Paul L. Caron

Saturday, January 7, 2023

How The IRS’s Misinterpretation Of The ACA Precludes Millions Of Families From Accessing Affordable Health Coverage

Patrick D. O'Neil (J.D. 2022, Georgetown), Note, What’s in a Contribution?: How the IRS’s Misinterpretation of the ACA Precludes Millions of Families from Accessing Affordable Health Coverage, 110 Geo. L.J. 953 (2022): 

Georgetown Law JournalThis Note is about the “family glitch” in the Affordable Care Act (ACA), focusing on the regulatory interpretation of the statutory afford-ability requirements. Under the ACA, individuals are not eligible for premium tax credits to purchase health insurance coverage if they receive an offer of affordable health insurance coverage from an employer. However, the Internal Revenue Service (IRS) determined that an offer of employer-sponsored insurance that includes dependent coverage should preclude dependents from receiving premium tax credits if the employee’s self-only coverage is affordable. This makes entire families ineligible to buy subsidized insurance on the ACA Marketplace if any individual in the family is eligible for affordable self-only coverage, even if the premiums for family coverage are prohibitively expensive.

This Note demonstrates that regardless of whether one interprets the statute using a textualist approach, a legislative intent approach, or an objective purpose approach, the statute requires that affordability be determined by the employee’s full contribution for family coverage rather than self-only coverage. In other words, the IRS’s interpretation is without support under the three dominant theories of modern statutory interpretation. This Note then assesses varying methods of fixing the family glitch and how they may be affected by what the future has in store for the ACA.

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