Earlier this year, the Texas Legislature passed a bill to wind down the Texas Health Insurance Pool. The Texas Health Insurance Pool, or “high risk pool,” was created to provide coverage for Texans who were denied coverage due to pre-existing conditions. It has been a lifeline for thousands of Texans for more than a decade, but it has never been an affordable for most because state law sets the premiums twice as high as comparable private market coverage.
As we’ve explained previously, the high risk pool will no longer be needed in 2014, when for the first time, the Affordable Care Act prevent people from being denied coverage or charged more due to pre-existing conditions. Texans whose only option is pricey risk pool coverage today will be able to choose from any plan offered by any insurer in Texas for coverage effective January 1, 2014, and they won’t pay more because of their pre-existing condition.
Some risk pool enrollees have already secured coverage for 2014. Cancer survivor Bob Flood and his family paid $3,000 each month for coverage in the risk pool and have enrolled in alternate coverage for 2014 that costs less than $1,000 to cover the family. But not all of the 23,000 risk pool enrollees have enrolled in other coverage. The technology issues with healthcare.gov have kept many people, including risk pool enrollees, from being able to apply for subsidies and coverage in the Marketplace.
The Texas legislation closing the risk pool contains a contingency allowing the Texas Commissioner of Insurance to keep the risk pool open if Marketplace operations are delayed. The Department of Insurance announced on Friday that the pool coverage will be extended until March 31, 2014. This aligns the end of risk pool coverage with the last day for open enrollment in the Marketplace, and gives risk pool enrollees an additional 3 months to get other insurance in place and avoid any gaps in coverage.
Extending pool coverage through March 2014 will provide current enrollees with needed time to get detailed information on their coverage options, make informed choices, and to enroll through the Marketplace. Individuals can also enroll in plans outside of the Marketplace, which do not rely on a functional healthcare.gov website, but the only way low- and middle-income enrollees can secure premiums subsidies is through the Marketplace website or phone line.
Unfortunately, there could be some tradeoffs for enrollees with extended risk pool coverage. Risk pool coverage has high deductibles. The most popular risk pool plan has a $5,000 deductible (for an individual, not a family). Risk pool deductibles re-start each year in January. If an enrollee remains in the risk pool for the month of January, for example, they would face a full year’s risk pool deductible for January, and then start over with a whole new deductible if they select an new plan in February. Meeting two deductibles within one year could prove financially difficult for many enrollees, especially moderate-income ones.
Another issue is premium increases. While most of us are used to once-a-year hikes, premiums historically have increased twice a year in the risk pool so costs remain twice that of regular coverage. It is possible that risk pool rates could increase between now and the end of March.
CPPP and the National MS Society sent a letter to the department last week that outlines the affordability issues related to an extension of risk pool coverage and potential fixes. The board of the Texas Health Insurance Pool will likely meet soon to determine if and how to address these issues. The risk pool has been conscientious about communicating changing information to enrollees, providing accurate and timely updates to its members. I’m certain the risk pool board will thoroughly examine how to make the extension and ultimate transition of coverage work well for risk pool enrollees.
Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
Navigators are organizations and individuals who are trained, certified, and funded by the federal government to help people enroll in coverage options through the 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.
Texas is one of 17 states that have passed laws to place additional state restrictions or standards on top of uniform federal standards. The Governor instructed the Texas Department of Insurance (TDI) to write rules to place potentially onerous (and possibly illegal) restrictions on navigators in Texas. TDI responded by reviewing, as required by the Texas law, the federal navigator program. On Friday, November 15, TDI released a summary of potential insufficiencies in the navigator program that could be addressed in state rule. TDI asked for comments on the summary by 5 p.m. Friday, November 22. TDI has not yet initiated a formal rulemaking process.
At CPPP (one of the four partner organizations behind the Texas Well and Healthy Campaign), we are still digesting TDI’s summary, but want to highlight a few items:
- TDI seeks to regulate entities and people who help individuals complete the single, streamlined application for coverage used by the Marketplace, Medicaid and CHIP, whether or not they are associated with a federal navigator grant recipient; however, TDI exempts entities or individuals regulated under separate state or federal law. Certified Application Counselors will not be subject to TDI oversight. Organizations participating in the Community Partner Program and HICAP programs also appear to be exempt.
- Individuals who are just helping their children, parent, neighbor, or friend apply for coverage (but who are not soliciting enrollment assistance to the public) do NOT appear to be exempt. It would be unreasonable to expect people who help a family member or neighbor fill out an application at their kitchen table to register with the state. It is possible that people who help their family and friends apply and take the additional step to become an “authorized representative,” as provided for in federal regulation for the Marketplace, Medicaid, and CHIP, would be exempt.
