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.

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.

1. 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.

2. 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.

3. 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!

Webinar on Navigators for Community Organizations
Friday, February 22
3:00 – 4:00 p.m.
To register, click here

The Affordable Care Act creates and funds a “Navigator” program that will provide community-based, in-person assistance to help people enroll in Medicaid, CHIP, and private health insurance through the Health Insurance Marketplace (formerly known as the “Exchange”) in 2014.  We expect a grant funding announcement from the U.S. Department of Health and Human Services within the next month or two.  The purpose of the webinar is to educate Texas community groups about Navigators ASAP, before the grant application is released.

10. Education and health groups unite for a better Texas budget

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.

9. Health reform gets its day in court

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.

8. Cities and states succeeding at curbing child obesity

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.

7. Texas Consumer Health Assistance Program closes

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.

6. Census finds Texas makes progress in insuring kids

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.

5. Governor Perry says Texas won’t

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.

4. Texans receive $187 million in rebates from their health insurers

Thanks, Affordable Care Act!

3. Medicaid, Medicaid, Medicaid

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.

2. Voters head to the ballot box

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.

1. The Supreme Court upholds health reform

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

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 cwatson@childrensdefense.org, 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

Since then, pundits, scholars, and people on all sides of the issue have offered wildly different estimates on who the law would actually help. Now, thanks to Dr. Michael Cline and Dr. Steve Murdock of the Hobby Center for the Study of Texas at Rice University, Texans don’t need to speculate. There is data that illustrates who would benefit in our state.

Methodist Healthcare Ministries commissioned a study authored by Dr. Cline and Dr. Murdock—who once served as the official State Demographer of Texas (in case you were wondering why the name sounded familiar)—to help us better understand how the new law would impact our community.

Texas has the highest uninsured rate in the nation. This unfortunate ranking is not necessarily breaking news; it’s a distinction our state has earned in the past. But, it’s worth mentioning since the U.S. Census Bureau just recently released 2010 Census data that confirms our unfortunate standing in the nation. So how many uninsured Texans does it take to put our state nearly dead last? As of 2010, an estimated 23.7 percent of all Texans (5.9 million people) had no health insurance coverage. Given our numbers, it stands to reason, that we have a lot to gain from the ACA.

According to Dr. Cline and Dr. Murdock, in the study titled Estimates of the Impact of the Affordable Care Act on Counties in Texas, if Texas implemented the new law—even with a moderate effort to increase enrollment in public and private health insurance— by 2014 every county in Texas would see a decrease in the number of uninsured people. The total number of uninsured people in our state would essentially be cut in half; from 5.9 million to 2.9 million. Nearly 3 million people in our state stand to gain from the ACA due to the expansion of Medicaid and the accessibility of affordable health insurance through the private sector.

According to the two researchers, all this is largely dependent upon the efforts of the State and healthcare advocates enrolling people in public health insurance (Medicaid and CHIP), and how well the health insurance exchange is developed and marketed. The Center for Public Policy Priorities (CPPP) has further analyzed the data and summarized the key findings in a brief titled Choices and Challenges: How Texas County Uninsured Rates Will Drop Under Health Care Reform. That brief also includes some recommendations on how the state can leverage the ACA to reduce its uninsured rate.

Aside from the sheer number of people who would benefit, health care as an industry will also realize tremendous gains through expanded funding of previously uninsured patient visits.

As a healthcare provider, we here at MHM know this law will make an important difference in peoples’ lives based on what we hear time and again from those served in our clinics and the programs we support throughout South Texas. The difference between paying rent, or getting health care; buying food or getting much-needed medicines. The findings in this study make the choices before our policy makers clear, and invite them to make that difference for three million Texans.

We are ready to do our part to help our community realize all the ACA has to offer. We hope our legislators are ready too.

Written by: Kevin C. Moriarty, President and CEO of Methodist Health Care Ministries. Cross-posted with permission from the Methodist Health Care Ministries blog.

No surprise, Texas still has the worst uninsured ranking in the country, with 6.08 million uninsured (23.8% of all Texans).  This is a teeny bit better than last year’s 24.6% uninsured rate—just barely “statistically significant.”

But the picture remains brighter for Texas kids, whose uninsured rate is stable at 16.3% of kids under age 19 (1.2 million uninsured Texas kids).  Only in Texas could we celebrate moving to 49^th from last place, but Nevada has now solidly claimed the worst-kids’-coverage spot with their 19.3% child uninsured rate.

Of course, 1.2 million uninsured children is nothing for Texas to applaud—we have about 9 uninsured children for every one in Nevada.

Another interesting factoid:  of our 1.2 million uninsured Texas children, around 740,000 are children under the CHIP income cap who are either US citizens or legal residents.  That means—you guessed it—they could be enrolled in Medicaid or CHIP, but they aren’t!  So, clearly we still have loads of work to do educating Texas parents about their options and making it easier than ever for eligible kids to get care and keep their care.

