Some supporters of the health law are dreading the possibility of talk at the Thanksgiving dinner table turning to the nation’s health law. If getting drawn into a debate over the Affordable Care Act felt rough at other years’ feasts, this year, with the law rolling out, it feels especially dicey.
The good news is we’re here to help with some great information and links you can read up on well before that turkey dinner:
- On rates in the Health Insurance Marketplace: Many people will be getting much better coverage for less than they pay now. While some people will pay more, many of these people have had a bare-bones policy that few would consider good health insurance. Stacey Pogue with the Center for Public Policy Priorities explains more here.
- On those recent health plan cancellations: Stacey also breaks down what you need to know on this score. Additionally, a new report from Families USA shows just how few people-0.5%-are both at risk of losing the coverage they had and without financial assistance to purchase a new, better plan.
- On coverage expansion: As Anne Dunkelberg points out in an Austin American-Statesman op-ed, there are also a lot fewer Texans who risk having to change plans than there are Texans who are affected by Texas’ leaders decision not to expand Medicaid in the state. Over at MomsRising, some fellow champions for health coverage help explain who the folks in the coverage gap are.
- On navigators: The people helping folks enroll in the health insurance marketplace have an important job to do and plans for them need to remember, as our blog post explains: “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.”
- On other things happening in health policy beyond Obamacare: A new report from the Georgetown Center for Children and Families shows Medicaid and CHIP are huge successes. Medicaid has not only helped many more kids get covered; children also are receiving the care they need to lead healthier lives. And as Clayton Travis of Texans Care for Children explains, some new rules pertaining to mental health will help a lot of people with mental health concerns get treatment they need.
- On the big picture of whether the Affordable Care Act is working: Check out this chart posted by the Washington Post about how the nation’s health care costs are declining-even while care itself improves-thanks to the Affordable Care Act.
We wish you a wonderful Thanksgiving holiday!
Your friends at Texas Well and Healthy
P.S. We are very excited to be working with Get Covered America (a campaign of Enroll America) to connect uninsured Texans with the chance to get coverage through the Health Insurance Marketplace. Get Covered America is looking for volunteers to help spread the word. There are many different volunteer opportunities. If you hear from Get Covered America about volunteering opportunities, we hope you’ll take the time to talk with them, and learn how you can help get Texas covered.
Millions of hard-working families across the United States are left out of affordable coverage because their state lawmakers refuse to expand access to health care.
Their reasons are strictly political, and the inaction of these lawmakers has created the “Medicaid coverage gap,” where 6-7 million uninsured individuals fall into without any access to care. They do not qualify for Medicaid as-is but also do not make enough to purchase private insurance. These low-wage workers left uninsured represent crucial industries to the economy and to our everyday lives. Your childcare provider, your local hairdresser, the server at your favorite restaurant—these are the people who are left out of affordable coverage.
The time for action is now. After January 1st 2014, states that have not expanded Medicaid begin losing millions of dollars each day they do not act. Stand up for those left out of affordable coverage. Call your legislator and tell them the time for Medicaid expansion is now.
A Georgetown University Center for Children and Families report released today found some surprising news for Texas children. Even though the state continues to have the most uninsured children in the nation, the Lonestar State has made real progress in covering kids, with about a quarter of a million fewer uninsured children than it had four years ago. In fact, no state has seen as large of a positive swing in the number of children with health insurance.
“This is good news for children and the state of Texas since health insurance coverage greatly improves the economic security of families who are faced with tough budget decisions on a daily basis,” said Laura Guerra-Cardus with the Children’s Defense Fund – Texas. “Investing in our children’s health today helps create a strong workforce tomorrow since kids with coverage show up to school ready to learn and stay in school longer.”
Between 2009 and 2012, the number of uninsured children in Texas dropped by about 4 percentage points, with an estimated 256,000 children gaining coverage, according to data from the Georgetown University research center. A new report on improvements between 2010 and 2012 attributes the gains to the success of Medicaid and the Children’s Health Insurance Program (CHIP) in reaching uninsured children.
“Medicaid and CHIP are examples of federal-state partnership programs that work,” said Joan Alker, author of the Georgetown University CCF report. “Together they are improving health insurance coverage for children and are a testament to what states can accomplish when they lean in and work with the federal government to meet the needs of their residents.”
