It was a busy day for health care in a couple courtrooms today.
But Texans can rest assured that financial assistance is still available for the insurance they bought on healthcare.gov; their insurance hasn’t been affected; and financial help should still be available to buy insurance when open enrollment for healthcare.gov starts again on November 15th.
So what happened?
Today the D.C. Circuit Court of Appeals ruled that the Affordable Care Act (ACA) does not authorize the financial subsidies that consumers have used to buy health insurance on healthcare.gov in Texas and other states that did not set up their own online health insurance marketplaces.
A couple hours later, the 4th Circuit Court of Appeals contradicted the earlier ruling by concluding in a separate case that the subsidies are perfectly legal.
The ACA, the health insurance that over 700,000 Texans bought through the federal Marketplace, and those financial subsidies all remain untouched as the case works its way through the appeals process.
Most observers expect the subsidies will be upheld as the case moves forward.
You can follow the blow-by-blow here.
And if you’re thinking about getting health insurance on healthcare.gov when open enrollment starts again in November, you can calculate here just how much financial assistance you can receive to make sure your insurance policy is affordable.
Written by Peter Clark, Texans Care for Children.
Expanding health care coverage in Texas could create over 200,000 new jobs, reduce property tax pressure, and lower premiums for taxpayers and businesses.
Texans statewide stand to benefit economically and medically if the state legislature accepts federal health care funds to expand Medicaid — or adopts a Texas alternative that expands coverage — according to a new interactive tool and new report released this week.
“Health & Wealth County Checkup,” the new interactive tool from the Center for Public Policy Priorities, shows the large number of Texans in each county who could gain health care coverage and benefit economically if Texas accepts federal health care funds or otherwise expands health care coverage in the state. Statewide over 1 million Texans who lack insurance and could gain coverage if Texas expanded Medicaid instead have no access to low-cost health coverage.
Significantly, the Health & Wealth County Checkup also shows new jobs, new local tax revenue, growth in personal income and other benefits stemming from health care expansion. In Harris County, for example, expanded health care could create more than 60,000 new jobs per year. The tool presents the most recent estimates from respected Texas and national experts, including the US Census, Kaiser Family Foundation, Texas Health and Human Services Commission, economist Dr. Ray Perryman, and former Texas Deputy Comptroller Billy Hamilton.
“Expanding health care coverage in Texas could create over 200,000 new jobs while reducing property tax pressure and lowering premiums for taxpayers and businesses,” said Anne Dunkelberg, associate director of the Center for Public Policy Priorities. “Accepting federal health care funds to expand coverage means a healthier and wealthier Texas.”
The accompanying report, titled “Health Care, the 2013 Legislature, and the Affordable Care Act,” offers the first comprehensive reflection of how state-level decisions, actions, and omissions in health care intersect with the implementation of the Affordable Care Act in Texas. Methodist Healthcare Ministries of South Texas commissioned the report, which follows the recent surge in Affordable Care Act enrollments in Texas and offers a roadmap for the 2015 legislature to address health care in the state.
See what benefits the Health & Wealth County Checkup shows for your Texas county.
Read more about the new interactive tool in the Associated Press.
First released by Center for Public Policy Priorities.
A total of 734,000 Texans purchased health insurance through the federal Marketplace from October 1, 2013 to April 19, 2014, according to a report released today by the U.S. Department of Health and Human Services. Despite state leaders’ opposition to the Affordable Care Act (ACA), 439,000 Texans selected a private plan in March and April, compared to 295,000 prior to March 1.
The results show that the ACA is effectively providing Texans with affordable insurance but that more work is needed.
“Texas has made more progress on affordable health insurance in the last six months than in the last decade,” said Stacey Pogue, Senior Policy Analyst at the Center for Public Policy Priorities, a member of the Texas Well and Healthy coalition. “Nonetheless, when we look at other states that took an ‘all hands on deck approach’ to helping people enroll, we know that Texas could do much more. Texas needs to get serious about making sure families have the insurance they need to stay healthy and financially stable. Too many Texans are still one illness or one accident away from going bankrupt.”
Betsy Furler, a mother and speech therapist in Houston, is one of the eight million Americans who now has private insurance thanks to the ACA.