Forgive me if I can’t resist talking a little bit about our Texas parents who lack health coverage.  Texans are much less likely to get health care through their job (or spouse or parent’s job) than in the US as a whole.  Barely over half of Texans are covered this way 50.6% (compared to US 55.1%).  And, working-age adults here have an uninsured rate that is nearly twice what our kids face: 30.9% or nearly one in three adults 19 to 64.  The why is simple; Medicaid and CHIP are there for our poor and low-income kids, but Texas adults don’t have those options.

Other signs on my deep dive of the importance of Medicaid and CHIP for children: both the number and percentage of Texas kids with private insurance has dropped in the last four years, but the number and percentage of kids with Medicaid and CHIP has taken up the slack.  The only group of Texas children whose uninsured rate went up was those kids just over the CHIP limit, in families between 200-300% FPL.

There is some good news about “really big kids, ” too: uninsured rates improved significantly for Texans 19-25 since 2010, who now have new options to stay on a parent’s health plan until they hit their 26^th birthday.  You can really see the impact in the numbers, because the uninsured rate for Texas adults 26-64 did not improve at all.

O.K., time to dive back into the numbers again.  Stay tuned for an update on how Texas uninsured would fare under the ACA’s private and public health coverage options in 2014!

Written by: Anne Dunkelberg, Center for Public Policy Priorities

Image from Flickr Creative Commons

Dear Cheasty,

I am a veteran of the Vietnam War and I get my health care through the VA. Is the Affordable Care Act going to make me buy insurance, too? I don’t think it should, because I already get all my health care at the VA.

Sincerely,

Vexed Veteran

Dear Veteran,

I think we can safely take the “vexed” out of your name, because the Affordable Care Act will not affect the health care you already receive from the Veterans Health Administration. If you get health care from the VA, you are NOT required to purchase additional insurance. If you want  to buy additional coverage, you are welcome to do so (it won’t compromise your existing VA benefits), but nothing in the law requires you to buy insurance. Hooray!

So that’s the quick and dirty: if you are eligible for VA health care, you will remain eligible. Nor does the Act change the TRICARE or TRICARE for Life benefits your family may receive. But let’s look at some other situations veterans find themselves in.

For veterans who are NOT eligible for VA health care and do not get insurance through an employer, they and their families may qualify for tax credits and subsidies that make purchasing health insurance easier and more affordable. Starting January 1, 2014, those veterans, just like every other uninsured Americna, can shop for insurance on the Health Insurance Exchange, and hopefully get some help finding coverage they can afford.

Well, what about veterans who get insurance coverage through an employer, you might ask? What then?

In that case, veterans will benefit from the consumer protections in the Affordable Care Act. To sum it up, you will get preventive care with no co-pays, you won’t have lifetime or annual caps on your insurance benefits, and you won’t have to worry about being denied insurance (or charged more!) because of pre-existing conditions. If you want to know about additional benefits under the ACA, click here to read all about it.

So there you have it, Veteran. If you get health coverage through the VA, nothing will change for you in 2014. But if you know other veterans who don’t, the Affordable Care Act will be able to help them get access to better, more affordable coverage for them and their families. I hope this explanation has helped put you ‘at ease,’ soldier. (Haha.)

To a well and healthy Texas,

Cheasty Anderson

Do you have more questions about health reform? Email Cheasty at anderson@cppp.org

Dear Cheasty,

I’ve heard about the Affordable Care Act and how small businesses don’t have to provide insurance, but large employers do have to, or they’ll pay a penalty. I run a business with 16 full-time office employees (whom we insure) and over 250 part-time employees (who don’t get insurance), and I’m curious whether that means I’m a small or large employer. I heard you speak at a presentation last week and you said that it would be based on FTE’s. Also, I’d like to know the effect on part-time employees.  Will I have to provide insurance for all of my employees?  I would love to know the answer when you get a chance.

Thanks,

Trying to Get My Ducks in a Row

Dear Ducks,

I take my hat off to you for doing your best to understand one of the more complicated aspects of the Affordable Care Act – determining whether large employers have to pay a penalty if they don’t insure their full-time employees. OK, first let’s sketch out the broad regulations, and then I’ll talk about your case in particular.

Starting in 2014, the ACA essentially requires large employers to provide full-time employees with affordable health coverage.  Small employers (fewer than 50 employees) have no obligation to provide insurance, will face no penalties if they do not, and may even qualify for tax credits to help them afford coverage.

The difference between a small employer (no obligation to provide insurance) and a large employer (obligation to provide insurance) hinges on the magic number 50. Fifty FTEs (full-time equivalent positions – keep in mind that the limit for “full time” in the ACA is 30 hours a week) is the line between small and large. In other words, if you have 51 or more FTE employees, you are a large employer, and therefore required to provide insurance to all full-time employees (only those employees who work 30 hours a week or more, on average).

