The Affordable Care Act roll-out online has been rocky, it’s true. But the HealthCare.gov website is only part of a much bigger law that many Texans understand will bring affordable health coverage to millions of people who need it.
In Texas, many of us are uninsured or have been “uninsurable” because of a pre-existing condition. The most important part of the health law–the part that makes good insurance available, regardless of health history and at prices families can afford–is working just fine. Getting Texans covered is still the end game, so let’s keep in mind three things.
1. Patience will be rewarded. Texans have until December 15 to enroll in coverage that begins on January 1, and the enrollment period lasts through March. Officials are working to iron out the kinks as quickly as possible. In the meantime:
2. This is a good time to get prepared. If you’re thinking of enrolling, use this time to gather what you’ll need:
- Have you got your paperwork together? You’ll need a Social Security or immigration number for everyone in your household enrolling and the previous year’s tax return (or a W2 or pay stub) to enroll.
- Have you set up an account? You can do so by phone with little wait time. The number is 1-800-318-2596.
- Have you found out about financial assistance you qualify for? A resource from the Kaiser Family Foundation calculates an estimate for you.
- Have you browsed the plans available to you? The best place to do so is at this HealthCare.gov page. You can also get some sense of prices and your options using tools from Get Covered America and the Texas Tribune.
- Have you met with someone? A navigator or certified application counselor can assist you in talking through your options and getting enrolled. Find one near you here.
3. Keep some perspective: This is the first time a website of this scale, able to do these things, has ever been tried. Still, it isn’t the first time a change in health policy has been slow getting out of the gate before making a positive difference in millions of lives. Medicare Part D, the CHIP program and Medicare and Medicaid all had bumpy beginnings, but each is widely accepted and appreciated now. The Affordable Care Act will get there, too, as more people enroll.
Written by: Christine Sinatra, Texans Care for Children
Having completed my online and in-person training, I was able to sign up for a 4-hour shift on the first day of open enrollment. It’s no longer news that the www.healthcare.gov web site was not functional on day one, and as I write this HHS and their contractors are still struggling with it.
On October 1, though, people were hungry for basic information, so there was plenty to talk about. With the options to consider, it seemed unlikely many folks could have been ready to complete the whole process at one sitting. In four hours, I worked with seven families. Diverse as they could be, all wanted affordable health care for their families and children.
I was happy to be able to tell two different couples (in their 50s and early 60s) with grown kids that they would qualify for discounts on their premiums. Two other families each had so much uncertainty about their 2014 income that we couldn’t be sure yet whether they would qualify for Marketplace premium help—or if the parents would fall into the Texas Medicaid Coverage Gap and stay uninsured. One mother with two children in Medicaid today learned that she was, in fact, left out in Texas due to our failure to expand Medicaid for adults. And I was able to assure an applicant that no premium discrimination would be allowed based on sexual orientation.
Each one of these families was headed by one or more workers. The highest income of the seven families I worked with that day was about $48,000, right around the median household income for Texas—half of Texan households earn less than that. All of them were courteous, appreciative, and trying hard to master their options despite the technology shortcomings. Insure Central Texas is doing a great job educating as many people as possible and trying to overcome the computer obstacles, and this work is going on in community organizations all across the country.
Uncooperative computer systems aside, it is still satisfying to see families get excited at the prospect of greater financial security and access to good care. Fingers crossed, I hope to be able to report soon on getting a family all the way to selecting a health plan and paying their first premium!
Written by: Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from Better Texas Blog.
“Massive Demand as Obamacare Opens for Texans” was the headline last week, when the Health Insurance Marketplace first opened for business. While we don’t know the precise number of Texans who have enrolled, it’s great to see the early reports that enrollment in the Marketplace is beating expectations. Nationwide, roughly 5 million people visited the federally run Marketplace website Healthcare.gov–just on its first day. Millions more made calls, visited enrollment sites, and checked out the new marketplaces in states that had set up their own health insurance exchange.
Even with the federal government shut down, the roll-out of health insurance options for millions of Texans has been able to move forward. And although glitches and technical overload have kept things from going perfectly online, progress on that front is happening every day. Those who couldn’t enroll at the website can still visit an enrollment site or make a call, and they do have time: Enrolling any time before December 16 allows for coverage that starts in the new year. Open enrollment lasts through March 31, 2014, but an Associated Press article today reminds folks that it would be wise to get your coverage no later than Valentine’s Day.