- Individuals subject to TDI oversight will have to register with the department , pay fees, and possibly incur expenses related to: registration, fingerprinting, a background check, a state-issued ID, additional training in Medicaid and HIPAA, and examinations.
- Navigator entities will have to buy a surety bond to protect individuals against errors. Reports from other states indicate that no one is selling surety bonds to navigators. If they simply aren’t for sale, this requirement could pose an impossible hurdle. Furthermore, federal regulations clearly pre-empt state requirements that navigators hold errors and omissions insurance. While the federal rules do not specifically address mandatory surety bonds, such a requirement certainly violates the spirit, if not the letter, of federal law.
- Part 5 of the summary appears to prevent certain individuals who perform some navigator services from using the term “navigator” in their titles or as part of an entity’s name or website, which could prove problematic because the term navigator is used widely and was in use before ACA passage.
CPPP hopes to work with TDI to advance appropriate standards to protect consumers without limiting access to critical navigator services.
Written by: Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas Blog.
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.
Having completed my online and in-person training, I was able to sign up for a 4-hour shift on the first day of open enrollment. It’s no longer news that the www.healthcare.gov web site was not functional on day one, and as I write this HHS and their contractors are still struggling with it.
On October 1, though, people were hungry for basic information, so there was plenty to talk about. With the options to consider, it seemed unlikely many folks could have been ready to complete the whole process at one sitting. In four hours, I worked with seven families. Diverse as they could be, all wanted affordable health care for their families and children.
I was happy to be able to tell two different couples (in their 50s and early 60s) with grown kids that they would qualify for discounts on their premiums. Two other families each had so much uncertainty about their 2014 income that we couldn’t be sure yet whether they would qualify for Marketplace premium help—or if the parents would fall into the Texas Medicaid Coverage Gap and stay uninsured. One mother with two children in Medicaid today learned that she was, in fact, left out in Texas due to our failure to expand Medicaid for adults. And I was able to assure an applicant that no premium discrimination would be allowed based on sexual orientation.
Each one of these families was headed by one or more workers. The highest income of the seven families I worked with that day was about $48,000, right around the median household income for Texas—half of Texan households earn less than that. All of them were courteous, appreciative, and trying hard to master their options despite the technology shortcomings. Insure Central Texas is doing a great job educating as many people as possible and trying to overcome the computer obstacles, and this work is going on in community organizations all across the country.
Uncooperative computer systems aside, it is still satisfying to see families get excited at the prospect of greater financial security and access to good care. Fingers crossed, I hope to be able to report soon on getting a family all the way to selecting a health plan and paying their first premium!
Written by: Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from Better Texas Blog.
Here at Texas Well and Healthy we are always striving to produce easy-to-understand materials about health care reform. Our partner KidsWell knows a thing or two about providing informative and clear resources on the Affordable Care Act—their brightly colored and highly visual website does a great job of sharing resources on children’s health coverage and the ACA. Their website includes state-by-state summaries of health care reform implementation and campaigns impacting children’s health and relevant weekly highlights from all fifty states.
Visuals are often key in comprehending large amounts of data. KidsWell’s National Spotlights feature provides interactive maps showcasing developments in health policy reform that are particularly relevant to advocates with an interest in child health. KidsWell also has a powerful health care reform search tool that will help you find all the latest health care reform information. You can search by keywords, state, topic, issuing agency and other criteria. Their database is updated each week so you know you’re getting accurate, recent data.
Additionally, KidsWell coordinates over 30 children’s advocacy organizations (including us) who are working to increase health insurance coverage for our nation’s children and families. By helping advocacy organizations work together, and by using this website as a health reform information hub, KidsWell is building a lasting legacy of healthy children.
Texas Well and Healthy is proud to be a featured partner of the KidsWell Campaign this week. You can see where we are highlighted on their website’s homepage. Take a moment to visit the site and check out their resources. You won’t regret it!
Written by Liz Moskowitz, Texans Care for Children
“Massive Demand as Obamacare Opens for Texans” was the headline last week, when the Health Insurance Marketplace first opened for business. While we don’t know the precise number of Texans who have enrolled, it’s great to see the early reports that enrollment in the Marketplace is beating expectations. Nationwide, roughly 5 million people visited the federally run Marketplace website Healthcare.gov–just on its first day. Millions more made calls, visited enrollment sites, and checked out the new marketplaces in states that had set up their own health insurance exchange.
