Earlier this year, the Texas Legislature passed a bill to wind down the Texas Health Insurance Pool. The Texas Health Insurance Pool, or “high risk pool,” was created to provide coverage for Texans who were denied coverage due to pre-existing conditions. It has been a lifeline for thousands of Texans for more than a decade, but it has never been an affordable for most because state law sets the premiums twice as high as comparable private market coverage.
As we’ve explained previously, the high risk pool will no longer be needed in 2014, when for the first time, the Affordable Care Act prevent people from being denied coverage or charged more due to pre-existing conditions. Texans whose only option is pricey risk pool coverage today will be able to choose from any plan offered by any insurer in Texas for coverage effective January 1, 2014, and they won’t pay more because of their pre-existing condition.
Some risk pool enrollees have already secured coverage for 2014. Cancer survivor Bob Flood and his family paid $3,000 each month for coverage in the risk pool and have enrolled in alternate coverage for 2014 that costs less than $1,000 to cover the family. But not all of the 23,000 risk pool enrollees have enrolled in other coverage. The technology issues with healthcare.gov have kept many people, including risk pool enrollees, from being able to apply for subsidies and coverage in the Marketplace.
The Texas legislation closing the risk pool contains a contingency allowing the Texas Commissioner of Insurance to keep the risk pool open if Marketplace operations are delayed. The Department of Insurance announced on Friday that the pool coverage will be extended until March 31, 2014. This aligns the end of risk pool coverage with the last day for open enrollment in the Marketplace, and gives risk pool enrollees an additional 3 months to get other insurance in place and avoid any gaps in coverage.
Extending pool coverage through March 2014 will provide current enrollees with needed time to get detailed information on their coverage options, make informed choices, and to enroll through the Marketplace. Individuals can also enroll in plans outside of the Marketplace, which do not rely on a functional healthcare.gov website, but the only way low- and middle-income enrollees can secure premiums subsidies is through the Marketplace website or phone line.
Unfortunately, there could be some tradeoffs for enrollees with extended risk pool coverage. Risk pool coverage has high deductibles. The most popular risk pool plan has a $5,000 deductible (for an individual, not a family). Risk pool deductibles re-start each year in January. If an enrollee remains in the risk pool for the month of January, for example, they would face a full year’s risk pool deductible for January, and then start over with a whole new deductible if they select an new plan in February. Meeting two deductibles within one year could prove financially difficult for many enrollees, especially moderate-income ones.
Another issue is premium increases. While most of us are used to once-a-year hikes, premiums historically have increased twice a year in the risk pool so costs remain twice that of regular coverage. It is possible that risk pool rates could increase between now and the end of March.
CPPP and the National MS Society sent a letter to the department last week that outlines the affordability issues related to an extension of risk pool coverage and potential fixes. The board of the Texas Health Insurance Pool will likely meet soon to determine if and how to address these issues. The risk pool has been conscientious about communicating changing information to enrollees, providing accurate and timely updates to its members. I’m certain the risk pool board will thoroughly examine how to make the extension and ultimate transition of coverage work well for risk pool enrollees.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
Some supporters of the health law are dreading the possibility of talk at the Thanksgiving dinner table turning to the nation’s health law. If getting drawn into a debate over the Affordable Care Act felt rough at other years’ feasts, this year, with the law rolling out, it feels especially dicey.
The good news is we’re here to help with some great information and links you can read up on well before that turkey dinner:
- On rates in the Health Insurance Marketplace: Many people will be getting much better coverage for less than they pay now. While some people will pay more, many of these people have had a bare-bones policy that few would consider good health insurance. Stacey Pogue with the Center for Public Policy Priorities explains more here.
- On those recent health plan cancellations: Stacey also breaks down what you need to know on this score. Additionally, a new report from Families USA shows just how few people-0.5%-are both at risk of losing the coverage they had and without financial assistance to purchase a new, better plan.
- On coverage expansion: As Anne Dunkelberg points out in an Austin American-Statesman op-ed, there are also a lot fewer Texans who risk having to change plans than there are Texans who are affected by Texas’ leaders decision not to expand Medicaid in the state. Over at MomsRising, some fellow champions for health coverage help explain who the folks in the coverage gap are.