Which reminds us, we’ve been wanting to spread the love and bring you more testimonials from people who have contacted us, real Texans with real health coverage stories, getting health insurance in the Marketplace:
“Getting insured is an absolute dream come true for me, and I am so excited about it.”
- Jennie from Houston
“For us it’s a lifesaver. We have been dealing with insurance that has an unmanageable deductible and have held off on tests because we’re waiting for health care to kick in in January.”
- Laura from North Texas
“So happy to have my family of four covered again starting Jan 1. My wife and I both run our own businesses and the insurance we had until recently cost too much and did far too little. Preventative care should be covered and encouraged-it’s a no-brainer. And I shouldn’t have to worry about losing my house if I have a heart attack/cancer/whatever tragic event. The Healthcare Exchange website is over-inundated and a bit frustrating, but that’s because there are so many other people like us, excited to get reasonable and smart health coverage.”
- Jack from Austin
“If I were to get insurance through the marketplace, I would be at peace. I hope that the marketplace offers something that will allow the average and normal person to go to the doctor and not be so stressed out over it.”
- Amanda from Houston
Written by: Christine Sinatra, Texans Care for Children.
The Countdown To Coverage series continues with a look at an essential health benefit: coverage for mental health. We also share how consumers can be sure to choose a plan in the Health Insurance Marketplace that meets their needs.
Mental health benefits and the Affordable Care Act (ACA)
Access to behavioral health care is not just a matter of having health insurance; it also requires an adequate scope of covered benefits in a health plan. For many years, benefits for Mental Health and Substance Use (MH/SU) services were not included in many health plans. In addition, when an employer did chose to offer mental health care coverage as a part of the employer-sponsored plan, MH/SU conditions were typically capped at a much lower level of coverage than that for physical conditions. As a result, people who needed MH/SU services either went without what their insurance did not cover, or were exposed to high costs if they accessed services beyond the coverage limits. To reduce this disparity, Congress passed the Wellston-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, that requires that group health plans (with 51+ full-time employees) that choose to provide MH/SU benefits—and all Medicaid managed care plans—must ensure that the coverage for those benefits is no more restrictive than the coverage terms for medical/surgical services.
The ACA expands those federal “parity” provisions. The essential health benefits (EHB) standard in the ACA raises the bar by requiring most health plans to cover MH/SU services, which will improve the opportunity for early intervention and continuous treatment for this vulnerable population. Individual market and small employer plans in 2014 will all be required to meet new minimum standards for the benefits they cover. Each plan must include a package of ten EHBs including mental health and substance abuse services; hospitalization; prescription drugs; rehabilitative and habilitative services; preventive and wellness services and chronic disease management; ambulatory patient services; emergency services; maternity and newborn care; laboratory services; and pediatric services, including oral and vision care.
The Marketplace plans must provide MH/SU benefits no more limited than their medical benefits, as directed by MHPAEA. Individuals and small groups in 2014 will be able to buy plans both inside and outside the Marketplace, and all coverage sold to individuals and small employers from that point forward must meet the EHB standards, whether inside or outside the exchange. In short, these plans must provide MH/SU benefits equal to medical benefits. Applying any limits to MH/SU benefits that are more restrictive than for medical benefits will be prohibited, including higher out-of-pocket financial requirements; more limited treatments; unequal use of preauthorization of services, fail-first policies, or utilization reviews; or a narrower application of “medical necessity” definitions for MH/SU treatment.
The combined effect of ACA’s standards for Essential Health Benefits and the extension of MH/SU parity to private insurance plans in 2014 should significantly increase access to adequate treatment of these conditions for all insured persons. In the process, it promises to reduce a lot of avoidable ER visits, and even some avoidable incarcerations.
Choosing a plan
Selecting a health care plan for you or your family can be intimidating, especially if this is your first time and/or you have a chronic condition such as mental illness. As we have shared with you in our blog series, Countdown to Coverage, there is a lot to understand before you select a plan and for people who suffer from mental illness and substance use disorders, there are important things to consider when selecting a plan in the Marketplace.
Prior to the ACA, many health plans did not included coverage for mental health and substance abuse services or if they did, the benefits where less than those offered for physical conditions. Also, insurance companies could flat-out deny coverage to those with pre-existing conditions like mental illness. However, under the ACA, each plan in the Marketplace will have to provide core benefits, known as the essential health benefits, including mental health and substance abuse services and insurance companies can no longer deny coverage because of pre-existing conditions.