Even with the federal government shut down, the roll-out of health insurance options for millions of Texans has been able to move forward. And although glitches and technical overload have kept things from going perfectly online, progress on that front is happening every day. Those who couldn’t enroll at the website can still visit an enrollment site or make a call, and they do have time: Enrolling any time before December 16 allows for coverage that starts in the new year. Open enrollment lasts through March 31, 2014, but an Associated Press article today reminds folks that it would be wise to get your coverage no later than Valentine’s Day.
Which reminds us, we’ve been wanting to spread the love and bring you more testimonials from people who have contacted us, real Texans with real health coverage stories, getting health insurance in the Marketplace:
“Getting insured is an absolute dream come true for me, and I am so excited about it.”
- Jennie from Houston
“For us it’s a lifesaver. We have been dealing with insurance that has an unmanageable deductible and have held off on tests because we’re waiting for health care to kick in in January.”
- Laura from North Texas
“So happy to have my family of four covered again starting Jan 1. My wife and I both run our own businesses and the insurance we had until recently cost too much and did far too little. Preventative care should be covered and encouraged-it’s a no-brainer. And I shouldn’t have to worry about losing my house if I have a heart attack/cancer/whatever tragic event. The Healthcare Exchange website is over-inundated and a bit frustrating, but that’s because there are so many other people like us, excited to get reasonable and smart health coverage.”
- Jack from Austin
“If I were to get insurance through the marketplace, I would be at peace. I hope that the marketplace offers something that will allow the average and normal person to go to the doctor and not be so stressed out over it.”
- Amanda from Houston
Written by: Christine Sinatra, Texans Care for Children.
The opening of the Health Insurance Marketplace opened up a door that was previously closed to millions of Texans who had never before had access to affordable health care options. We wanted to put a face to the large number of Texans who will be benefiting from the Marketplace and to find out what getting covered means to them.
Our new Tumblr blog, Lets Enroll Texas, documents Texans who are experiencing the joy, excitement, relief, and peace of mind of finding quality and reasonably priced heath insurance options. Below are a few of the people we met on October 1 at an Insure Central Texas enrollment center. Read what they had to say, and follow our Tumblr to continue to meet new Texans who are thankful for the Marketplace. Have a story to tell? Email me.
Written by Liz Moskowitz, Texans Care for Children
Many people have been asking whether the federal government shutdown, caused by a small group of Affordable Care Act opponents, will delay the roll-out of health insurance options for millions of Texans. The quick and dirty answer is NO. The shutdown does not delay the Health Insurance Marketplace or any other part of the law.
That’s really good news, because the demand among Texans for new affordable health coverage options is great. With millions of people visiting the Healthcare.gov Marketplace website in the first two days of open enrollment, things haven’t gone perfectly, and some people have experienced technical glitches that prevented their being able to complete the online application process. Still, people who want to enroll have until December 15 to sign up for coverage that would go into effect on the first day possible: January 1, 2014. After about 50 years worth of anticipation and demand by Americans waiting for this country to finally catch up with the rest of the industrialized world, the moment to enroll is finally here, and the response has been overwhelming.
With any new major system roll-out, technical issues are common and to be expected, and people need to be encouraged to just keep trying back while the administration works quickly to resolve them.
But, there are other ways people can and should connect to the Marketplace. People can find local in-person application assisters in their community (some are listed at localhelp.healthcare.gov). Some communities, like Houston, have banded together and stepped out in front of potential logistical challenges, by setting up local call centers to refer callers to neighborhood locations such as libraries and clinics for application assistance.
People can also call the Marketplace hotline at 1-800-318-2596. In fact, I just did, and my call was answered in under one minute. Impressive!
As a reminder, the full open enrollment period extends through March 31, 2014. Waiting beyond that to enroll if you’re uninsured may result in a tax penalty, though not if your situation is on this list of exemptions. For example, those who do not earn enough to have to file taxes and those who earn minimum wage (i.e., they would have qualified for Medicaid had Texas opted to expand it for adults) are among those who will not be penalized and not required to buy insurance.
Written by: Anat Kelman-Shaw, Children’s Defense Fund.
On October 1, millions of Texans will be able to shop for affordable health care options through the new Health Insurance Marketplace. Though many people will access the Marketplace online, some of us may feel more comfortable meeting with someone in-person who can answer any questions we may have and help us better understand the new enrollment process. We spoke to some folks in Austin who will work with the nonprofit Foundation Communities, which has opened up two enrollment centers that are free to the community. They will be Certified Application Counselors during the six-month enrollment period that starts this week. For more information about people and places available to help in your area, find resources at LocalHelp.Healthcare.gov. (Note: This site is still being updated, so if you don’t find information for your community today, be sure to check back regularly.)