- On navigators: The people helping folks enroll in the health insurance marketplace have an important job to do and plans for them need to remember, as our blog post explains: “Insurance is difficult to understand, especially for people who haven’t had it before. Navigators provide in-person help-answering questions, deciphering plan options, and helping people enroll.”
- On other things happening in health policy beyond Obamacare: A new report from the Georgetown Center for Children and Families shows Medicaid and CHIP are huge successes. Medicaid has not only helped many more kids get covered; children also are receiving the care they need to lead healthier lives. And as Clayton Travis of Texans Care for Children explains, some new rules pertaining to mental health will help a lot of people with mental health concerns get treatment they need.
- On the big picture of whether the Affordable Care Act is working: Check out this chart posted by the Washington Post about how the nation’s health care costs are declining-even while care itself improves-thanks to the Affordable Care Act.
We wish you a wonderful Thanksgiving holiday!
Your friends at Texas Well and Healthy
P.S. We are very excited to be working with Get Covered America (a campaign of Enroll America) to connect uninsured Texans with the chance to get coverage through the Health Insurance Marketplace. Get Covered America is looking for volunteers to help spread the word. There are many different volunteer opportunities. If you hear from Get Covered America about volunteering opportunities, we hope you’ll take the time to talk with them, and learn how you can help get Texas covered.
Millions of hard-working families across the United States are left out of affordable coverage because their state lawmakers refuse to expand access to health care.
Their reasons are strictly political, and the inaction of these lawmakers has created the “Medicaid coverage gap,” where 6-7 million uninsured individuals fall into without any access to care. They do not qualify for Medicaid as-is but also do not make enough to purchase private insurance. These low-wage workers left uninsured represent crucial industries to the economy and to our everyday lives. Your childcare provider, your local hairdresser, the server at your favorite restaurant—these are the people who are left out of affordable coverage.
The time for action is now. After January 1st 2014, states that have not expanded Medicaid begin losing millions of dollars each day they do not act. Stand up for those left out of affordable coverage. Call your legislator and tell them the time for Medicaid expansion is now.
A Georgetown University Center for Children and Families report released today found some surprising news for Texas children. Even though the state continues to have the most uninsured children in the nation, the Lonestar State has made real progress in covering kids, with about a quarter of a million fewer uninsured children than it had four years ago. In fact, no state has seen as large of a positive swing in the number of children with health insurance.
“This is good news for children and the state of Texas since health insurance coverage greatly improves the economic security of families who are faced with tough budget decisions on a daily basis,” said Laura Guerra-Cardus with the Children’s Defense Fund – Texas. “Investing in our children’s health today helps create a strong workforce tomorrow since kids with coverage show up to school ready to learn and stay in school longer.”
Between 2009 and 2012, the number of uninsured children in Texas dropped by about 4 percentage points, with an estimated 256,000 children gaining coverage, according to data from the Georgetown University research center. A new report on improvements between 2010 and 2012 attributes the gains to the success of Medicaid and the Children’s Health Insurance Program (CHIP) in reaching uninsured children.
“Medicaid and CHIP are examples of federal-state partnership programs that work,” said Joan Alker, author of the Georgetown University CCF report. “Together they are improving health insurance coverage for children and are a testament to what states can accomplish when they lean in and work with the federal government to meet the needs of their residents.”
The Georgetown University CCF report found that in the state of Texas, about 84 percent of children had coverage, which is not as high as the 98 percent coverage rate for seniors, but better than the coverage rate for adults ages 18-64 in 2012. About two-thirds of working-aged adults have health insurance. Many of these adults fall into the so-called coverage gap, which means they would be eligible for Medicaid coverage if and when Texas accepts federal funds to improve that vital federal-state partnership.
A national survey released along with the Georgetown University CCF report found that getting all children covered is important to Americans. Almost nine out of ten (88%) surveyed said they wanted all children in their state to get covered.
“The truth is, as of this fall, nearly every Texas family can find health coverage for their children that fits with the family budget, now that new options are opening up in the Health Insurance Marketplace,” said Clayton Travis with Texans Care for Children. “That’s good news for everyone, as more kids will be able to stay healthy, show up for school and get ahead in life when they have the coverage they need.”
Families interested in finding out if their children qualify for Medicaid, CHIP or financial support with a new health plan in the marketplace should visit HealthCare.gov or call (800) 318-2596.