Most individuals who are uninsured will be able to gain coverage through the Marketplace, which will offer a variety of health insurance plans. Plans will be presented in four tiers – bronze, silver, gold, and platinum – which makes it easy to compare plans.
The tier you choose affects how much your premium costs each month and your total out-of-pocket costs like copays and deductibles. Individuals with chronic conditions generally visit the doctor more frequently and take more prescription medications, which means more out-of-pocket costs within a year.
When choosing your health plan, keep this in mind:
- The bronze, silver, gold, and platinum plans do not reflect the quality or amount of care the plans provide.
- All plans in all tiers will contain essential health benefits
- In general, the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care. For example, the Bronze plan will generally have a lower premium but a higher out-of-pocket cost than a Silver plan.
Written by: Katharine Ligon, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
If you’ve been following us on Facebook or Twitter, you might have noticed that we’ve spent the last couple of weeks sharing some of the great things health care reform is already doing for Americans. How come? Well, for one, according to the Pew Research Center, 44% of Americans don’t even know if the Affordable Care Act is still in effect. And, as a recent Texas Tribune article that summed up polling on the law concluded, even fewer Texans have a good feel for what’s in the law and how it helps them.
If you support health reform, why not help get out the word by sharing some facts about why it matters for Texans? (Those handy buttons for sharing at the bottom of this blog post make that easy.) And if you’re unsure yourself about what’s in the Affordable Care Act, click on any of the images below to go to our quick, fun video shorts, explaining each of these 4 ways the law is already helping Texans and will help still more in 2014.
1. Coverage for those with pre-existing conditions means peace of mind for many Americans who were once denied health insurance:
2. Preventive care’s covered. Since 2012, women haven’t had to pay out-of-pocket costs for many types of preventive care. In 2014, anyone with health insurance will receive all preventive care services at no extra cost.
3. Insurers are held accountable. Now more of your premium dollars for private insurance have to go toward actual health care; insurers can’t just spend ever-growing amounts on administrative costs or CEO bonuses.
4. Health insurance companies can no longer deny you health care because of lifetime spending caps. So if you get really sick and need expensive treatment, you don’t have to worry about not getting the care you need.
It’s not too late to join in this health care celebration by liking and sharing this post with your friends. Also, please stay tuned: our friends with the Center for Public Policy Priorities will be posting in this space throughout September about what’s coming up now that full implementation of the nation’s law is almost here.
Thanks, and here’s to a well and healthy Texas!
By: Liz Moskowitz and Christine Sinatra, Texans Care for Children. Special thanks to our former community educator with this campaign, Cheasty Anderson, who stars in the videos linked to above.
Three years in, a progressive health care law is helping Texans have better financial security, healthier lives and a better outlook. Some of our elected leaders, however, continue to try to block the Affordable Care Act and distort facts about what lies ahead, especially when it comes to what happens with Medicaid under the law.
The truth is Obamacare is already helping millions of Texans. It’s keeping big insurance companies with previously loose regulations from ripping people off—preventing caps on your benefits and steep rate hikes, for example—so that Americans are saving $2.1 billion per year. Besides holding insurers accountable, the law extends the promise of health care to more people. Patients with pre-existing conditions, young adults who can stay on their parents’ health plan and consumers, including seniors on Medicare, needing a break on costs related to preventive care and certain prescriptions all have benefited because of the ACA.
But the law’s biggest changes come next year. That’s when Texas, the state with the highest rate of uninsured adults and the highest number of uninsured children in the country, has the most to gain.
Long before the Affordable Care Act, too many employers were finding it hard to offer families coverage. Fewer employers offered health insurance every year from 2000 to 2011, in every state but one: Massachusetts. There, in the place whose health reform approach became a model for Obamacare, employers are more likely to cover workers.
Succeeding in employer coverage for more working Texans, assuring more people have the health care they need, and, yes, saving society costs, all require moving forward with health reform. (Opponents rarely mention that repealing the law would cost $109 billion over a decade, while leaving it on the books reduces the deficit.)
If Texas fully implements this law—including accepting federal dollars to cover more hard-working, low-income families on Medicaid—three-quarters of our 6 million uninsured would qualify for either tax credits or Medicaid. For many, affordable health care would be within reach for the very first time.