“After worrying about insurance for years, I was thrilled to buy coverage in the Marketplace for my whole family,” said Ms. Furler. “My son is now insured, and our premiums are half of what they used to be. I no longer have to take a job just for the insurance, so I’ve been able to start my own small business.”
BACKGROUND ON HEALTH CARE COVERAGE NUMBERS
- Eight-four percent of Texans who signed up also received financial assistance, lowering their monthly costs.
- Thirty percent of Texans who selected insurance plans through the Marketplace were 18-34 years old.
- Approximately six million Texans were uninsured in 2012. With 25 percent of the state uninsured, Texas has the worst rate in the nation.
- About half of the state’s one million uninsured children and teens are eligible for Medicaid or CHIP.
- More than one million Texas adults are in the Coverage Gap. Their jobs do not provide insurance, but their income is not high enough to qualify for assistance in the Marketplace. The Texas legislature can provide insurance to Texans in the Coverage Gap by accepting federal health care funds.
BACKGROUND ON CONTINUING ENROLLMENT
- Individuals who have a “qualifying life event,” such as the loss of a job or birth of a child, may apply for insurance at any time. The next open enrollment period starts again on November 15 for coverage beginning on January 1, 2015.
- Pregnant women, as well as children and teens from low- to middle-income families, may enroll year round in Medicaid or the Children’s Health Insurance Program (CHIP). There is no deadline to enroll in those programs.
Updated: Our April 18th blog post reported that the American Mental Health Counselors Association (AMHCA) estimated 652,000 Texans with mental health conditions or substance use disorders are in the Coverage Gap. However, AMHCA’s analysis is based on an estimate of 2.3 million Texans who could benefit from a broad Medicaid expansion, including legal immigrants and those above the poverty line. A more common definition of the Texas Coverage Gap, however, only includes uninsured Texans below the poverty line who are excluded from low-cost health coverage in the Marketplace, and so would likely benefit from the state accepting federal health care funds to close the Gap. Most estimates place that number closer to one million people. AMHCA’s report did not estimate what portion of the 652,000 uninsured Texans is below the poverty line. If they make up the same share as estimated for the larger population (28%), then about 293,000 out of the Coverage Gap population of roughly one million would be Texans with mental health conditions or substance abuse disorder. An updated version of the original blog post is below.
The Affordable Care Act’s rollout is nearly complete and many Texans with mental illness and substance use disorders are already reaping the benefits. They are receiving financial assistance to purchase health coverage in the newly created Health Insurance Marketplace, which many people access through Healthcare.gov. All health plans sold in the Marketplace must include mental health and substance use benefits and those benefits must be at parity with health benefits. If they missed their chance to sign up by the March 31 deadline, they can buy Marketplace insurance for 2015 starting on November 15, 2014, or enroll anytime if they lose a job or have a baby.
Unfortunately, many individuals with mental health and substance use disorders still do not have access to health coverage. As highlighted in a recently released report by the American Mental Health Counselors Association (AMHCA), more than a quarter of all individuals eligible for Medicaid expansion or an alternative solution have a mental health condition or substance use disorder.
In fact, of the total number of Texans in this Medicaid expansion population, more than 1 million individuals are left with no affordable options at all. Because they cannot afford health insurance and make too little money to qualify for financial assistance in the Marketplace, these Texans fall into the Coverage Gap.
To fix the Coverage Gap and provide them with insurance, their states must accept new federal Medicaid dollars. Twenty-five states, including Texas, have neglected to do so.
Nearly 8 out of 10 of these uninsured individuals with mental health and substance use conditions who would be eligible for Medicaid expansion or an alternative solution reside in just 11 southern states. The majority of these individuals with serious mental illness are between the ages of 18 and 34.
The research is clear on the benefits of health coverage for those with mental illness and substance use disorders. Uninsured individuals with mental illness often go without needed preventive and routine care that would keep them healthy and thriving in their community. If individuals do not get the treatment needed for their mental illness, they can end up in more expensive crisis and in-patient care. Additionally, those with mental illnesses face a larger risk of co-morbid illnesses such as obesity, diabetes and high blood pressure. Therefore, we need to ensure that those with mental illness have access to a full range of health benefits – benefits that they wouldn’t get in many states’ indigent public mental health systems.
Finally, while the Coverage Gap is made up of low-income working adults, nearly half are also parents. We know when parents have health coverage, their children are better off. In fact, children whose parents live with depression often have higher rates of mental health problems themselves and require more care. By covering parents in the Coverage Gap we have the means to improve the family environment in which children develop.