For earlier data from 2009 and 2011, read the Georgetown University Center for Children and Families prior report here.
Written by: Christine Sinatra, Texans Care for Children. Cross-posted at State of the Children blog.
It seems that bogus comparisons of health insurance premiums before and after the Affordable Care Act (a.ka. Obamacare) keep popping up. Many of these analyses are misleading at best—comparing apples to oranges and ignoring what people will actually pay once subsidies are included.
Given that we probably won’t see the end of these comparisons any time soon, I want to take a minute to set the record straight. No reliable information exists on average pre-ACA rates for health insurance policies in the individual market (where people who don’t get job-based insurance buy directly from insurance companies). In other words, there is no good price benchmark to compare ACA rates to. When you see a report or headline that claims ‘Obamacare is raising individual market premiums by X%,’ you should wonder, compared to what?
Often the comparison point is the “teaser rate” for the cheapest policies on the pre-ACA market. Folks who’ve had to shop directly for health insurance in the past may know about teaser rates all too well. They are the advertised sticker prices for health insurance, that can be increased significantly once an insurance company tacks on surcharges for pre-existing conditions (assuming the insurer doesn’t deny coverage all together based on pre-existing conditions). But teaser rates and pre-existing conditions go away with the ACA. Premiums are based only on where you live, your age, and whether you use tobacco, and premiums are reduced on a sliding-scale for people earning under 4 times the poverty level (about $46,000 a year for an individual and $94,00 for a family of four).
Using teaser rates is just one thing that makes many premium comparisons misleading. CPPP recently outlined several stark differences in pre- and post-ACA coverage that are glossed over in rate comparisons, including:
- Ignoring the effects of the premium tax credits that many people in the individual market, particularly young adults, will qualify for. With tax credits factored in, some lower-income individuals will qualify for $0 premium Bronze policies, and others will pay less post-ACA for good coverage than they’d pay for pre-ACA bare bones coverage.
- Ignoring pre-existing condition coverage exclusions. Today, insurers routinely exclude coverage for health care costs, associated with pre-existing conditions, leaving enrollees paying insurance premiums while they lack coverage for needed health care services. This stops in 2014.
- Downplaying coverage denials. Pre-ACA, many people have been denied coverage all together due to pre-existing conditions.
- Failing to explain just how bad the coverage is in the cheapest pre-ACA policies and how much it will improve under the ACA. Pre-ACA coverage in the individual market is like Swiss cheese – full of holes. Some of cheapest pre-ACA policies in Texas have $10,000 deductibles for an individual and out-of-pocket spending limits of up to $13,000. Under the ACA, out-of-pocket spending limits for individuals are capped at $6,350 and are reduced on a sliding-scale for lower-income Marketplace enrollees. Not only do enrollees shoulder more financial risk through deductibles and copays before the ACA, they have fewer benefits. The cheapest pre-ACA policies often fail to cover or restrict benefits for maternity, mental health, substance use treatment, prescription drugs, and pediatric dental services—all covered post-ACA.
Reports that imply there is any direct and fair way to compare premiums or make a blanket statement about how much premiums have increased are inaccurate and irresponsible.
Here are some facts about how rates will change: some Texans will pay more than what they pay (or would pay) for the skimpiest pre-ACA plans (and get better coverage in return), while others will have access to much better coverage under Obamacare than what has been sold in the past, and they’ll pay less for it.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas.
Here at Texas Well and Healthy we are always striving to produce easy-to-understand materials about health care reform. Our partner KidsWell knows a thing or two about providing informative and clear resources on the Affordable Care Act—their brightly colored and highly visual website does a great job of sharing resources on children’s health coverage and the ACA. Their website includes state-by-state summaries of health care reform implementation and campaigns impacting children’s health and relevant weekly highlights from all fifty states.
Visuals are often key in comprehending large amounts of data. KidsWell’s National Spotlights feature provides interactive maps showcasing developments in health policy reform that are particularly relevant to advocates with an interest in child health. KidsWell also has a powerful health care reform search tool that will help you find all the latest health care reform information. You can search by keywords, state, topic, issuing agency and other criteria. Their database is updated each week so you know you’re getting accurate, recent data.