Name: Josh Rabinowitz
What would you tell people who are considering visiting an enrollment center?
A couple of years ago I broke my collarbone playing touch football. The surgery I needed cost $30,000. Since I had insurance, it only cost me about $5,000. That’s the difference. I didn’t really believe in insurance until then, or realize why I might need it down the line. But you just never know.
Why are you volunteering to help people enroll in coverage?
I think the best way to figure out if the Marketplace is a viable option is to do the best job we can with it, and go 100%. You can’t make that decision by putting people in a position to fail.
I also wanted to learn more about the Affordable Care Act for personal and professional reasons. My partner has a pre-existing condition, and his risk pool insurance plan will be ending January 1st. He’ll be looking into health care options on the Marketplace, and I’m going to look for myself, too. I also own a small business in the medical industry, and I want to make sure I understand the law’s provisions that will impact aspects of my business, like reimbursability for devices and treatments.
How would you complete this sentence? Health coverage means . . .
Preparing for the unexpected.
Occupation: Project Manager in the tech industry
Why did you want to volunteer to help people enroll in the Marketplace?
I think the Affordable Care Act is really beneficial to the community. It has many pluses and can cover a lot of people who currently have no health insurance. I believe in it and thought volunteering would be a good way to give back to the community.
Will you be checking out the Marketplace?
I get some help with health coverage through my job, but I do have to pay, too. I will at least investigate the Marketplace to see what my options are.
Are you excited for October 1?
I am excited. It’ll be nice to finally be able to see the Affordable Care Act in action and see people getting enrolled.
What would you tell people who are considering visiting an enrollment center?
You can come in and see what your options are without having to make any commitments. Everything is confidential, so you don’t have to worry about anybody getting a hold of the private information that you will provide.
Why do you think it’s important that so many people have health coverage?
There is such a high percentage of people, especially in Texas, who don’t have health coverage, and it costs society a lot. If as many people as possible have health insurance, we can all pay for our fair share and have access to preventive care and other health services.
How would you complete this sentence? Health coverage means . . .
Name: Elizabeth Colvin
Occupation: Director, Insure Central Texas
How will the Insure Central Texas locations help people? Why should people visit?
Our Insure Central Texas centers are a place for people to drop in, ask questions about the new healthcare law, and get in-person assistance with understanding the new health insurance plans and what they will cost. Our trained volunteers are ready to answer questions, walk people through the online Marketplace, and help people fill out the application to obtain health insurance and financial aid that will reduce the costs. We are open to serve the community and are here for just about anyone – the person who is shopping for insurance for the first time, a musician or free-lancer working without health benefits, or a single mother who doesn’t have insurance through her employer.
How would you describe the volunteers to someone unsure of visiting an enrollment center?
Our trained volunteers are volunteering their time to help individuals and families in Central Texas figure out how the new healthcare insurance laws work and what insurance will cost. Our volunteers are official Certified Application Counselors and participated in an on-line training and additional training by Foundation Communities. Most importantly, our volunteers have no agenda other than helping people in Central Texas. They aren’t trying to sell anything and have no association with insurance companies. They want to help each individual and family learn about how the new laws impact them and what insurance options and financial aid are available for their personal situation.
Why are you excited about the Marketplace opening October 1?
For the first time in Texas, insurance companies cannot deny you coverage for a pre-existing condition or chronic health issue. The Marketplace will give families who previously couldn’t afford insurance the opportunity to obtain a good health insurance plan and possibly receive financial aid to reduce the cost. We all have friends and family members who are working without insurance and live with the worry of being uninsured. Having quality health insurance gives you peace of mind and the ability to manage your health.
How would you complete this sentence? Health coverage means . . .
Without health insurance, an unexpected illness, a long-term condition, or an accident can result in years of medical debt for a family. No family should lose all their savings or go bankrupt just because a loved one gets sick.
Note: Starting October 1, Insure Central Texas centers will be open 7 days a week at two convenient locations. No appointment is needed. Visit InsureCentralTexas.org or call 2-1-1 (option 1) and ask for information on Insure Central Texas.
Written by: Liz Moskowitz, Texans Care for Children.
Texas Marketplace Rate Examples
Every individual will have a unique story and characteristics (income, age, region, etc.) that will affect their premiums and subsidy amount. To get us started, however, let’s walk through a couple examples of what a Texas resident might expect to see in the Health Insurance Marketplace on October 1.