Texas has made great strides recently to provide more treatment and services to some uninsured individuals with mental illness and substance use disorders. But, as the AMHCA report states, “What better way to dramatically reduce stigma, discrimination and outright rejection… than opening up the Coverage Door to [all] those with mental illness so it is treated like any other illness.”
Closing the Coverage Gap for those with mental illness can be Texas’ next great step forward.
Written by Clayton Travis, Texans Care for Children. Cross-posted from the State of the Children blog.
Just weeks away from the March 31 closing of the Affordable Care Act’s (ACA) open enrollment period for 2014, thoughts are turning to how to help the folks who will remain uninsured. The open enrollment process has brought home to low-income Texans—and the community groups and health care providers helping them to apply—the stark reality of the Coverage Gap: the lack of an affordable coverage option for an estimated one-million-plus working-age, US citizen Texans living below the poverty line, both with and without dependent children.
As of today, 25 states are moving ahead with the ACA’s Medicaid Expansion or a state-customized alternative. Of those, 22 are using Managed Care to deliver coverage, which requires no special “waiver” approval from federal Medicaid officials. Another three (AR, IA, MI) are closing their Coverage Gaps with managed care plus “1115 waivers,” special agreements with the federal Medicaid agency that can allow states to test out new approaches.
One more state, PA (the 26th state), recently submitted its formal 1115 waiver request to close the Coverage Gap, and negotiations will follow.
NH, UT and VA (that would make 29) are all in legislative processes around closing the Gap. The NH Senate approved a bill to pursue a Medicaid Managed Care-1115 waiver approach and sent it on to a supportive House.
Both UT and VA adjourned their legislatures without completing the Coverage Gap conversation, but their Governors have signaled they will call special sessions to work on the issue.
Looking further ahead, ME, IN, and OK are all looking at the upcoming end dates/renewals of their Medicaid 1115 waivers, and discussions around how to maintain the successes gained from these waivers are expected to also involve consideration of Coverage Gap solutions.
Common themes: what has been approved?
When tracking state’s Coverage Gap proposals, be sure to notice whether or not a proposed state variation has received federal approval. For example, several states have expressed interest in requiring premiums for folks below the poverty line, but so far only premiums for individuals above poverty have gained federal approval. Pennsylvania’s Governor originally proposed making new adult coverage conditional on participation in a job search, training and employment program, but has now altered his 1115 waiver request to include a “voluntary, 1-year, incentive-based pilot.” Neither the new optional work program nor his proposal to eliminate some Medicaid benefits for the current Medicaid population has yet been approved by the federal government.
As noted, most states are maximizing the use of HMO-style managed care, as many states now have “mature” Medicaid Managed Care sectors with the capacity to serve more adults. Arkansas got permission to enroll all of its adult expansion group in Marketplace coverage, because managed care markets were not well established for either Medicaid or private commercial insurance. In contrast, in Texas and PA three out of four insurers who sell insurance in the new Marketplace also already have Medicaid-CHIP health plans. Some states are seeking a combination of Medicaid Managed Care and Marketplace coverage, e.g. using Medicaid Managed Care for people below poverty and Marketplace coverage for adults from 100-138% of the federal poverty line (FPL).
Newly-covered adults can be provided a commercial-style benefit package rather than the traditional Medicaid benefit package which includes long term care. Medicaid “alternative benefit plans” (i.e. commercial-style benchmark plans) and Marketplace plans both include the ten essential health benefits and are subject to mental health and substance abuse parity, so both provide a good standard of basic coverage.
States using the commercial-style benefits for newly-covered adults must also determine how to ensure access to federally qualified health centers, family planning providers, non-emergency medical transportation, and comprehensive care for youth ages 19 and 20. Approved variations include Iowa’s waiver to experiment for a year with whether and how non-emergency medical transportation is provided to the newly-covered adults.
Also, states must screen for “medically frail” persons in the newly-covered adult population, to make sure those with complex medical needs retain access to traditional Medicaid benefits.