Additionally, KidsWell coordinates over 30 children’s advocacy organizations (including us) who are working to increase health insurance coverage for our nation’s children and families. By helping advocacy organizations work together, and by using this website as a health reform information hub, KidsWell is building a lasting legacy of healthy children.
Texas Well and Healthy is proud to be a featured partner of the KidsWell Campaign this week. You can see where we are highlighted on their website’s homepage. Take a moment to visit the site and check out their resources. You won’t regret it!
Written by Liz Moskowitz, Texans Care for Children
The opening of the Health Insurance Marketplace opened up a door that was previously closed to millions of Texans who had never before had access to affordable health care options. We wanted to put a face to the large number of Texans who will be benefiting from the Marketplace and to find out what getting covered means to them.
Our new Tumblr blog, Lets Enroll Texas, documents Texans who are experiencing the joy, excitement, relief, and peace of mind of finding quality and reasonably priced heath insurance options. Below are a few of the people we met on October 1 at an Insure Central Texas enrollment center. Read what they had to say, and follow our Tumblr to continue to meet new Texans who are thankful for the Marketplace. Have a story to tell? Email me.
Written by Liz Moskowitz, Texans Care for Children
On October 1, millions of Texans will be able to shop for affordable health care options through the new Health Insurance Marketplace. Though many people will access the Marketplace online, some of us may feel more comfortable meeting with someone in-person who can answer any questions we may have and help us better understand the new enrollment process. We spoke to some folks in Austin who will work with the nonprofit Foundation Communities, which has opened up two enrollment centers that are free to the community. They will be Certified Application Counselors during the six-month enrollment period that starts this week. For more information about people and places available to help in your area, find resources at LocalHelp.Healthcare.gov. (Note: This site is still being updated, so if you don’t find information for your community today, be sure to check back regularly.)
Name: Josh Rabinowitz
What would you tell people who are considering visiting an enrollment center?
A couple of years ago I broke my collarbone playing touch football. The surgery I needed cost $30,000. Since I had insurance, it only cost me about $5,000. That’s the difference. I didn’t really believe in insurance until then, or realize why I might need it down the line. But you just never know.
Why are you volunteering to help people enroll in coverage?
I think the best way to figure out if the Marketplace is a viable option is to do the best job we can with it, and go 100%. You can’t make that decision by putting people in a position to fail.
I also wanted to learn more about the Affordable Care Act for personal and professional reasons. My partner has a pre-existing condition, and his risk pool insurance plan will be ending January 1st. He’ll be looking into health care options on the Marketplace, and I’m going to look for myself, too. I also own a small business in the medical industry, and I want to make sure I understand the law’s provisions that will impact aspects of my business, like reimbursability for devices and treatments.
How would you complete this sentence? Health coverage means . . .
Preparing for the unexpected.
Occupation: Project Manager in the tech industry
Why did you want to volunteer to help people enroll in the Marketplace?
I think the Affordable Care Act is really beneficial to the community. It has many pluses and can cover a lot of people who currently have no health insurance. I believe in it and thought volunteering would be a good way to give back to the community.
Will you be checking out the Marketplace?
I get some help with health coverage through my job, but I do have to pay, too. I will at least investigate the Marketplace to see what my options are.
Are you excited for October 1?
I am excited. It’ll be nice to finally be able to see the Affordable Care Act in action and see people getting enrolled.
What would you tell people who are considering visiting an enrollment center?
You can come in and see what your options are without having to make any commitments. Everything is confidential, so you don’t have to worry about anybody getting a hold of the private information that you will provide.
Why do you think it’s important that so many people have health coverage?
There is such a high percentage of people, especially in Texas, who don’t have health coverage, and it costs society a lot. If as many people as possible have health insurance, we can all pay for our fair share and have access to preventive care and other health services.
How would you complete this sentence? Health coverage means . . .
Name: Elizabeth Colvin
Occupation: Director, Insure Central Texas
How will the Insure Central Texas locations help people? Why should people visit?
Our Insure Central Texas centers are a place for people to drop in, ask questions about the new healthcare law, and get in-person assistance with understanding the new health insurance plans and what they will cost. Our trained volunteers are ready to answer questions, walk people through the online Marketplace, and help people fill out the application to obtain health insurance and financial aid that will reduce the costs. We are open to serve the community and are here for just about anyone – the person who is shopping for insurance for the first time, a musician or free-lancer working without health benefits, or a single mother who doesn’t have insurance through her employer.
