Texas Well and Healthy

The latest Kaiser Health Tracking Poll revealed that 51 percent of Americans feel they don’t have enough information about the ACA to understand how it will impact them and their family.

We hope that share will drop  in the coming months as the roll out of new Health Insurance Marketplaces in October  brings with it stepped-up news coverage, marketing, and outreach (in fact the poll already shows an uptick over two months ago in the share of the public who’ve heard about new Health Insurance Marketplaces).

If you are among the 51 percent of Americans who need more information on how Obamacare will affect you, we recommend checking out a couple of great resources from the Kaiser Family Foundation. You’ll also want to be aware of some key dates below.

First, if you only have 7 minutes available to learn about the ACA, consider spending it watching “The YouToons Get Ready For Obamacare.”  It’s a short, understandable video that explains upcoming changes and helps people understand their coverage options, including job-based coverage, Medicare, Medicaid, and the new Marketplace.

Second, KFF’s subsidy calculator is an interactive tool that lets you enter information on your age, family size, and income and then get an estimate of the premiums YOU will pay and how much subsidy help you will get in the new Health Insurance Marketplace.

Finally, if you plan to look for coverage in the new Health Insurance Marketplace, you’ll want to keep a couple of key dates in mind.

October 1, 2013 – March 31, 2014 = Open Enrollment in the Marketplace

Open enrollment is the time of the year when people can enroll in plans in the Marketplace.  In this first year, open enrollment will last 6 months.  You cannot enroll outside of open enrollment unless you have a “qualifying life event”—a change in your life including marriage, divorce, child birth, loss of job-based coverage, and loss of Medicaid or CHIP coverage.

(Note:  Small businesses with 50 or fewer  employees can buy a new plan at any time during the year; open and closed enrollment times apply only to individuals and families who buy directly from insurers in the Marketplace.)

December 15, 2013 – Enrollment Deadline for Coverage Effective January 1

If you enroll any time between October 1, 2013 and December 15, 2013 and make your first premium payment, your new health coverage will start on January 1, 2014.

(During the rest of open enrollment, if you enroll between the 1st and 15th day of the month and pay your premium, your coverage will begin on the first day of the next month. For example, if you enroll on January 12, 2014, your coverage begins February 1, 2014.  If you enroll between the 16th and the last day of the month and pay your premium, your coverage will begin on the first day of the second following month. For example, if you enroll on January 17, 2014, your coverage will start on March 1, 2014.)

January 1, 2014 – First Day New Coverage Can Start

January 1, 2014 is the first day coverage sold in the Marketplace will take effect for people who enrolled by December 15, 2013.

Written by: Stacey Pogue, Center for Public Policy Priorities. Cross-posted from the Better Texas blog.


Three years in, a progressive health care law is helping Texans have better financial security, healthier lives and a better outlook. Some of our elected leaders, however, continue to try to block the Affordable Care Act and distort facts about what lies ahead, especially when it comes to what happens with Medicaid under the law.

The truth is Obamacare is already helping millions of Texans. It’s keeping big insurance companies with previously loose regulations from ripping people off—preventing caps on your benefits and steep rate hikes, for example—so that Americans are saving $2.1 billion per year. Besides holding insurers accountable, the law extends the promise of health care to more people. Patients with pre-existing conditions, young adults who can stay on their parents’ health plan and consumers, including seniors on Medicare, needing a break on costs related to preventive care and certain prescriptions all have benefited because of the ACA.

But the law’s biggest changes come next year. That’s when Texas, the state with the highest rate of uninsured adults and the highest number of uninsured children in the country, has the most to gain.

Long before the Affordable Care Act, too many employers were finding it hard to offer families coverage. Fewer employers offered health insurance every year from 2000 to 2011, in every state but one: Massachusetts. There, in the place whose health reform approach became a model for Obamacare, employers are more likely to cover workers.

Succeeding in employer coverage for more working Texans, assuring more people have the health care they need, and, yes, saving society costs, all require moving forward with health reform. (Opponents rarely mention that repealing the law would cost $109 billion over a decade, while leaving it on the books reduces the deficit.)

If Texas fully implements this law—including accepting federal dollars to cover more hard-working, low-income families on Medicaid—three-quarters of our 6 million uninsured would qualify for either tax credits or Medicaid. For many, affordable health care would be within reach for the very first time.

Later this year, that will be the case for many middle-income Texans (earning roughly $24,000-$92,000 a year for a family of four), who will receive subsidies to purchase private coverage in an online health insurance marketplace. Prices will be far better than individual health plan offerings today. The Kaiser Family Foundation found 4 out of 5 people with that coverage are likely to pay less next year for comparable insurance.