Cost-sharing for the newly-covered adults is allowed, with the majority of states following federal law and rules that exempt children and pregnant women, and set upper limits based on income-to-poverty levels. Waivers experiment with new approaches outside of the basic federal rules, including modest premiums and $10 co-pays for non-emergency ER visits, mostly targeted to the new adults who are above the poverty line. Protections that mirror those in the Marketplace cap premiums at 2% of family income, and total combined costs at 5% of family income, consistent with federal standards. Both MI and PA are looking at reducing out-of-pocket costs for enrollees who get check-ups or meet other wellness goals.
Flexibility is available to state and federal Medicaid officials, but it is not unlimited. The part of the Social Security Act that allows 1115 waivers requires that exceptions to federal law under a waiver must “further the objectives” of the federal Medicaid law. Some of the requests that have been turned down to date include reducing benefits for the traditional Medicaid population (as opposed to the newly covered adults). Moreover, in order to capture the 100% federal matching funds available through 2016, states may not cap enrollment and must cover the full adult coverage expansion income range (up to 138% of the FPL), not just stopping at the poverty line.
How to Keep Up?
As noted above, the landscape is changing every day. One of the most reliable and timely sources of waiver and Medicaid Expansion news is the Georgetown University Center for Children & Families “Say AAh” blog. The Kaiser Family Foundation follows waiver developments and keeps an updated tally of state actions, and this report from the Center for Health Care Strategies summarizes key recent developments in AR, IA, and MI.
Keep following the CPPP and Texas Well and Healthy blogs, too, and for a deeper dive, you can get involved in closing the Texas Coverage Gap through the Cover Texas Now coalition’s Texas Left Me Out campaign.
It’s thrilling to know over seven million people enrolled for health coverage by the March 31st deadline and will now have access to quality, affordable health care. If you happen to not be one of the millions of people with a newly purchased plan, all hope is not lost. Here are a few ways you can still enroll in coverage:
- If you began enrolling in the Marketplace before the March 31st deadline, but weren’t able to complete the application because of issues with the website, overwhelmed phone lines, or other technical issues, you have until April 15th to enroll. Visit Healthcare.gov or call 1-800-318-2596 for assistance.
- If you qualify for a Special Enrollment Period you may be eligible to enroll in coverage. Call 1-800-318-2596 for assistance. Here are some examples of circumstances that would make you eligible to sign up for coverage outside of open enrollment:
- A qualifying life event, which includes:
- Loss of other health coverage
- Change in your family size like having a baby or getting married. Note that getting pregnant does NOT qualify you for a special enrollment period
- Moving to a different state
- Special circumstances or complex cases, which include:
- An exceptional circumstance, such as a serious medical condition or natural disaster that prevented you from enrolling
- Other examples include misinformation, victims of domestic abuse, system errors, and more. View a more comprehensive list of special circumstances that may qualify for a special enrollment period here.
- A qualifying life event, which includes:
- Though Texas leadership decided to not expand Medicaid in our state, people eligible for Medicaid (including low-income children, pregnant women, and some parents) may enroll at any time during the year. Similarly, families can apply for CHIP for their children year round.
- If none of these options apply to you, the next open enrollment period starts November 15th.
The Supreme Court will hear arguments Tuesday on a lawsuit involving women’s preventive health care benefits guaranteed by the Affordable Care Act (aka Obamacare). At issue is whether for-profit employers can opt out of covering contraception in their health insurance plans if the business owner has a religious objection to birth control. The ACA requires most health insurance to cover a full range of cost-effective and proven preventive health care services, including but not limited to, contraception. The ACA already exempts religious employers, like churches, from the contraception requirement.
Polling finds that a majority of Americans believe that employers should not be able to opt out of including contraceptive benefits in health insurance plans. Birth control is one of the most-used preventive health services among women. Insurance coverage for it should be standard issue, just as recommended preventive care services for children and men are included in insurance plans.
Making sure all women have access to the tools they need to plan the timing and size of their families is a critical piece of the puzzle in building equal economic opportunity for Texans who aspire to overcome poverty, join the middle class, and enjoy prosperity. Birth control is also critical for improving public health. Women’s preventive health care—including birth control—helps women stay healthy, have healthy pregnancies, and avoid unplanned pregnancy. Today, over half of Texas births are unplanned. When women lack the tools to plan and space their pregnancies, babies face higher risks of prematurity and low birth weight.
