Leveraging Health Care Reform To Address Underinsurance In Working Families

Written by Douglas Strane, Rebecka Rosenquist, & David Rubin. Published on Health Affairs: https://www.healthaffairs.org/


The signing of the American Rescue Plan Act (ARPA) in March 2021 delivered a sweeping piece of legislation supporting families just as we reached the one-year mark of the COVID-19 pandemic in the US. The $1.9 trillion package includes a number of measures that provide direct support to families, including several new provisions that make historic strides to reduce childhood poverty. Also within the ARPA are many provisions on health insurance coverage focused on making coverage options for individuals and families more affordable as the country emerges from the pandemic.

As necessary as the ARPA’s coverage provisions and other federal pandemic relief packages have been, they do not address fundamental weaknesses in family and dependent health insurance coverage that have worsened in recent years. In building on employer-based insurance and the Affordable Care Act’s (ACA’s) health insurance Marketplaces, the ARPA maintains the status quo for “underinsured” children and families with health insurance coverage that fails to protect them financially, offer robust pediatric benefits, or guarantee access to appropriate provider networks to support comprehensive pediatric care.

This blog post explores what this vulnerability means for dependent coverage in particular, including how our own research shows that working parents have been seeking alternatives to employer-based dependent coverage for years. Future reforms need to focus on the challenges that underinsurance poses to families, which may mean difficult conversations about the role and future of employer-based insurance in its current form.

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