CORRECTION: In second paragraph, people were deemed ineligible for subsidies to help pay their insurance premiums if they could get employer-sponsored coverage; now they are not. A previous version of the story inaccurately described the "family glitch." (1:40 p.m. MDT, Nov. 2, 2022)

Open enrollment for health insurance through CoverME.gov begins today, and consumer advocates said Mainers looking for a new plan, or to change their current coverage, can benefit from a change to the so-called "family glitch."

In previous years, families who could get family health coverage through their employer were deemed ineligible to get subsidies to help pay for marketplace insurance, regardless of the cost to add family members to the employer's plan.

Helen Roy, outreach and education coordinator at Consumers for Affordable Healthcare, said the "glitch" is now gone, so families have more affordable options.

"If what they are paying to put the family on that employer plan is more than 9.12% of their total income, they will be eligible for the premium subsidies," Roy explained.

Eliminating the family glitch is just one change in this year's open enrollment. Roy noted Consumers for Affordable Healthcare can help people find a plan and check on their eligibility for subsidies.

Congress has expanded the subsidies for health-insurance premiums, so folks who purchase plans through the federal exchange will pay no more than 8.5% of their household income on health coverage through 2025.

Roy pointed out having a Consumer Assistant help sort through the insurance options can prevent any surprises down the road.

"Let's look at the plans, figure out which one's going to work best," Roy advised. "Then, once we've got that part nailed down, we'll go in, do your application and your enrollment."

Consumers for Affordable Healthcare has a helpline at 800-965-7476, or people can set up an appointment on the group's website.

More insurers are expanding mental health coverage, wellness incentives and virtual care options, all of which gained popularity during the pandemic. So, people can ask about their options for integrated plans to cover hearing, dental or vision.

Aaron Child, a self-employed arborist in Damariscotta, said an insurance specialist helped him with some confusing terminology.

"I don't know how many people I've spoken with that have picked a plan and go, 'Ahh, I don't know if I did the right thing.' And I tell 'em, you know, 'Make a phone call and be a little bit more sure about what you're doing,'" Child recommended.

Open enrollment is the only time during the year, outside a special enrollment window, when people can sign up for a plan or change their current health coverage. Open enrollment runs Nov. 1 through Jan. 15.

Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

A Connecticut bill would expand the state's paid sick leave law.

The initial 2011 law requires 40 hours of paid sick leave for workers at employers with 50 businesses or more. The new bill covers all workers regardless of their employer's size.

Janée Woods Weber, executive director of the nonprofit She Leads Justice, said the legislation can benefit workers without access to paid sick leave.

"These are people for whom taking a few hours off when their child has a cold or perhaps they need to take themselves to a doctor's appointment are the kinds of challenges that many of us don't worry about, those of us who do have access to paid sick days," Woods Weber explained.

Small businesses were concerned about how the change could affect them. To address worries, the bill has a three-year implementation cycle giving them time to adapt. It also creates a task force studying the feasibility of providing tax credits to businesses with the smallest workforces. The bill passed the House and awaits a vote in the Senate.

An estimated 11% of workers are eligible for paid sick leave under the current criteria. Though expanding the law has taken over a decade, Woods Weber argued it has always been necessary.

"Nobody should be forced to make what is often times a very difficult and sometimes impossible choice between their livelihood," Woods Weber emphasized. "Getting a paycheck and getting to take paid time off to take care of themselves or a loved one if they get sick."

She added once the bill is passed, the state can build on it by allowing people to earn additional time off, at least up to 40 hours. It stems from the pandemic, when people had to isolate for up to five days if they contracted COVID-19, which could burn through their allotted sick time.


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