Later this year, that will be the case for many middle-income Texans (earning roughly $24,000-$92,000 a year for a family of four), who will receive subsidies to purchase private coverage in an online health insurance marketplace. Prices will be far better than individual health plan offerings today. The Kaiser Family Foundation found 4 out of 5 people with that coverage are likely to pay less next year for comparable insurance.
Nearly all who earn less than that threshold for marketplace subsidies are working Texans in poverty. They, too, will have an affordable health care option—but only if our state agrees to extend Medicaid for them. Medicaid already helps millions of kids, seniors and Texans with disabilities get care they need. Health reform was designed so that all states have every reason to approve an opportunity to cover low-income workers, too: the federal government picks up the full tab for the extension for three years and at least 90 percent of the cost every year after that.
On the other hand, refusing to accept this funding would leave Texas employers on the hook to pay higher federal tax penalties as a result of the state’s position. Jackson Hewitt Tax Service estimates those costs would be as high as $299-$448 million per year. Moody’s credit agency has also put states like Texas on notice, noting that local hospitals and communities will pay more if Medicaid isn’t there to cover the 1.5 million Texans who qualify for it under the ACA. That means failure is imminent and expensive to taxpayers if Texas does not expand Medicaid.
Chambers of commerce, local governments, hospitals and groups throughout Texas all say it’s time for our state do the right thing and accept the funding to cover more Texans on Medicaid. This is an opportunity to meet people’s needs, do right by employers and put our state on firmer financial footing—something we should all agree is right for Texas.
Written by: Keilah A. Jacques, CitySquare Public Policy Coordinator and a partner in the Texas Well and Healthy Campaign.
This op-ed ran today in the Dallas Morning News.
Texas lawmakers are deciding right now whether the state will accept billions of dollars in federal funds that would allow 1.5 million currently uninsured Texans to have health coverage they need. The Medicaid expansion that would make this possible would also bring Texas an estimated $6 billion of annual economic benefit and many health care jobs. Yet some Texas leaders are proposing leaving money on the table and people uninsured.
We need your help to keep that from happening! If you or a group you work with supports Texas extending Medicaid coverage for hard-working, low-income Texans who would qualify for it under health reform, we need to hear from you! Here’s what you can do.
- Sign on in support: Take just a moment now using the “Sign On” link below to let us know you stand for bringing health care coverage and jobs to our people.
- Sign on a group or organization you work with: If you are authorized to speak for a community group, an organization, or a company that supports Medicaid expansion, use the same form to let us know. We’re collecting sign-ons from across Texas.
- Ask your friends, family, coworkers, and groups you’re a part of to sign, too: With so much at stake, we need every voice raised. Please consider forwarding this message!
This Friday, Feb. 22, Texas Well and Healthy invites you to two learning events you can attend from anywhere in Texas. First, our campaign is hosting an important health care action call at noon all about 2013′s Health Care Advocacy Day, March 5. (Just two weeks away! Have you registered?) Then at 3 p.m., the Center for Public Policy Priorities will host a webinar for community organizations on “Navigators,” the community-based, in-person assistance-providers who, under the Affordable Care Act, will help people enroll in Medicaid, CHIP, and private health insurance through the Health Insurance Marketplace (also known as the exchange). More about these two events can be found below.
Friday, February 22
This call is for ALL Texas health care activists, as we prepare you for March 5 Health Care Advocacy Day. If you are registered to join us at the Capitol, use this call to familiarize yourself with tools and talking points that will come in handy at the Capitol. If you’re not able to be with us on March 5, find out how to virtually participate in advocacy day from outside Austin. We’ll also offer an update on what’s happening in the legislature that could prove promising for the Medicaid expansion and better health care for Texas families. The call is open to all interested parties, but you must RSVP! Email firstname.lastname@example.org
Webinar on Navigators for Community Organizations
Friday, February 22
3:00 – 4:00 p.m.
To register, click here
- Who is eligible to be a navigator
- What services must they perform
- How are they funded
- How are they trained/certified
- The draft grant timeline
- State legislation affection navigators, and more
Stacey says, “We don’t know all of the details at this point, but we know enough to help community groups start an internal conversation about whether they should apply to be Navigators. We hope you can join us!” Register now.