The Georgetown University CCF report found that in the state of Texas, about 84 percent of children had coverage, which is not as high as the 98 percent coverage rate for seniors, but better than the coverage rate for adults ages 18-64 in 2012. About two-thirds of working-aged adults have health insurance. Many of these adults fall into the so-called coverage gap, which means they would be eligible for Medicaid coverage if and when Texas accepts federal funds to improve that vital federal-state partnership.
A national survey released along with the Georgetown University CCF report found that getting all children covered is important to Americans. Almost nine out of ten (88%) surveyed said they wanted all children in their state to get covered.
“The truth is, as of this fall, nearly every Texas family can find health coverage for their children that fits with the family budget, now that new options are opening up in the Health Insurance Marketplace,” said Clayton Travis with Texans Care for Children. “That’s good news for everyone, as more kids will be able to stay healthy, show up for school and get ahead in life when they have the coverage they need.”
Families interested in finding out if their children qualify for Medicaid, CHIP or financial support with a new health plan in the marketplace should visit HealthCare.gov or call (800) 318-2596.
For earlier data from 2009 and 2011, read the Georgetown University Center for Children and Families prior report here.
Written by: Christine Sinatra, Texans Care for Children. Cross-posted at State of the Children blog.
Important news came out this week about Texas and its uninsured children. The Census Bureau released data on how many people have health insurance, as well as data on poverty and income levels. If we look at how our children’s health coverage fared there are two stories to tell. One is: Texas is doing better at enrolling our children in health insurance programs. The other is: We still need to do more, as evidenced by the fact that we have more uninsured kids than any state.
First, for the good news. According to an analysis of past Census data from The Urban Institute and funded by the Robert Wood Johnson Foundation, the rate of Texas children who are eligible for and enrolled in Children’s Medicaid or the Children’s Health Insurance Program (CHIP) has been steadily increasing. Texas had a participation rate in public insurance for children of just 75% back in 2008, but it climbed to 76% in 2009, and 80% in 2010, an earlier report showed; it was up to 82% in 2011, according to the latest report. The availability of these critical, affordable health insurance options cuts the number of uninsured children by hundreds of thousands in just a few years.
This is great progress that Texas can be proud of. Hard work within state agencies to make improvements to our CHIP and Medicaid system over the years, community partners working across Texas to enroll children and the efforts of people involved with the Connecting Kids to Coverage Challenge have all helped make this possible. Participation rates in the state are expected to continue to grow with implementation of the Affordable Care Act in 2014.
However, it isn’t all good news on the children’s coverage front. Texas has the highest overall number of uninsured children and of Medicaid- or CHIP-eligible kids not enrolled. In 2011, the Urban Institute report says, Texas children made up 15% of the nation’s total eligible but uninsured kid population. In fact, although our Medicaid and CHIP participation rate increased, it was still the eighth-worst among states.
Children not being able to get enrolled in the public health insurance options designed for them is an underlying cause for Texas’ high children’s uninsured rate overall. This translates to over 1 million Texas children without insurance of any kind, according to the Census’ Current Population Survey. This is a missed opportunity for all Texans. When children have healthcare coverage they are more likely to:
- stay healthier with regular checkups,
- get needed immunizations,
- be in school learning instead of home with a sickness and
- get medical care before a small illness can turn into a big one.
Opportunities through federal health reform will ensure that nearly every child has access to affordable coverage. Starting Oct 1, Texas families can enroll in coverage through the federally facilitated Health Insurance Marketplace. Financial assistance will be available to make coverage fit with families’ budgets, even for the families who have traditionally been priced out of the market.
There are also a number of changes coming for families enrolling their children (or expectant moms) in Medicaid and CHIP. The Affordable Care Act is cutting some of the red tape that stood between families and the coverage they need for their children—meaning kids who were once denied services might be able to get help now, and stay covered, too.
Finally, if Texas gets smart and decides to allow low-income hard working parents to enroll in Medicaid, studies show that their children are more likely to be enrolled and stay enrolled. The pieces are there to give all children the healthcare coverage they need. It’s up to state leadership to put them together.
Written by: Clayton Travis, Texans Care for Children. Cross-posted from State of the Children blog.
