The Internal Revenue Service (IRS) disappointed consumer groups and unions when it released a final rule Jan. 30 that could leave some families without  affordable health insurance coverage or premium tax credit subsidies to help pay for it.

Timothy Jost, a law professor at Washington and Lee University in Lexington, Va., and consumer representative to the National Association of Insurance Commissioners, told BNA that he had hoped IRS would allow families to receive the subsidies in situations where a family member has coverage that meets the Affordable Care Act requirement for "affordable" employer-sponsored coverage but the family cannot afford family coverage. Instead, IRS went with a stricter reading of the statute that does not allow families to receive premium tax credits through the online health insurance exchange markets that will begin operating in 2014.

"It just seems to me that you can't have it both ways," Jost said. ACA requires employers to provide qualified coverage that costs employees no more than 9.5 of their income for self-only coverage. If employers with at least 50 full time employees do not provide such coverage, they are liable for steep penalties under the law.

A 2012 Government Accountability Report estimated that 460,000 children would be ineligible for coverage under the interpretation of the statute adopted by the IRS. A spokesman for the American Academy of Pediatrics said the final rule makes it imperative that Congress reauthorize the Children's Health Insurance Program.