Texas Well and Healthy

On Tuesday, SeptemScreen Shot 2014-09-17 at 4.07.22 PMber 16, the U.S. Census Bureau released annual estimates on health insurance coverage based on the Current Population Survey (CPS) and the American Community Survey. To better understand the difference between the two surveys, view our side-by-side comparison.

The new data released today are for 2013, and do not include the effects of the full implementation of the Affordable Care Act. Impact of the Affordable Care Act, such as the opening of the Health Insurance Marketplace and Medicaid and related coverage expansions, will be not reflected until next year’s data release in September 2015.

While the Current Population Survey includes detailed information about health insurance coverage and has been used to show decades-long trends in the past, changes in this year’s survey methodology mean that the 2013 CPS data cannot be compared to previous years. For year-to-year comparisons for Texas, the Census Bureau and the Center for Public Policy Priorities recommend using the American Community Survey (ACS) 1-year estimates. To encourage use of the ACS, which has reported health insurance estimates since 2008, the Census released limited state-level health insurance estimates from that survey today alongside the newly-revised CPS data report.

The Census Bureau will release the complete ACS data tables, including income and poverty, this Thursday, September 18.

Today’s health insurance data release shows:

  • Texas continues to have the highest uninsured percentage in the U.S. (22.1% of Texans of all ages uninsured when surveyed). (Nevada and Florida are the next in line.) (ACS)
  • Texans with health coverage saw a tiny, but statistically significant, increase from 2012 to 2013, of less than one-half of one percent. The pre-2014 provisions of the Affordable Care Act have worked to stabilize private and public health coverage. (ACS)
  • Texas has the largest number (604,000) of uninsured children with family incomes below twice the poverty line (200% of the federal poverty level: potentially eligible for Medicaid or CHIP), and is second only to Nevada in the percentage of low-income uninsured children. (ACS)
  • The ACS survey estimates 8.3% of low-income Texas children are uninsured, compared to 5.1% in California, and 2.3% in New York.
  • CPS estimates for Texas show children (ages 0 to 18) across the full income spectrum are only half as likely to be uninsured as working age adults 19 to 64. This is almost entirely due to the availability of Medicaid and CHIP coverage for Texas children, but the lack of any parallel public insurance for those children’s parents and other low-wage adults.
  • Texans remain far less likely to get covered through their own job, or a spouse or a parent’s job, than the average American. (57.1% of Americans versus 50.7% of Texans). Only Arkansas, Florida, New Mexico, and Mississippi have lower rates of employer-sponsored insurance. (CPS)
  • The weakness of Texas’ employer-sponsored coverage has been a big factor in Texas’ last-place uninsured rate ranking, and creates a substantial demand for the new health insurance Marketplace where individuals and families can buy coverage with sliding-scale premium assistance.

CPPP will provide further analysis after the Census releases detailed poverty and income data on September 18. For more details please contact bernstein@cppp.org

Written by Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from Better Texas blog.

The ACA and You

With the Senate State Affairs holding a hearing on the ACA today, 19 organizations sent the following letter to all Texas state legislators urging them to inform their constituents about their health insurance options under the ACA.

Open enrollment for the Marketplace starts two months from today, running from November 15 to February 15.

The full text of the letter is below. You can download the pdf here.

September 15, 2014

State Representatives and Senators

Texas Legislature

Austin, Texas

Dear Representatives and Senators,

As the Senate State Affairs Committee meets today to discuss the impact of the Affordable Care Act (ACA), we encourage you to inform your constituents about their available options to obtain health insurance, particularly when the open enrollment period for 2015 coverage in the Marketplace starts just two months from today.

Although Texas state government has not been a partner in promoting the new health insurance options, many Texas families have benefited from the Marketplace and other aspects of the ACA. During the first open enrollment period, which ended in April of this year, 734,000 Texans signed up for coverage through the federal health care marketplace. Eighty-four percent of those Texans received financial assistance to make their insurance policies more affordable.