Despite Texas elected officials’ current—and regrettable!—decision to exclude the poorest uninsured adult Texans from coverage in 2014, there are some important Medicaid changes afoot here for 2014. In fact, all 50 states are making these changes, no matter what their current decision on adult Medicaid expansion. Texas Health and Human Services Commission’s staff certainly know it; they have put in plenty of long hours over the last year planning and prepping for these changes.
Here are some of the big-picture changes for 2014:
- There will be a single application (paper, phone, or online) that can be used in every state to apply for Medicaid, CHIP (Children’s Health Insurance Program), or to get lower-cost coverage in the individual Health Insurance Marketplace. (Compare today: 50 states, 50 different applications.) States can also customize their own application (with federal approval), but must accept both the federal and the state version.
- All 50 states will use the same income counting rules. The new rules are generally based on how the IRS figures “adjusted gross income” for federal income taxes, but with some adjustments that are designed to protect current Medicaid coverage. For example, income of grandparents or other non-parent relatives who are raising children will remain uncounted when determining Medicaid eligibility for those children—even if the children are treated as dependents on their grandparents’ tax return.
- “Asset tests” will end for Medicaid children, parents, pregnant women, and CHIP kids. Looking beyond income to tally up not only money in the bank but also the value of possessions and vehicles will end in 2014. All but four states had already dropped these “resource tests” for children, but Texas still used them and over half the states still applied them to parents seeking Medicaid. (Note: Medicaid for seniors and persons with disabilities, based on Social Security Administration law and rules, will still look at assets when applying for medical care and long term care benefits.)
- Face-to-face interviews to apply or renew will no longer be required. Almost all states have already dropped mandatory in-person application and renewal interviews for children’s and parent’s Medicaid and CHIP, and in 2014 all states will retire those requirements. Importantly, though, in-person and telephone application assistance will remain an option in every state for those who prefer it. (Note: Medicaid for seniors and persons with disabilities, based on Social Security Administration law and rules, may still require interviews.)
- Electronic Verification tools will be used to the greatest possible degree. Medicaid, CHIP, and the new Health Insurance Marketplace are all expected to rely on electronic databases (employer/wage, new hire, Social Security, IRS, vital statistics, etc.) to the maximum degree possible to verify eligibility criteria for health care benefits( e.g. income, residence, citizenship, and immigration status). It is likely that families with lots of monthly variation in hours of work and dollars earned will still face additional paper documentation requirements. Still, many families will be able to avoid having to collect and submit numerous documents, and a growing percentage will have their eligibility determined in “real time.”
- Former Texas Foster Children will be eligible for Medicaid until they turn 26. Because the ACA allows young adults to stay on their parents’ health plan until age 26, Congress tried to create a parallel opportunity for youth “aging out” of foster care who would not otherwise have the same chance for coverage.
- Medicaid renewal will be required only once every 12 months. Children, parents, and adults without dependent kids (in the states that have expanded coverage to adults) will only have to renew eligibility once a year. Importantly, there is a difference between a 12-month renewal period and 12-month “continuous” eligibility; the latter means persons need not report income changes during the 12-month period. States like Texas that do not offer 12 months of continuous eligibility for children in Medicaid (we provide 6 months), and which have no continuous coverage for the small number of parents we cover on Medicaid, will likely still require families to report changes in income that occur during the 12-month period—at least in the near term.
- CHIP kids 6-18 from 100-138 percent FPL will move to Medicaid. Texas and most states have had a perplexing stair-step eligibility set up for children, leaving some families with preschool-aged kids in Medicaid while their school-aged kids in CHIP. In 2014, most of the stair-step will be removed, so that all kids (age 1 through 18) with family incomes under 138 percent of the federal poverty level (FPL) will enroll in Medicaid, and those from 138-200 percent FPL will get CHIP coverage. Texas plans to re-sort the currently enrolled CHIP kids when they first come up for renewal in 2014. (Note: infants up to their first birthday will still be covered in Medicaid up to 185 percent FPL, the same income cap that applies for women’s maternity coverage.)
To get involved and stay informed on developments in the Medicaid-CHIP eligibility system, and its interface with the new Health Insurance Marketplace, join the Texas CHIP Coalition.
Written by: Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from the Better Texas blog.
