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Elena Marks

Of course Obamacare repeal would have a big negative effect on Texas

I mean, duh.

Right there with them

As many as a half-million Texans could become uninsured under the Republican plan to replace the Affordable Care Act, wiping out at least half the gains the state has made in reducing the number of uninsured residents in recent years, according to health care analysts.

Texas still has the nation’s highest percentage of people without health insurance, but that uninsured rate has dropped significantly, falling to about 19 percent from 26 percent over the past four years. About 1 million more Texans gained coverage under the health care overhaul known as Obamacare, which became law in 2010.

Under the Republican plan to repeal and replace the health care law, 500,000 could lose coverage by 2020, either through changes in federal assistance to purchase coverage and Medicaid, the government health care program for the poor, or the end of individual mandates that require people to have insurance, said Ken Janda, president and CEO of Community Health Choice whose company offers insurance plans on the federal exchanges.

Analysts such as Vivian Ho, health economist at Rice University’s Baker Institute for Public Policy, advocates like Elena Marks, CEO of Houston’s Episcopal Health Foundation, and insurers, such as Molina Healthcare, confirmed Janda’s estimates.

“Certainly, Texas is going to have more uninsured people again,” Janda said. “I don’t see much positive coming out of Congress.”

[…]

Dr. Mario Molina, CEO of the California-based Molina Healthcare, a Fortune 500 company, said in an interview he cannot yet commit that his company will be in the Texas market next year on the exchange because of the uncertainty that currently exists surrounding the promise to repeal and replace the ACA. Currently his company is one of only three insurers who offer ACA coverage in Houston.

“I am very nervous,” he said. “There is little that Congress has done so far that indicates the insurance market will be stable.”

Blue Cross and Blue Shield of Texas, which offers plans on the exchange in every Texas county, including Harris, also expressed concerns about the uncertainty of federal health care policy.

“It’s imperative that we have market stability and regulatory certainty,” the company said in an emailed statement. “We will make decisions about our product offerings for 2018 once we have more information about any legislative or regulatory changes that will be made impacting the individual health insurance markets.

Health care providers, meanwhile, worry what will happen if hundreds of thousands of Texas residents lose insurance. Katy Caldwell, executive director of Houston’s Legacy Community Health, which serves many low-income patients, said fewer insured patients will mean longer wait times as clinic staff become overwhelmed. But a jump in the uninsured rate would create more than inconvenience, she said.

“The thing that really concerns me is people foregoing their medication. I hear it all the time now: ‘I have to choose between food and my medicine’ or ‘I cut my pill in half because I can make a 30-day supply last 60 days,'” Caldwell said. “This has every potential to get worse.”

Honestly, I think that half million estimate is very much on the low end, possibly the optimal scenario under the Ryan bill, which to be sure has no obvious path forward at this time. The provision that would not only freeze Medicaid enrollments but prevent anyone who fails to re-enroll for any reason from ever re-enrolling would surely force many more people off, just as the six-month re-enrollment period for CHIP that was passed by the 2003 Legislature contributed to so many more children going without health insurance. And all that is before we consider the possible chaos in the broader healthcare market. So yeah, if a few years from now we come out of this with only a half million people having lost coverage, I’d consider that to be better than I expected.

The Latino health insurance enrollment gap in Texas

We have made great strides in reducing the uninsured rate in Texas thanks to the Affordable Care Act, but there’s still a lot of work to do.

It's constitutional - deal with it

It’s constitutional – deal with it

The percentage of Hispanics in Texas without health insurance has dropped by 30 percent since the Affordable Care Act (ACA) went into effect, but almost one-third of Hispanic Texans ages 18 to 64 remain uninsured.

That’s one of the conclusions of a new report released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

The report found the uninsured rate among Hispanics ages 18 to 64 in Texas dropped from 46 percent in September 2013 to 32 percent in March 2016. But even with those gains, researchers estimate approximately 2 million Hispanics remain uninsured across the state. However, nearly half of uninsured Texas Hispanics are currently eligible to get health insurance through ACA plans or other private health insurance, the report said.

“We estimate 920,000 Hispanics are eligible for coverage now, even without Medicaid expansion or any other widespread change in coverage,” said Elena Marks, EHF’s president and CEO and a nonresident health policy fellow at the Baker Institute. “This report clearly shows the need for outreach and enrollment efforts to continue to focus on Hispanic Texans who are uninsured but eligible for coverage.”

[…]

“After three open-enrollment periods of the ACA marketplace, the uninsured rate among Hispanics is still three times that of whites,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute and director of the institute’s Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “The disparity between the two groups remains striking. The Hispanic population is growing at a faster rate than the state average, which makes it increasingly important to the entire state that Hispanics gain affordable health insurance coverage.”

The report shows that although more Hispanic Texans remain uninsured, they enrolled in ACA health insurance plans at twice the rate of whites. Researchers found 21 percent of all insured Hispanics in Texas are covered by ACA plans, compared with only 11 percent of whites across the state.