Nearly all who earn less than that threshold for marketplace subsidies are working Texans in poverty. They, too, will have an affordable health care option—but only if our state agrees to extend Medicaid for them. Medicaid already helps millions of kids, seniors and Texans with disabilities get care they need. Health reform was designed so that all states have every reason to approve an opportunity to cover low-income workers, too: the federal government picks up the full tab for the extension for three years and at least 90 percent of the cost every year after that.

On the other hand, refusing to accept this funding would leave Texas employers on the hook to pay higher federal tax penalties as a result of the state’s position. Jackson Hewitt Tax Service estimates those costs would be as high as $299-$448 million per year. Moody’s credit agency has also put states like Texas on notice, noting that local hospitals and communities will pay more if Medicaid isn’t there to cover the 1.5 million Texans who qualify for it under the ACA. That means failure is imminent and expensive to taxpayers if Texas does not expand Medicaid.

Chambers of commerce, local governments, hospitals and groups throughout Texas all say it’s time for our state do the right thing and accept the funding to cover more Texans on Medicaid. This is an opportunity to meet people’s needs, do right by employers and put our state on firmer financial footing—something we should all agree is right for Texas.

Written by: Keilah A. Jacques, CitySquare Public Policy Coordinator and a partner in the Texas Well and Healthy Campaign.

This op-ed ran today in the Dallas Morning News.

Disguised as an insurance company, our community educator explains how the health reform law foiled the plans of those insurers who thought they could hike up premiums just to pad their own profits with no consequence.

Good thing health reform came along with its 80-20 rule (the one that might have had you getting a check back from your insurer recently!) and rate review fixes, as Cheasty Anderson explains.


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.


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

With so many pieces to the Affordable Care Act (ACA), it can be difficult to understand exactly how health reform is going to play out. One easy way to resolve this is to ask how it would affect you or a loved one. What if you found out you were infected with a life-threatening disease?

Let’s take HIV and AIDS, for example.

You may not be able to think of anyone you know who is living with HIV or AIDS, but don’t be fooled – more than 1 in 400 Texans are living with HIV, and that number is on the rise.

In Texas, we have a problem with HIV patients going untreated. Only 1 in 3 Texans living with HIV is receiving treatment. Not having health care coverage is a big reason.

Luckily, health reform is on its way, and, by 2014, the ACA is going to help make sure that Texans can access the medical care they need. Here’s how:

  1. By requiring most insurance plans cover preventive care and screening. Routine HIV testing will be paid for, which will increase our state’s low testing rate (only 21% of us got tested last year). It also means that people living with HIV will have access to the treatments that help them stay healthy and avoid transmission.
  2. By expanding Medicaid to cover most low-income Americans. Americans with HIV who meet the financial qualifications for Medicaid will be covered, increasing the likelihood that they will receive life-saving medical treatment.
  3. By ensuring that Americans living with diseases can get insurance. Starting in 2014, insurance companies won’t be able to deny or drop us based on pre-existing conditions. Until then, the government is subsidizing “Pre-Existing Condition Plans” for Americans who have been denied health insurance coverage due to pre-existing conditions like HIV or AIDS.
  4. By counting AIDS Drug Assistance Program payments as “true out of pocket” costs for Medicare recipients. The donut hole for people living with HIV/AIDS can be very large, and the health law will close it faster.

These measures are designed to make sure that all people, including those with HIV, have access to affordable care. Why? Because untreated HIV is everybody’s problem. By ensuring that people already living with HIV receive treatment, we can reduce the risk of transmission by about 96% and prevent new cases.  We don’t want Americans with HIV – or any other disease – to go without treatment for any reason, including public health. When they do, we lose the battle against these diseases in our communities and we also lose lives.

Whether we talk about it or not, the AIDS epidemic is real. Luckily, we’ve got a health care law in place that is trying to solve some of the problem. So, let’s talk about it!


Contributed by: Katherine C. Kornman


Dear Cheasty,

I got an email the other day that said my Medicare premium would go up to $247 a month with Obamacare. I live on my Social Security and I can’t afford my Medicare if this is true. Is it true?


A Worried Senior


Dear Worried Senior,

No, it is not true! It isn’t even partly true, or sort of true, or true-if-you-look-at-it-sideways.

There have been a number of emails that have circulated with scary lies about the Affordable Care Act (a.k.a. the ACA or “Obamacare”). These emails are scare tactics, pure and simple, and it is so smart of you to try and fact check the one you got recently about Medicare premiums.

Let me explain why this is false, and what the real truth is.

The premium that email is talking about is your optional Medicare Part B premium, which is currently $99.90 a month (if you’ve opted in to this part of the program). This premium is set BY SOCIAL SECURITY LAW (not the Affordable Care Act) and that law has not changed. Furthermore, the ACA (Obamacare) never will affect the Medicare premium calculation. It can’t be changed by the President’s executive order. It can’t be changed by anything other than Congress, and they haven’t done anything!