More Texans will enjoy the health protections and financial stability of insurance if Texas leaders commit to public outreach regarding these new health coverage options. Key points to share with your constituents include the following:

- The next open enrollment period for the Marketplace will run from November 15, 2014 to February 15, 2015.

- Texans can obtain insurance through the Marketplace outside of the open enrollment period if they change jobs, have a baby, get married, or experience another event that qualifies for a Special Enrollment Period.

- Eligible children and pregnant women can sign up for insurance through the Children’s Health Insurance Program (CHIP) or Medicaid at any time.

- Most Texans who purchase coverage through the Marketplace will qualify for financial assistance to make their insurance more affordable.

- Texans can access the Marketplace by visiting healthcare.gov or calling 1-800-318-2596.

- In-person assistance with enrollment is available in all major metro areas, and in many smaller cities and rural communities as well. Additional information is available to constituents through getcoveredamerica.org.

- Texas workers who do not receive insurance from their employers and have an annual income below $24,000 for a family of four still do not have any affordable insurance options. They are not eligible for premium subsidies through the Marketplace and the legislature has not developed a Texas plan to accept federal Medicaid funding for low-wage adults. These workers should contact their local clinics and county indigent programs to find out if they qualify for services.

We appreciate your consideration and any steps you can take to inform your constituents about their health insurance options.

Sincerely,

Simone Nichols-Segers

Government Activism Coordinator

National MS Society

 

Eileen Garcia

Chief Executive Officer

​Texans Care for Children

 

Blake Hutson

Senior Associate, Health Reform

Consumers Union

 

Laura Guerra-Cardus, M.D.

Associate Director

Children’s Defense Fund-Texas

 

Bee Moorhead

Executive Director

Texas Interfaith Center for Public Policy/Texas Impact

 

Sara E. Smith, JD

State Director

Texas Public Interest Research Group

 

José Eduardo Sánchez

Acting Southern Director

Young Invincibles

 

Tod Marvin

President & CEO

Easter Seals Central Texas

 

Anne Dunkelberg

Associate Director

Center for Public Policy Priorities

 

Lucy Ramirez

Chief Executive Officer

Nuestra Clinica del Valle, Inc.

 

Sonia Troche, MBA

Texas Regional Director

National Council of La Raza
Miriam Nisenbaum

Executive Director

National Association of Social Workers – Texas Chapter

 

Ana R. DeFrates

Director, Texas Latina Advocacy Network (LAN) Policy & Advocacy

National Latina Institute for Reproductive Health


Phillip Martin

Deputy Director

Texas Research Institute

 

Ann Williams Cass

Executive Director

Proyecto Azteca

 

Liz James

Chief Executive Officer

Lesbian Health Initiative of Houston, Inc. (LHI)

 

Phylis Peters

Director

Proyecto Juan Diego

 

Ginny Goldman

Executive Director

Texas Organizing Project

 

Katy Caldwell

Executive Director

Legacy Community Health Services

Recently, CCF teamed up with the researchers at the Urban Institute to take a first look at how the Affordable Care Act is impacting the rate of uninsured children. The high level data indicates that, so far, there has been no detectable change nationally, although children’s uninsured rates remains at historically low levels. But state Medicaid and CHIP programs come in different makes and models. So we thought we’d kick the tires and look under the hood to see what’s going on. Texas families would benefit from Medicaid

The welcome mat lacks traction in 23 states that have not expanded Medicaid.  Coverage expansions typically turbo-boost enrollment of uninsured children who were already eligible through increased outreach and awareness of coverage options. But four of the six states with the largest numbers of uninsured children (the majority of whom are eligible but not enrolled) have not yet expanded Medicaid beyond the very poorest parents. The lack of Medicaid expansion in these states is stalling momentum on the children’s coverage front.