Despite popular misconceptions about the low cost of contraception, many women struggle to afford birth control. The most effective forms of birth control, like IUDs, have up-front costs of up to $1,000 and some birth control pills can cost $60 a month. And even more affordable generic birth control pills require regular doctors’ office visits. The cost of contraceptives prevents many women, especially low-income women, from using birth control consistently or choosing the best and most effective form of contraceptive for them. The ACA’s guarantees that contraception: (1) will be covered by most health insurance, and (2) will not be subject to a copayment or a deductible, mean more women will have financial access to the tools needed to prevent unintended pregnancies and have healthier pregnancies.
The women’s preventive health care benefits under the ACA took effect in August 2012. Since then more than 1.9 million (and counting) women in Texas have been guaranteed access to birth control coverage in their health insurance plan without an additional out-of-pocket expense. This increased access to basic preventive health care supports women’s health, the health of babies, and family economic security.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
This commentary appeared in the Austin American-Statesman and was cross-posted from the Texans Care for Children website. The deadline to enroll in Marketplace coverage is March 31st. Check out affordable health care options at www.healthcare.gov.
Reaching the first rungs on the ladder of opportunity is easier when you’re able to start from a foundation of financial security. Having the basics covered gives you the chance to step back and concentrate on getting that next promotion, pursue an educational goal or save to invest in a home or new business. Without that secure base, though, advancement is much harder. Energy that could be used to get ahead instead gets diverted to staying afloat.
Fully half of Texas households don’t have the sort of financial security that leads to true freedom. According to a recent study from the nonprofit Corporation for Enterprise Development, many Texans’ savings and assets wouldn’t cover all their needs in the event of a crisis, like losing a job or having an illness or injury that makes it impossible to work. Many families, including a lot of people in the middle class, would have trouble making ends meet after a setback like that.
The good news is, this year, there’s a way for more people to protect themselves against the worst and bring a little added security into their lives. Given that the leading cause of bankruptcy is unexpected medical expenses, one of the best things Texans can do is make sure this year that they get every member of their family health insurance.
The new insurance options available under the Affordable Care Act are giving hundreds of thousands of Texans the chance, for the first time, to get the coverage they need. In our state, many workers are employed by small businesses or in the retail and service sectors, holding jobs that don’t offer good health benefits. Texas has the nation’s highest rate of uninsured people, and for many years, a lot of our friends, relatives and neighbors have struggled to find coverage they could afford. For the people with pre-existing conditions, having no insurance option at all was common.
This year, however, most Texans who are uninsured don’t just qualify for coverage — the largest group among them can get financial help paying for a health plan. Nearly a million more, including hundreds of thousands of children, are eligible right now for CHIP or Medicaid. The remaining low-wage uninsured Texans are waiting on the state Legislature to fix a gap in Medicaid coverage.
Overall, 6 in 10 shopping for coverage in the health insurance marketplace can find a plan for $100 per month or less. And this isn’t the skimpy coverage that used to be common, with all sorts of exceptions in fine print. Rather, pre-existing conditions — from asthma to diabetes to even cancer — are covered, as are essential benefits and preventive care that people need.
When you have good health insurance, you don’t have to worry as much about whether your family is taken care of. No Texan wants to wonder if one piece of bad news at the doctor’s office or one unexpected injury on the highway could lead to losing everything they’ve worked for. Coverage gives Texans a buffer against the double tragedy of health crises that become financial crises, too.
The 4 million Americans who have enrolled in a health plan to date managed to put that kind of uncertainty behind them. And given that 8 in 10 Texans who have enrolled so far received financial help paying for coverage, a lot right here in the Lone Star State are discovering they can cover their whole families for far less than what some media reports led them to believe.
All Texans who qualify for coverage need the chance to find out about these opportunities before the March 31 enrollment deadline. But that requires people to help spread the news. A lot more Texans could be talking to the people in their lives who have had to live without health insurance and encouraging them to check out their new options.
Only a little time remains before the enrollment deadline. Every day, more Texans are getting covered and finding a firm foundation beneath them that comes with knowing that they’re protected, even in the event of a medical crisis. More, too, are getting access to the kind of preventive care that staves off those kinds of crises in the first place. Assurance like that is a great foothold for any ladder to success, but it requires more of us taking action and spreading the word before the month ends.