Here’s something else to put your mind at ease. By law, (the Social Security law), you are protected from rising Medicare rates that might cut into your Social Security benefits. Here’s how it works. The only way they can raise Medicare rates is if your Social Security cost-of-living adjustment also goes up. And even then, they can’t raise your Medicare premiums more than your cost of living adjustment. That way, your net benefits stay the same! This provision in the law is called the “hold harmless” provision, and it means exactly what it says. They can’t harm your pocketbook, and they can’t harm you.

I hope this puts your mind at ease, Worried. Thanks for checking, and please write again if you get any more scary emails about health reform!

To a well and healthy Texas,

Cheasty Anderson

Health Insurance lingo has always been somewhat complicated and confusing, but with the passage of the Affordable Care Act it is increasingly important for the average Joe six-pack American (borrowing from a famous Alaskan governor) to understand this terminology. As the Affordable Care Act continues to be implemented, these terms will be used to define certain components of the bill.  Here’s a break-down of some of the most commonly used terms:

Premium: The monthly cost of your health insurance plan.

Co-payment: The set amount you pay each time you visit the doctor, pick up a prescription or visit the emergency room.

Deductible: The amount you have to pay before your insurance “kicks in”. Let’s say you have a $1,000 deductible. That means you must pay $1,000 before your insurance will begin to pick up any of the tab. If you have a higher deductible, your monthly premium will typically be lower.

Co-insurance: The percentage of the bill your insurer will pay after your deductible has been met. A typical co-insurance is 80-20. The insurer will pay 80% and you will be responsible for the remaining 20%.

Maximum Out of Pocket: The maximum amount you will personally pay for rendered health services during a year. This amount figures in your deductible and your portion of the bill.

Lifetime Benefit: The total amount of coverage you are eligible to receive over the course of your lifetime.

*Prior to the Affordable Care Act, insurers could place a lifetime limit on your coverage. Luckily that is no longer the case.  An estimated 105 million Americans have benefited from this new provision according to the U.S. Department of Health and Human Services.

Stay tuned for an upcoming segment on tackling the concepts behind various health insurance plans.

Contributed by Stephen Duckett, Health Policy Intern, Children’s Defense Fund and graduate student at the University of Texas Health Science Center at Houston, School of Public Health.


Dear Cheasty,

If my employer offers a pretty standard level of health insurance, will there be any changes to my plan when health reform is implemented in 2014? Do I get to keep that insurance plan if I like it? Will I see any benefit as an ‘average insured American’ who receives employer sponsored coverage?  Thanks!

Anxious in Austin

Dear Anxious,

Great news for you, my dear. When it comes to your particular health insurance situation, you can relax. The Affordable Care Act (a.k.a. health reform) includes a number of provisions that not only protect your current situation, but also improve it, at no cost to you.  Any way you look at it, for the “average insured American,” health reform is a win-win.

Here’s the first reason why you don’t have to worry:

Most Americans are covered by employer-sponsored health insurance, and that will remain true even after Obamacare goes into full effect in 2014. So if you and your employer like your plan, you can keep it.

And here’s even better news: the ACA will actually improve the plan you have in a number of ways.

First, the ACA has already ended lifetime limits and restricted annual limits on medical care. Second, if you have kids, the law rules that older kids can remain on their parents’ insurance until they are 26 years old – a great relief for a lot of young folks and their parents.  That benefit is also already in effect.  Third, if your insurance group has people with pre-existing conditions, your group is currently charged higher premiums and your coverage likely has a pre-existing condition “exclusion” that limits what the insurer will cover. These pre-existing condition exclusions will be gone in 2014. You will no longer pay more based on health status and your coverage will expand if you have a pre-existing condition.

So, Anxious, as you can see, a couple of changes have already improved your plan. But wait, there’s more!

If you aren’t the biggest fan of your health insurance plan, you may have other options. Let’s say you didn’t really like your insurance plan. Well, if you spend 9.5% or more of your household income on health insurance premiums, you can remove yourself from your employer’s plan and, taking your premium money with you, you can go purchase health insurance on the private insurance Exchange, where you would have a range of options and perhaps even access to cheaper prices (depending on how much you earn). Better coverage at a cheaper price?  Win!

Well, I hope this helps you relax about your coverage, Anxious in Austin. If you like your plan, you can keep it. If you don’t like it, you may have other options. Either way, Obamacare makes sure that you have as much power as possible – way more than you do right now – over your personal health insurance situation.

To a well and healthy Texas,

Cheasty Anderson
Center for Public Policy Priorities