How would you describe the volunteers to someone unsure of visiting an enrollment center?
Our trained volunteers are volunteering their time to help individuals and families in Central Texas figure out how the new healthcare insurance laws work and what insurance will cost. Our volunteers are official Certified Application Counselors and participated in an on-line training and additional training by Foundation Communities. Most importantly, our volunteers have no agenda other than helping people in Central Texas. They aren’t trying to sell anything and have no association with insurance companies. They want to help each individual and family learn about how the new laws impact them and what insurance options and financial aid are available for their personal situation.
Why are you excited about the Marketplace opening October 1?
For the first time in Texas, insurance companies cannot deny you coverage for a pre-existing condition or chronic health issue. The Marketplace will give families who previously couldn’t afford insurance the opportunity to obtain a good health insurance plan and possibly receive financial aid to reduce the cost. We all have friends and family members who are working without insurance and live with the worry of being uninsured. Having quality health insurance gives you peace of mind and the ability to manage your health.
How would you complete this sentence? Health coverage means . . .
Without health insurance, an unexpected illness, a long-term condition, or an accident can result in years of medical debt for a family. No family should lose all their savings or go bankrupt just because a loved one gets sick.
Note: Starting October 1, Insure Central Texas centers will be open 7 days a week at two convenient locations. No appointment is needed. Visit InsureCentralTexas.org or call 2-1-1 (option 1) and ask for information on Insure Central Texas.
Written by: Liz Moskowitz, Texans Care for Children.
Texas Marketplace Rate Examples
Every individual will have a unique story and characteristics (income, age, region, etc.) that will affect their premiums and subsidy amount. To get us started, however, let’s walk through a couple examples of what a Texas resident might expect to see in the Health Insurance Marketplace on October 1.
Single 27-Year-Old Houston Resident, Making $28,700 Annually
For this individual, the monthly pre-subsidy rate for the 2nd lowest cost silver plan will be about $201. At this income level (250% FPL), this individual can qualify for premium tax credits to help reduce their premium. This resident can expect to receive a monthly tax credit of approximately $8, reducing their monthly premium for this silver plan to roughly $193. If, however, the individual wants to apply this tax credit to a lower-cost bronze plan, they can! The after-subsidy cost of the lowest-cost bronze plan would be about $129.
Single 27-Year-Old Houston Resident, Making $15,300 Annually
What if our hypothetical 27-year-old Houston resident has a significantly lower income, closer to 133% FPL? Larger subsidies become available to those with lower incomes (who are above 100% FPL). This resident can expect to receive a monthly tax credit of approximately $163 to apply to the pre-subsidy $201 rate, reducing their monthly premium to about $38. As in the previous example, this person can still apply their tax credit to a lower-cost bronze plan, which would give them a monthly premium of zero dollars.
Single 40-Year-Old Austin Resident, Making $28,700 Annually
For this individual, the monthly pre-subsidy rate for the 2nd lowest cost silver plan will be about $250. This resident can expect to receive a monthly tax credit of approximately $57, reducing their monthly premium for this silver plan to roughly $193. If the individual chooses to apply this subsidy to the lowest cost bronze plan, the cost would be about $119 a month.
Single 40-Year-Old Austin Resident, Making $15,300 Annually
This lower-income resident can expect to receive a larger monthly tax credit of approximately $211 to apply to the pre-subsidy $250 rate, reducing their monthly premium to about $38. As in the previous example, this person can still apply their tax credit to a lower-cost bronze plan, which would give them a monthly premium of zero dollars.
But What Will I Pay?
For additional data and examples, reference our Texas Marketplace Premiums chart (which includes pre- and post-subsidy premiums for individuals at 250% FPL) and our Texas Rates by Income Levels (which examines premium rates for individuals of varying income levels in Houston). But first, find out what geographic rating area you are in by referencing this Texas Rating Areas.
You can also use the Kaiser Family Foundation subsidy calculator to get a sneak preview of some of the rates you can expect to see in the Marketplace on October 1.
And don’t forget to go to www.HealthCare.gov on October 1 to find out more about the full range of new coverage options!
How Does Rating Work in the Texas Health Insurance Marketplace?