Millions of Texans rely on Medicaid and CHIP (Children’s Health Insurance Program) for their health care coverage.
Unfortunately, the 2014-15 state budget fails to undo the deepest cuts made to these vital services in 2011 and is marked by both new and ongoing austerity measures. Our state’s inability to pay frontline health care workers a living wage, or keep Texas Medicaid provider payments on par with Medicare, parallels Texas’ struggle to adequately fund our other most basic needs.
Most senseless of all, state leaders missed an opportunity to draw down billions in federal Medicaid funds through the Affordable Care Act and provide health care to our poorest uninsured.
As a result, come January 2014, Texas adults living below poverty, like Melissa, a 41-year-old mom from Austin, will remain uninsured. Melissa is a self-employed artist and relies on CHIP for her son’s care, but neither she nor her husband are insured and they don’t qualify for Medicaid under current rules.
“Medicaid Expansion would give my family health insurance coverage we currently don’t have,” she says. “It would give me the security and peace-of-mind to know that the event of an illness or accident would not put an additional financial burden on my family.”
Read Anne’s analysis of what happened, and didn’t happen, with Medicaid and CHIP in the 2014-15 budget.
Cross-posted from Better Texas Blog. Alexa Garcia-Ditta and Anne Dunkelberg, Center for Public Policy Priorities
Health coverage was a big issue during the 83rd legislative session. Texans Care for Children’s Clayton Travis gives a brief synopsis—summing up in under 5 minutes what happened with regards to coverage for children, implementation of the Affordable Care Act and managed care in the state’s Medicaid program—in this new video.
Submitted by: Liz Moskowitz, Texans Care for Children
When Texans with mental health concerns receive help, our communities, families and businesses all benefit. That’s why it has been great to see our legislature improve public investments in mental health during the 83rd Legislative Session.
Funding our public mental health system is a real step forward, but it is only part of the solution when another important opportunity exists. Our state legislature had a chance to address perhaps the biggest barrier to wellness for hundreds of thousands of Texans with mental health concerns: a lack of health insurance that keeps them from getting the treatment and services they need. Our state could have produced a plan to accept federal dollars for about 1 million uninsured Texans, so that they would have a health insurance option. Unfortunately, this never happened and politics were placed over people.
Whole communities will benefit if we develop a solution to cover more Texans with available federal dollars. Right now, unmet mental health needs cost Texas businesses an estimated $270 billion in lost revenue each year. The public spends another $13 billion addressing mental illness and substance abuse. Access to ongoing treatment and services make all the difference in whether Texans with unmet mental health needs succeed at work, in school and in the community.
Rejecting the funds altogether will only put more pressure on our state funded systems. A vast majority of uninsured Texans who use our public behavioral health system for mental health and substance abuse services would be covered if Texas were to accept these federal funds next year. It is the efficient and right choice for our state, and the governor should make sure this is addressed before the year’s end.
New research shows the key role of coverage in mental health. In Oregon, an unusual circumstance led to a lottery system where some, but not all, uninsured people could get covered through Medicaid. When researchers compared the groups with and without coverage, they found the population that had health insurance had a 30 percent lower rate of depression than the uninsured group. That real and sizable improvement followed better access to health care.
It isn’t too late for a solution, but with every month after December that we stall, lives and dollars are lost. Let’s not make Texans wait and make our public mental health system pay more. There’s a way to address the need and help more people reach their full potential from day one of the new year.
Written by Clayton Travis, Texans Care for Children
“Health of Texas Children Improving, Surveys Show,” read a headline this week in the Dallas/Fort Worth publication D HealthCare Daily. The report goes on to say the National Survey of Children’s Health–from 2003, 2007 and 2011-2012–indicates progress for Texas kids “on several health-status measures, (including) a significant uptick in mental-health screening and diagnosis for children in recent years.”
What else is noteworthy from the study:
- Children reported to be in excellent or very good health in Texas climbed 5 percentage points to 82% in the last decade.
- Children who received a check-up in the past year climbed 8 percentage points to 83% over the same time period.
- Parents reporting their children were breastfed at any time climbed 6 percentage points.
- The rate of children receiving developmental screenings tripled from 2007 to 2011.
What can cause improvements like that? No doubt, a lot is a lot at play. But, with swings so large, public policy is often a part of the story.