“This shows that the ACA marketplace is an important source of affordable health insurance for Hispanics,” Ho said.

The report is only nine pages, so go take a look at it. I can tell you that the main reasons for the gap are the failure to expand Medicaid, and a still-significant number of people who have not yet enrolled in any plan. The authors recommend more outreach to the latter subgroup, but that’s easier – and a lot cheaper – said than done. There are numerous community and national organizations that have done a ton of hard work informing people about their health insurance and subsidy options, but they do so in an environment where the state government is actively hostile to them. There’s a reason why some states have lowered their uninsured rates a lot more than some others.

Another story on how Texas’ uninsured rate has fallen under Obamacare

Same book, next chapter.

It's constitutional - deal with it

It’s constitutional – deal with it

A study released Tuesday shows that the rate of Texans without insurance has dropped to its lowest point since the late 1990s because of the Affordable Care Act, Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation reported.

Prior to the implementation of the ACA in September 2013, the uninsured rate in Texas was about 26 percent – more than one in four. By this March, that rate had dropped to about 18 percent, the study said.

Researchers found declines in every age group, ethnic and racial demographic, and across income levels. Texans between the ages of 50 and 64 showed the steepest decline, dropping to 10 percent from 21 percent during that time period.

Those with low to modest incomes of $16,000 and $47,000 also showed big gains in coverage. Their rate of uninsured is now about 13 percent compared to 23 percent in 2013.

“For more than a decade prior to the ACA, the uninsured rate remained above 20 percent and was rising. It’s now clear that it’s moving in the opposite direction and the ACA deserves the credit,” Elena Marks, president and CEO of Episcopal Health Foundation, said in a statement Tuesday.

Despite progress, Texas continues to lead the nation in the number and rate of the uninsured.

In fact, the new study shines a light on a gaping hole in coverage across the state. Nearly half, or 46 percent, of Texans earning less than $16,000 per year remain uninsured, the report shows.

A copy of the report is here, and a compendium of Baker Institute research on the topic of health insurance under the ACA in Texas is here. Another recent study, by the U.S. Centers for Disease Control and Prevention, had Texas’ rate of uninsured residents below 17%, somewhat lower than what this one has. That may reflect a slight difference in methodology or definitions, it’s hard to say. The trend is clear, and so is the fact that by any measure, Texas is still the worst at getting its residents covered. Even among states that did not expand Medicaid, Texas’ uninsured rate is higher than average, as you can see on that first link. And yes, you can make less than $16K a year but not qualify for Medicaid in this state. Basically, unless you’re a child or you’re disabled, you’re SOL as far as that goes. But don’t worry, you can always go to the emergency room and get some service at a much higher cost to a much smaller tax base. That’s how Greg Abbott and Dan Patrick want it to be. Forbes has more.

The latest good news/bad news on Texas uninsured numbers

Good news: Texas’ percentage of uninsured residents continues to drop. Bad news: It’s still higher than what the national average was in 2010, the year before the Affordable Care Act was passed.

It's constitutional - deal with it

It’s constitutional – deal with it

The percentage of Texans without insurance has dropped dramatically since the launch of the Affordable Care Act, the U.S. Centers for Disease Control and Prevention reported Tuesday. In 2015, the uninsured rate fell to 16.8 percent.

While the state continues to lead the nation in the rate of people who are not covered, advocates for the health care law who have watched its implementation say the headway is undeniable. Prior to the law’s passage in 2010, the Texas rate of uninsured hovered around 25 percent, or one in four.

“This is indeed significant progress,” said Elena Marks, president and CEO of Episcopal health Foundation in Houston. She is co-author of a separate series of ACA tracking reports issued through Rice University’s Baker Institute for Public Policy.

Nationally, the rate of uninsured fell to a historic low of 9.1 percent last year, the National Health Interview Survey released Tuesday found. That translates to about 7.4 million people gaining coverage last year on top of the 8.8 million who signed up in 2014. It is the first time the uninsured rate has slid into the single digits.

In 2010, the national rate of uninsured was 16 percent.

“The historically low rate of uninsured in America reflects people’s desires for health coverage. Americans like having access to health care,” said Ken Janda, president and CEO of Community Health Choice, a nonprofit managed-care organization serving Harris and 19 other Texas counties.

[…]

The CDC study shows that last year adults in states that expanded Medicaid were less likely to be uninsured. In those states, the percentage of un-insured decreased to 9.8 in 2015 from 18.4 percent two years earlier. By contrast, the uninsured rate in states like Texas that chose not to expand the program decreased to 17.5 percent last year from 22.7 percent in 2013.

Raise your hand if you’re surprised that the states that have refused to expand Medicaid had the highest rates of uninsured residents pre-Obamacare. I’ve pretty much run out of things to say with these news stories, so fill in your own snarky/heartfelt/cynical comment as appropriate.

More kids in Texas have health insurance now

Thanks, Obama!

