverage, instead paying an estimated 16% of their household income on employer-sponsored insurance premiums or going without coverage.

The new rule includes the cost of family coverage when determining eligibility for subsidized health plans. While this adjustment seems technical in nature, it will result in long overdue expansion of affordable coverage for families. According to the White House, it is expected to help around 200,000 uninsured people gain coverage for the first time and lower the premiums for nearly a million families, particularly families of workers in the service industry, small business employees and low-paid workers.

The move to address the family glitch represents an advocacy victory that will make necessary progress toward ensuring children and families can access and afford the health care they need.

Law to protect infants from dangerous sleep products takes effect

A new law banning the sale of unsafe padded crib bumpers and inclined sleepers nationwide took effect on Nov. 12, helping to ensure safe sleep environments for infants.

With the bipartisan, AAP-championed Safe Sleep for Babies Act in place, these products, which have led to dozens of preventable infant deaths, no longer can be sold.

The law is the culmination of decades of pediatrician advocacy and extensive efforts to speak out about the dangers these products pose to infants. The AAP and pediatricians have urged that the safest sleep environment for babies is a firm, flat, bare surface. This message was amplified in the media, in messaging to parents and to Congress and federal regulators. This success was possible because of extensive pediatrician advocacy and particularly the leadership and subject matter expertise of Benjamin D. Hoffman, M.D., FAAP, incoming AAP president-elect, and Rachel Y. Moon, M.D., FAAP, a lead author of the AAP policy statement on safe sleep.

Notably, the Fisher Price Rock ‘n Play infant sleeper was recalled in 2019 after the Academy sounded the alarm on a Consumer Reports investigation showing that dozens of infants had died while using the sleeper since 2011. While this recall garnered national attention, other inclined sleepers remained on store shelves — despite going against the AAP’s recommendations for safe sleep.

The new law will help bring parents peace of mind that these dangerous inclined sleepers or padded crib bumpers will not be on store shelves and available for purchase. Previously, the presence of these items on the market sent a misleading message to parents, who often thought they were safe for their children.

“This victory would not have been possible without pediatricians who have advocated for strong infant safety policies at all levels of government, and the consequential impact this law will have on the health and safety of babies cannot be overstated,” AAP President Moira A. Szilagyi, M.D., Ph.D., FAAP, said in a press statement following the bill’s passage earlier this year.

Kyran P. Quinlan, M.D., M.P.H., FAAP, past chair of the AAP Council on Injury, Violence and Poison Prevention Executive Committee, attended an event hosted by the Consumer Product Safety Commission (CPSC) at Lurie Children’s Hospital in Chicago, to mark the law taking effect.

“Working together, we can continue the critical progress we’ve made and protect so many more families from unnecessary heartbreak,” Dr. Quinlan said.

The Academy will continue working to ensure the law is implemented and that the CPSC enforces it effectively so that these harmful products cannot find their way into families’ homes.

 Pediatricians amplify vote kids message

Leading up to the national midterm elections on Nov. 8, the Academy led a Week of Action to elevate the importance of voting with children’s needs in mind. The effort was part of the Academy’s nonpartisan Get Out the Vote campaign, Vote Kids. Pediatricians across the country took to social media to share why they #VoteKids and how they were getting the word out.


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