Here in Texas, between 2003 and 2011, our state shored up Children’s Medicaid and CHIP, cutting red tape in two systems that help kids throughout Texas see a doctor when they need to. The result? The number of uninsured children fell by hundreds of thousands in recent years, even as our overall child population grew. We still lag behind most of the nation in insuring kids, but Texas has made progress.
(For how Texas compares to the nation as a whole on the survey findings, see this snapshot from the Data Resource Center for Child and Adolescent Health.)
It is nice to see as more kids got covered, more families reported good news about their children’s health.
Because the governor is hesitant to expand Medicaid, the legislature will probably adjourn without taking full advantage of the dollars available to Texas to cover the uninsured through the Affordable Care Act. Fortunately there is more than one way to skin a cat, which in this case means a way to pull down all the dollars in the affordable care act through a market solution rather than by expanding traditional Medicaid, and it can be done before the legislature meets again in 2015.
Here’s how it would work. The Affordable Care Act divides the uninsured into three groups: 1) those who can afford health insurance; 2) those who can afford private health insurance with sliding-scale premium assistance; and 3) those who can’t afford health insurance. The act assumes that a state will enroll those who can’t afford health insurance in traditional Medicaid (drawing the line on affordability at those with incomes below 138 percent of the poverty level), but it doesn’t have to work that way.
The federal government negotiated an alternative plan with Arkansas that allows that state to take the federal dollars it would have gotten from enrolling its eligible citizens in traditional Medicaid and instead use those dollars to buy them private health insurance coverage. state Rep. John Zerwas, a medical doctor from Houston, proposed legislation to create a similar “Texas Solution.” While his proposal was approved in committee, it was not scheduled for a vote by the House, even though a majority apparently favored the idea.
Going forward, though, nothing stands in the way of our state leaders from striking their own deal with the federal government. Texas law provides all the authority our leaders need. Making a deal would be good for Texas.
More than a million Texas citizens could gain coverage, including more than 800,000 working Texans. This number includes young adults, but it also includes older adults who will not qualify for Medicare for years. And it includes more than 66,000 uninsured Texas veterans and their spouses.
This brings me to a problem you may not have heard about. Last summer, when the United States Supreme Court held the Affordable Care Act constitutional, it threw a wrench into the way the act works by also ruling that the federal government could not impose a penalty on states that chose not to expand Medicaid.
But act’s sliding-scale premium assistance is only available above the poverty line. If a state like Texas doesn’t already cover adults up to the poverty line and doesn’t expand Medicaid, then the state creates a terribly unfair coverage gap. Starting in 2014, those living from 100 to 138 percent of poverty can get sliding-scale premium assistance, while those living below 100 percent of poverty who don’t already qualify for Medicaid get nothing.
In Texas, if you are an adult, chances are you don’t already qualify for Medicaid. Texas Medicaid basically covers only low-income children, seniors, people with disabilities, and pregnant women. Only adults raising children and making less than $4,000 a year (for a family of three) qualify for Medicaid. Working age adults without children do not qualify at all.
This coverage gap creates a big problem for employers. If Texas chooses not to cover everyone up to 138 percent of poverty, Texas employers will pay higher taxes in 2014 because the Affordable Care Act taxes employers who don’t provide health benefits if their employees make between 100 and 138 percent of poverty and sign up for premium subsidies. The Jackson-Hewitt Tax Services estimates Texas businesses will pay $299 to $448 million each year in extra tax penalties for these workers if our leaders don’t provide a Texas Solution.
Finding a Texas Solution to fully implementing the Affordable Care Act would not only help employers, it would bring a projected $6 billion a year in federal funds to Texas communities, build the health care work force and reduce the need for local property taxes to fund indigent care.
Experts project it would also create up to 300,000 jobs, which is why 20 Texas chambers of commerce, the Texas Conference of Urban Counties, and the Texas Association of Business all supported a Texas Solution.
Fortunately, we can afford to develop a Texas Solution at little to no additional cost by shifting current costs to the federal tab and bringing in new revenues from increased business activity.
For the sake of Texas, our leaders need to make a deal with the federal government to fully implement the ACA through a Texas Solution that provides Texas citizens the health insurance they need.
Written by Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from Better Texas blog.