As 2012 comes to a close, we look back on some of the year’s most important developments for Texas health care–and what those might tell us about what’s to come in 2013 and beyond.
A whole lot of health policy gets decided at the state level, including some of the budget for health care. The two biggest items in the state budget are education and health care like Medicaid, whose recipients are overwhelmingly kids. That’s why it was a big deal in September when key education groups and health interests came together to say they refused to be pitted against one another over the state budget–and that they’re working together to collect signatures from Texans who agree both education and health for children matter in our state. This “cuts aren’t the answer” unity is really important in the year ahead.
As the second anniversary of passage of the Affordable Care Act came around, the U.S. Supreme Court heard arguments about the law, and many Americans came to hear for the first time some of the key benefits of the law and what it means for countless families.
We write mostly about health care here, but some new research has found something important about children’s health and public policy: smart, strategic efforts are making a difference at bringing down child obesity in many places. That’s a signal we need to keep up what’s working and not shrug our shoulders in the face of serious health challenges in our communities.
CHAP closed in April, which was bad enough, but then Texas also missed opportunities to continue providing hotline and other assistance to Texans who had questions about their health insurance rights and coverage. Saying farewell to Texas CHAP at a time of so much change in health care was unfortunate in 2012, but ramifications may be felt even more in the years ahead as more Texans seek out coverage options when near-universal health care kicks in in 2014 under health reform.
This year’s U.S. Census report found Texas, while still having one of the nation’s highest rates of uninsured children, no longer has the dubious distinction of being worst at insuring kids. The improvement came because we strengthened Texas CHIP and Medicaid, so more kids who qualify for these services can see a doctor when they need to.
After the Supreme Court decided states would have some leeway in implementing parts of the Affordable Care Act, our governor declared his rejection of plans for a tailored-for-Texas exchange and an entirely-paid-for-by-the-feds-for-three-years Medicaid extension that would cover more than 1 million Texan adults, many of them low-income parents. While legislators will have the final say and many are optimistic about a better final decision ahead, the governor’s early rumblings may have made it harder for some Texas families to have the security of good health care they need.
Thanks, Affordable Care Act!
Whether you’re paying attention to the current fiscal cliff talks or hearing about 600 Texans taking to the Capitol to make their voices heard on this subject, Medicaid was a hot topic this year. As we noted above, it already helps millions of Texas kids see a doctor and could help 1-2 million more low-income adults soon, if Texas agrees. Adding fuel to the Medicaid-media fire: two major studies out of Harvard University this year found Medicaid has major benefits for the populations it serves and it also likely saves thousands of lives that would otherwise be lost each year.
The 2012 elections mattered, as all elections do. From ensuring the Affordable Care Act can move forward thanks to President Obama’s reelection to other developments that could well prove helpful to families on Medicaid, these elections’ impact will be felt for years to come.
By a razor-thin margin, the court allowed the Affordable Care Act to remain the law of the land. As we have mentioned, this is a very big deal for kids, families, and Texas, especially in 2014 when the law takes full effect. Texans are more likely to receive health and mental health care they need, because of the ACA and the court’s ruling. Many families already are benefiting from things like insurer rebates, bans on “preexisting condition” barriers for children, and preventive care, including women’s health care, with no co-pays–all things that would have gone away if the court had made a different call.
That’s my list. What would you add or change?
Written by: Christine Sinatra, Texans Care for Children
Editor’s Note: The Texas Well and Healthy Campaign is proud to introduce you to the newest member of our team – Courtney Watson!
Courtney is an organizer with over 12 years experience and has worked with non-profits on community campaigns with a special focus on healthcare. Her goal for Texas Well and Healthy is to educate people about the Affordable Care Act and how it will impact small businesses in Texas.
As many of you know, small businesses account for the majority of the employers within the state of Texas and are a driving force behind our economy. In fact, there are more than 2.2 million small businesses in Texas, and small firms make up more than 98% of the state’s employers.
If you are connected with business groups or small business owners who want more details on how the ACA will affect small businesses in Texas and choices they have for better healthcare in Texas, let me know! You can email me at email@example.com, or feel free to call at (512) 788-1301.
The majority of Texans work in small business or know someone who does. We must spread the word on how the ACA is creating affordable, quality healthcare for everyone!
Written by: Courtney Watson, Children’s Defense Fund – Texas