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What Happens When Marriage Makes Health Insurance Unaffordable

Sherry Poulin and her mother Laura Brennaman. Courtesy: Laura Brennaman
Sherry Poulin and her mother Laura Brennaman. Courtesy: Laura Brennaman

For the first time in her life, 32-year-old Sherry Poulin is uninsured. The problem started not long after she married her husband, Louis, in May of 2014, “we were sitting in the kitchen and he had brought home all of his insurance information to show me,” she said.

His employer offered family health benefits. When they started looking at the prices they realized it just wasn’t affordable.

Poulin used to pay $50 a month for a subsidized plan through Obamacare. Now she was looking at about $500 a month. Poulin married in to what’s known as the family glitch. When she got married, she lost her subsidy.

Under the Affordable Care Act, if one person in a family has a job that offers health insurance to the rest of the family, nobody can get subsidies on the federally-run exchanges. Yes, her husband’s job did offer her health insurance, but at about 10 times more than she was paying with subsidies.
On the exchange, almost everyone who buys insurance gets tax breaks to make it more affordable. Poulin works for just above minimum wage at a Fort Myers coffee shop that doesn’t offer insurance. Her family income is less than $53,000 a year.

Even though she has a chronic sleep disorder and needs to see a doctor every three months, she decided not to buy insurance. “It has you know, kind of scared me that something bad could happen,” said Poulen.

Nobody’s counting exactly how many people are going without insurance because they’re in this family glitch. But a recent study from the Kaiser Family Foundation estimates that more than 400,000 Floridians went without health coverage—even when they could have gotten it through work.

And when people find out they don’t qualify for those marketplace tax breaks, people get upset, said Greg Jenkins. For the past three years, Jenkins has helped people sign up for Obamacare. He’s a navigator with the Epilepsy Foundation of Florida in Miami. He has seen a lot of people in the family glitch.

“They’re upset with—let’s call the affordable care act Obamacare—and they’re upset with their employer,” said Jenkins. “The option is suck it up and cover the spouse and dependents and pay the full freight or no coverage at all.”

Jenkins tries to point adults in this situation towards charity programs. And for their children, Florida Kidcare is a government subsidized insurance option. That’s what Sherry Poulin did. She put her 4-year-old daughter, Story, on Kidcare. For herself, she pays out of pocket to see her doctor. For her sleep disorder, she takes half the prescribed medication.

Poulin’s mom, Laura Brennaman, didn’t know her daughter was trying to stretch out her medication. She’s a former emergency room nurse. Now she’s the policy director for Florida CHAIN--the group advocates for affordable health care and for fixing the family glitch. Brennaman wants employers to understand how offering high-cost insurance sometimes leaves people in a worse position than if they offered nothing at all to families.

Steven Ullmann directs the Center for Health Sector Management and Policy at the University of Miami. “So you have a family that is caught between the rock and the hard place,” he said.

Big employers have to offer “affordable” health insurance options employees to avoid federal tax penalties. But the rules aren’t the same for family members.

Ullmann said as health insurance costs keep rising, the family benefit is one of the few places employers can legally shift costs without getting fined under the Affordable Care Act. “Not affordable through the employer, not affordable through the exchanges, through the federal subsidies,” said Ullmann. “And that’s the glitch.”

For Sherry Poulin, that glitch doesn’t just mean going without insurance and taking half of her medication. It means she doesn’t run around and play with her daughter the way she used to. “I’m just too tired for that. It sucks. It makes me feel like a crappy mom,” Poulin said. Which is part of why she’s trying again to find health insurance—even without the subsidies.

Open enrollment overlaps with the holiday season and her mom, said her gift this year is going to be help paying for health insurance.

WMFE is a partner with Health News Florida, which receives support from the Corporation for Public Broadcasting.

Health reporting on WMFE is supported in part by Florida Hospital and the Winter Park Health Foundation.