Travis is Hogg Foundation Mental Health Policy Fellow at Texans Care for Children. Garcia is Texas state director for Enroll America. Learn more about new health insurance options and find help at www.getcoveredamerica.org.
The Texas Department of Insurance recently finalized rules that require “navigators” to register with the state and take additional training. CPPP chronicled the changes made in the final rule and questions moving forward in a new policy page.
Navigators under the Affordable Care Act are organizations and individuals who are trained, certified, and funded by the federal government to help people enroll in coverage options through the Health Insurance Marketplace, including private insurance, Medicaid and CHIP. 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. Their help is crucial in a place like Texas, with more than 6 million uninsured individuals.
Changes in the Final Rule
The proposed rules for navigators proved contentious. Advocates raised concerns that the proposal would be expensive and prevent navigators from helping consumers compare the benefits of different plans in the Health Insurance Marketplace. The Texas Department of Insurance (TDI) held two public hearings on the rules and sifted through nearly 300 pages of comments. In the end, the final rule was much improved, but the aggressive timelines in the final rule present challenges for navigators and TDI alike. TDI removed the prohibition related to comparing benefits, took steps to reduce the cost of training, and clarified limits on the use of the term “navigator” (people who serve as patient navigators or cancer navigators will still be able to use the word “navigator” in their job titles without running afoul of the law).
The rule, which took effect on February 10, requires many organizations and individuals who help consumers apply for or enroll in coverage through the Marketplace to:
- Complete registration with the Texas Department of Insurance by March 1. Navigators will undergo fingerprinting and a background check as part of registration.
- Take 20 hours of state mandated training by May 1, 2014. This extra state training is required on top of the 20-30 hours of federal training provided to federally grant-funded navigators
Certified Application Counselors are exempt from the new rule, as are organizations and individuals who are performing application assistance under state law or federal law, other than the Affordable Care Act. The flowchart on page 6 of our report can help organizations and individuals who provide application and enrollment assistance determine whether and how they are subject to the new rule.
Update on Registration
Both navigators and the Texas Department of Insurance have been working diligently to ensure navigators come into compliance according to the rule’s very tight timeline. Some navigators reported initial challenges accessing the state’s electronic fingerprinting process. But leading up to March 1, all federally grant-funded navigator organizations report having submitted their organization’s registration materials and registration materials for most or all individual navigators as well. TDI reports quick turnaround times when processing complete applications, and TDI staff worked over the weekend of March 1-2, to help ensure applications submitted near the deadline were not held up.
TDI’s rule leaves it up to private vendors or navigators themselves to create, get certified through TDI, and deliver training to navigators statewide. The next challenge will be ensuring that training is available to and completed by navigators across the state by May 1, 2014.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
Do you want to help spread the word about the March 31st deadline enrollment? Below are resources, images, in Spanish and English, and sample tweets you can share with your networks. With only a few weeks left before the enrollment deadline, all hands on deck are needed to help connect Texans with their new health care options, and your help is appreciated and necessary. Thank you!
A list of helpful tools consumers can use to help guide them through the process of enrolling in coverage:
- Enroll America has a Get Covered Calculator, which is free, easy to use, and provides realistic cost estimates for new coverage. If you’d prefer free, in-person application assistance, you can use the Get Covered Locator tool to find enrollment sites within 25 miles of your zip code.
- On our website, we have a guide with helpful tips on how to protect yourself from health insurance scammers and identity thieves. Most people will not encounter any fraudulent activity, but it’s is important to be informed of the risk and of ways you can protect yourself.
- A new resource, Financial Help for Health, features stories of people who have enrolled through the Marketplace and are saving hundreds of dollars on their monthly insurance premiums through tax credits. The website has a tool that explains the tax credit and how to use it.
- Visit Healthcare.gov or call 1-800-318-2596 for help with the enrollment process.
Sample Tweets (Copy and paste tweets as they are, or feel free to modify them however you’d like.)
You may be eligible to receive financial assistance to pay for health coverage! Find out here: www.healthcare.gov #LetsEnrollTX
The enrollment deadline is March 31st. Connect with affordable health care options here: www.healthcare.gov #LetsEnrollTX
El 31 de Marzo es el ultimo dia para comprar un seguro medico en el nuevo Mercado. Vaya a www.cuidadodesalud.gov
Enrollment Deadline Images (Right click and save the images to your computer to share on social media and elsewhere.)