Health insurance issuers in the Marketplace can rate consumers based on their age, geographic region, tobacco use, and family size. The U.S. Center for Consumer Information & Insurance Oversight has sorted all of Texas’ 254 counties into 26 different “geographic rating areas,” across which insurance premiums may vary. Issuers cannot charge a person more based on their health status or gender, and can charge older consumers no more than three times the rate for younger consumers due to their age. Consumers who smoke may be charged up to 50 percent more than the base rate, and consumers who purchase family plans may be charged more based on the size of their family.
Aside from these individual rating factors, premiums will vary depending on the plan selected. Plans in the Marketplace will be offered in four metal tiers: bronze, silver, gold, and platinum. Plans in each tier will offer comparable benefits, but at varying levels of cost-sharing. A plan, for example, in the bronze category covers, on average, only 60 percent of overall enrollee medical costs (with the remaining 40 percent paid for out-of-pocket through deductibles, copays, and coinsurance), while a silver plan contributes 70 percent and a gold plan 80 percent, for example. Plans in higher metal tiers can be expected to have a higher monthly premium since consumers are paying to have a lower deductibles and copays. The size of your premium tax credit will be calculated using the rate for the 2nd lowest-cost silver plan in the Marketplace, discussed below.
What about Subsidies?
In Texas, individuals and families with household income between 100% and 400% of the Federal Poverty Level (FPL) will be eligible to receive premium tax credits to help make monthly premiums more affordable. Persons at varying levels of poverty will be required to pay no more than a certain percentage of their income towards health insurance, using the 2nd lowest cost silver plan as a base rate for calculating the subsidy amount. For example, the cost of the 2nd lowest-cost silver plan can be no more than 8.05% of income for an individual at 250% FPL. But for an individual at 133% FPL, the cost of the 2nd lowest-cost silver plan is capped at 3% of income. The subsidy can subsequently be applied to plans in other metal coverage tiers, such as bronze or gold.
How can I learn more?
Written by Megan Randall, Center for Public Policy Priorities. Cross-posted from Better Texas Blog.
The Health Insurance Marketplace is about to open up to millions of Texans on October 1!
You can actively use social media to encourage your friends, family, and online networks to check out the new Marketplace at healthcare.gov to see what kind of health care options for which they may be eligible. Twitter and Facebook are great ways to reach out to those you know to tell them about this amazing opportunity.
We have put together a social media toolkit that can help us all spread the word. But, it will only work if we all take part. Below are some highlights from the toolkit, plus more, that you can share with your friends, family, and online community.
Use the hashtag “#LetsEnrollTX” for all your tweets about enrollment.
There will be a live tweetchat from 12 – 1 p.m. CST on Tues, Oct 1 to discuss the Health Insurance Marketplace open enrollment. @MomsRising and @TXWellHealthy will host a discussion about it and you can join using the hashtags #GetCovered and #LetsEnrollTX.
Example tweets for October 1:
- “The new Health Insurance Marketplace is here! Explore your new, low-cost health care options at www.HealthCare.gov #LetsEnrollTX”
- “RT if you’re thrilled that millions of Texans now have new, affordable health care options available to them starting today! #LetsEnrollTX”
Example Facebook post:
- “Exciting news: The Health Insurance Marketplace is now open! The Marketplace provides Americans with a new way to compare and shop for health insurance that fits their budget. You can visit healthcare.gov for more info. What does getting covered mean to you? Let us by know commenting below.”
- Use several Marketplace images we made to make your posts more visual and prominent. Just right click on each image, and save it to your desktop.
POST A PICTURE OF YOURSELF HOLDING A SIGN
- Post a picture of yourself holding a sign that reads “Getting covered means ________.” Please complete the sentence with what coverage means to you and your family! The words on the sign should be in big letters and easy to read. Tweet with hashtag #LetsEnrollTX and share on Facebook, too.
- For those of you who plan to be at enrollment sites and have the opportunity to speak to Texans getting enrolled, you can take their picture or video too. Or interview your friends and family! Go to our toolkit to find out more.
SEND US WHAT YOU HAVE
- If you have completed photos, videos, interviews, please email what you collect to email@example.com. We will share all the information on a Tumblr blog, as well as use it for various other media purposes.
Posted by Liz Moskowitz, Texans Care for Children.