Most Medicaid expansion states were already firing on all pistons. The majority of states (21 of 27) that expanded Medicaid have higher than national rates of eligible uninsured children enrolled in Medicaid or CHIP with a median participation rate of over 90 percent. Perhaps even more telling is that the median uninsured rate for children in these states is a low 4.5 percent. A combination of high participation of eligible children and a low uninsured rate means expansion states were already in the lead.

Building a new fleet of Medicaid eligibility systems. All states are taking advantage of substantial federal funding to replace their model T computer systems, some of which have been in use for more than 30 years. Under the best of circumstances, implementing a new high-functioning IT system is more like crafting a custom-designed racing machine rather than buying a new car off the lot. Doing so with a limited pit crew given the recession’s depletion of state human resources has proven exceptionally difficult.

Getting the MAGI eligibility engine humming. The ACA brought about the most transformative changes to how Medicaid and CHIP programs operate in the history of these programs. Re-engineering your business practices while building new IT systems is doubly challenging.  And while ACA enactment might have been the call to “start your engines,” states didn’t get the green flag until federal regulations and guidance in implementing MAGI eligibility and new verification procedures were finalized many months later. Ultimately, realizing the vision of real-time, electronically verified eligibility will provide additional horsepower for enrollment and retention.

Backlogs of marketplace accounts transfers choked the systems. Creating consistent, error-free functionality to electronically transfer data between marketplaces and Medicaid/CHIP agencies proved especially difficult. A number of states continue to work through application backlogs that could boost enrollment in the near future and eventually free up resources to tune-up other processes.

Going flat at renewal. Annual eligibility renewals impact enrollment like a slow leak in a tire although eligible people who lose coverage at renewal usually reapply within a few weeks or months. In the new world of MAGI, at least the first round of renewals will be more complicated as states gather new eligibility data, including tax-filing status and access to minimum essential coverage. Although two-thirds of states delayed renewals to gain extra time, the impact of implementing MAGI renewals might be enough to make some tires go flat, at least temporarily.

Well-oiled states are making progress. There is good news. Colorado, Arkansas, and other states are reporting gains in children’s coverage. And Florida, which has yet to expand Medicaid, has seen a surge in children’s enrollment that many attribute in part to transitioning CHIP kids between 100 – 133% FPL to Medicaid, and thereby eliminating premiums which are a known barrier to coverage. But if the national uninsurance rate for children is flat and some states are making gains, this could mean that we are losing ground in other states where implementation challenges have made it difficult to enroll and retain coverage. For the better part of two decades, we’ve gained mileage as states pioneered improvements in children’s coverage. Accelerating the adoption of the most efficient and effective practices across the nation by making the system more aerodynamic is a central goal of the ACA.

Running under the caution flag means the race will take more time. The race to the finish can’t be completed in record time when systems aren’t operating at optimal speed. When the ACA passed, many people wondered why implementation should take four years; looking in the rearview mirror puts the complexity of this transformation in perspective.

Ultimately, we are optimistic that further gains can and will be made in covering the nation’s children. Dale Earnhardt once said, “The winner is not the one with the fastest car, it’s the one who refuses to lose.” We have found a way to cover 99 percent of seniors and we will continue to drive home the need to do no less for children. But to stay on track, we’ll need not only well-tuned engines but also a full tank of gas. While the checkered flag may be in sight, extending CHIP funding beyond 2015 is critical to getting over the finish line.

Written by Tricia Brooks, Georgetown Center for Children and Families. Cross-posted from the Say Ahhh! Health Policy Blog.

It was a busy day for health care in a couple courtrooms today. KeepCalmStudio.com-[Crown]-Keep-Calm-And-Know-You-re-Covered

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.

 

Coverage Gap Interactive Tool Infographic

Check out these infographics from Progress Texas that show the benefits of closing the Coverage Gap statewide and in 10 major counties across Texas. 

 

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 734000state 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—Within Limits. 

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 Missed deadlineto 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.
  • 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.