So here’s where the penalty comes into play. If you choose not to provide insurance for your employees, and any of your full-time workers get subsidized health coverage in the exchange (relatively likely if you are a large employer that doesn’t provide insurance), you will pay the tax penalty. That tax penalty is $2,000 a year for your total number of full-time employees minus 30. In other words, if you have 70 full-time employees and choose not to insure them, you’ll pay $2,000 a year on each of those 40 employees (broken into 12 monthly payments).

Confused yet? Great! Let’s keep going.

Let’s say that you DO provide health insurance, but it’s not very good insurance. If the insurance you provide either (a) costs the employee more than 9.5% of his/her household income, or (b) offers exceptionally poor coverage (e.g., it fails to cover at least 60% of the cost of covered benefits, on average) then those employees may seek out and qualify for subsidized health insurance on the Health Insurance Exchange.  If any of your employees does that, then we go through another set of questions.

Ready for the next set of qualifiers and if/then statements? OK! Let’s say that you offer your employees an expensive health insurance plan, or one with poor benefits. If one or more of your employees qualifies for subsidies and enrolls in an Exchange plan, you will have to pay the shared responsibility penalty.

But this penalty may be less than the flat fee assessed at the “I don’t offer insurance at all” level, described earlier. Instead, here you’d pay the lower of the following two amounts: EITHER $2,000 a year for each full-time employee (minus the first 30), OR $3,000 a year for just the number of full time employees who receive government subsidies for insurance on the Health Insurance Exchange.

OK, how are you doing, Ducks. Still with me? You are? Wow, I’m impressed. This is dizzying stuff! OK, now let’s look at your scenario.

You employ 16 full-time and 275 part-time employees. By any calculation, you, Ducks, are a large employer and would be obligated to provide insurance for all full-time employees (30+ hours/week). But I’m not sure how many hours a week your part-time staff work, so I’ll just assume that each part-timer works an average of 20 hours a week.

You already provide insurance (and you’re probably a good boss, so I’ll assume it’s fairly decent insurance) for your 16 employees, so none of them will qualify for or seek out subsidized coverage on the Exchange. You are only obligated to insure those employees that work 30 hours a week or more (on average), so chances are good that you are all ready for full ACA implementation in 2014, Ducks. You will not have to offer coverage to previously uncovered employees, and you won’t have to pay a penalty because you are already providing insurance to your full-time (remember: 30+ hours a week!) staff.

If you (or anybody out there) have more questions about their status relative to insuring employees, feel free to write me, but I also recommend you consult with your tax guy or an attorney who understands the regulations, just to make sure all relevant details get taken into consideration.

To a well and healthy Texas,

Cheasty Anderson

More questions for Cheasty? Email them to anderson@cppp.org

Well, don’t you fret. There are several areas in which the Affordable Care Act will improve the lives of those suffering from mental health disorders:

Mental Health Care as an Essential Health Benefit

The Affordable Care Act spells out a list of mandated categories of coverage that insurance plans will now be required to include in an individual’s benefit package. And guess what? Mental health care – including substance abuse and behavioral health services – is one of the ten categories. This is a big deal, because in the past mental health often wasn’t treated like other health services. Insurance companies will no longer be able to exclude mental health care benefits from their general package of benefits or offer it as a more expensive supplemental package.

Mental Health Parity

Mental health benefits must match physical health services offered under the law. This means whatever the day and visit limits, dollar limits, coinsurance, co-payments, deductibles, and out-of-pocket maximums are for physical health care, that same standard should apply to mental health. Providing mental health services at “parity” with physical health services has been required of some insurance markets since 1996, but the ACA expands parity to nearly all insurance markets.

Integrated Mental and Physical Health

The Affordable Care Act also promotes the growing trend to provide individuals with integrated care, which means meeting physical and mental health care needs in the same location. Integrated care has been shown to improve health outcomes for individuals by insuring they get all the services they need in one stop and by getting doctors to talk and work together for their patients.

Integrated care “health homes” will be set up with federal funding to build the infrastructure needed for patients to receive comprehensive care management, care coordination, health promotion, and comprehensive transitional care for inpatient to other settings, including follow-up care and individual and family support. Each of these services would greatly benefit people coping with physical and mental health disorders at the same time.

The Affordable Care Act makes some substantial jumps in access and quality of care for those with mental health disorders, but there are several ways in which Texas could utilize the ACA further:

1. Make the Medicaid program available to the newly qualified ACA population.
2. Enforce mental health parity laws.
3. Invest in the mental health workforce.
4. Take advantage of federal dollars to implement integrated health strategies.

Talk to your state legislators and advocate for taking full advantage of the Affordable Care Act so that those who struggle with mental health disorders can receive the help and assistance they need.

Written by: Clayton Travis, Texans Care for Children