Single 27-Year-Old Houston Resident, Making $28,700 Annually
For this individual, the monthly pre-subsidy rate for the 2nd lowest cost silver plan will be about $201. At this income level (250% FPL), this individual can qualify for premium tax credits to help reduce their premium. This resident can expect to receive a monthly tax credit of approximately $8, reducing their monthly premium for this silver plan to roughly $193. If, however, the individual wants to apply this tax credit to a lower-cost bronze plan, they can! The after-subsidy cost of the lowest-cost bronze plan would be about $129.
Single 27-Year-Old Houston Resident, Making $15,300 Annually
What if our hypothetical 27-year-old Houston resident has a significantly lower income, closer to 133% FPL? Larger subsidies become available to those with lower incomes (who are above 100% FPL). This resident can expect to receive a monthly tax credit of approximately $163 to apply to the pre-subsidy $201 rate, reducing their monthly premium to about $38. As in the previous example, this person can still apply their tax credit to a lower-cost bronze plan, which would give them a monthly premium of zero dollars.
Single 40-Year-Old Austin Resident, Making $28,700 Annually
For this individual, the monthly pre-subsidy rate for the 2nd lowest cost silver plan will be about $250. This resident can expect to receive a monthly tax credit of approximately $57, reducing their monthly premium for this silver plan to roughly $193. If the individual chooses to apply this subsidy to the lowest cost bronze plan, the cost would be about $119 a month.
Single 40-Year-Old Austin Resident, Making $15,300 Annually
This lower-income resident can expect to receive a larger monthly tax credit of approximately $211 to apply to the pre-subsidy $250 rate, reducing their monthly premium to about $38. As in the previous example, this person can still apply their tax credit to a lower-cost bronze plan, which would give them a monthly premium of zero dollars.
But What Will I Pay?
For additional data and examples, reference our Texas Marketplace Premiums chart (which includes pre- and post-subsidy premiums for individuals at 250% FPL) and our Texas Rates by Income Levels (which examines premium rates for individuals of varying income levels in Houston). But first, find out what geographic rating area you are in by referencing this Texas Rating Areas.
You can also use the Kaiser Family Foundation subsidy calculator to get a sneak preview of some of the rates you can expect to see in the Marketplace on October 1.
And don’t forget to go to www.HealthCare.gov on October 1 to find out more about the full range of new coverage options!
How Does Rating Work in the Texas Health Insurance Marketplace?
Health insurance issuers in the Marketplace can rate consumers based on their age, geographic region, tobacco use, and family size. The U.S. Center for Consumer Information & Insurance Oversight has sorted all of Texas’ 254 counties into 26 different “geographic rating areas,” across which insurance premiums may vary. Issuers cannot charge a person more based on their health status or gender, and can charge older consumers no more than three times the rate for younger consumers due to their age. Consumers who smoke may be charged up to 50 percent more than the base rate, and consumers who purchase family plans may be charged more based on the size of their family.
Aside from these individual rating factors, premiums will vary depending on the plan selected. Plans in the Marketplace will be offered in four metal tiers: bronze, silver, gold, and platinum. Plans in each tier will offer comparable benefits, but at varying levels of cost-sharing. A plan, for example, in the bronze category covers, on average, only 60 percent of overall enrollee medical costs (with the remaining 40 percent paid for out-of-pocket through deductibles, copays, and coinsurance), while a silver plan contributes 70 percent and a gold plan 80 percent, for example. Plans in higher metal tiers can be expected to have a higher monthly premium since consumers are paying to have a lower deductibles and copays. The size of your premium tax credit will be calculated using the rate for the 2nd lowest-cost silver plan in the Marketplace, discussed below.
What about Subsidies?
In Texas, individuals and families with household income between 100% and 400% of the Federal Poverty Level (FPL) will be eligible to receive premium tax credits to help make monthly premiums more affordable. Persons at varying levels of poverty will be required to pay no more than a certain percentage of their income towards health insurance, using the 2nd lowest cost silver plan as a base rate for calculating the subsidy amount. For example, the cost of the 2nd lowest-cost silver plan can be no more than 8.05% of income for an individual at 250% FPL. But for an individual at 133% FPL, the cost of the 2nd lowest-cost silver plan is capped at 3% of income. The subsidy can subsequently be applied to plans in other metal coverage tiers, such as bronze or gold.
How can I learn more?
Written by Megan Randall, Center for Public Policy Priorities. Cross-posted from Better Texas Blog.