It's constitutional - deal with it

It’s constitutional – deal with it

The number of uninsured children in Texas fell by almost 100,000 during the first year of full implementation of the Affordable Care Act, signalling a potential trend across all age groups, a new study by the Robert Wood Johnson Foundation finds.

The findings were welcomed in a place with stubbornly high uninsured rates, particularly among the poor and racial and ethnic minority groups.

“This is good news. Texas is a state with a comparably young population, so the more of them that are insured the bigger the impact for the entire population,” said Elena Marks, president and CEO of Houston’s Episcopal Health Foundation.

The thought is that as parents find coverage options for their children they are more likely to learn about coverage options for themselves, which will lead to higher overall coverage rates.

In 2013, as the health-care law took hold, 977,000 Texas children were without coverage, the new research shows. That equates to 13.2 percent of the state’s under-18 population. By 2014, that uninsured rate had fallen to 11.8 percent.

[…]

Typically children are insured in greater numbers than adults since states, including Texas, offer safety net coverage through the Children’s Health Insurance Program, also known as CHIP, which provides low-cost insurance for children whose parents earn too much to qualify for Medicaid or do not have other coverage.

“Despite the politicking around health policy lately, I think we can all agree that coverage for kids is essential for their healthy development and to get a healthy start in life,” Katherine Hempstead, who directs health insurance issues for the Robert Wood Johnson Foundation, said in an interview Monday.

Despite the gains, 880,000 Texas children – the highest number nationally – still have no coverage.

That includes 533,000 Hispanic children, Guerra-Cardus said. She added that 94 percent of those are U.S. citizens.

The Robert Wood Johnson study shows nearly half of the nation’s 5 million uninsured children live in Texas and five other states: California, Florida, Georgia, Arizona and New York.

The research provides a baseline to track future children’s coverage trends, Hempstead said, adding that the report will be duplicated next year.

I couldn’t find a copy of the study when I looked, but there was a lot of news coverage of it out there when I googled around. It goes without saying that having healthy children is one of the best investments that a society can make, but then our state government threw 250,000 kids off of CHIP in 2003 in the name of “fiscal conservatism”, so I guess it doesn’t go without saying. There’s a reason why the reforms of the Affordable Care Act have had such a profound impact in Texas – there was so, so much that needed to be done. And as long as the current crew is in charge, there’s still so much more left to do.

Fewer Texans having trouble paying medical bills than pre-Obamacare

What else can you say but “Thanks, Obama!”

Fewer Texans say they have problems paying their medical bills in 2015 compared to 2013, according to a new report released by EHF and Rice University’s Baker Institute for Public Policy.

The report found that since enrollment began in the Affordable Care Act’s Health Insurance Marketplace (ACA), the percentage of Texans who reported problems paying health care bills dropped almost 15 percent (25.8 percent in 2013 to 22 percent in 2015). The drop was consistent across income levels and health insurance status, and corresponds with national data showing the percentage of adults reporting problems paying medical bills dropped across the U.S.

Data released this week in a nationwide Kaiser Family Foundation/New York Times survey show 26 percent of U.S. adults reported having problems paying medical bills in the past year.

“The fact that Texans had fewer problems paying their medical bills in 2015 is good news,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute and director of the institute’s Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “One reason fewer Texans are having problems paying medical bills is because more Texans now have health insurance. However, one in five Texans still has problems affording health care. And it’s no surprise our data show the uninsured and those with lower incomes continue to struggle paying those bills more than anyone else.”

The report found 30 percent of uninsured Texans reported problems paying their health care costs in 2015, down from 35 percent in 2013. Researchers found just 20 percent of those with health insurance said they had problems paying medical bills last year, down from 23 percent in 2013.

When it comes to skipping health care services because of cost, the report found uninsured Texans are more likely to skip all services (primary care, specialist care, prescription drugs, etc.) than those with insurance. However, researchers discovered fewer uninsured Texans said they skipped getting care in 2015 compared to 2013.

“On the whole, uninsured Texans reported fewer problems with affording health care in 2015,” said Elena Marks, EHF’s president and CEO, and a nonresident health policy fellow at the Baker Institute. “While our data doesn’t explain exactly why that is happening, the Texas economy improved during that time which might have helped the uninsured pay for care.”

In addition, Marks said because the number of insured patients increased across the state, more charitable care may have been available to the uninsured. New 1115 Medicaid waiver projects across Texas also may have enabled more uninsured adults to access affordable health services, Marks said.

The full report is here. Elena Marks and Vivian Ho are familiar names to anyone who’s been following health insurance news in Houston – they’ve been on this stuff since the beginning. Now just imagine how much better things could be if we’d only expand Medicaid, too.

The demography of the uninsured in Texas

Another look at those who have been helped by Obamacare in Texas, and those who would be helped if the state wasn’t actively resisting.

It's constitutional - deal with it

It’s constitutional – deal with it

The states’s uninsured continue to be most likely Hispanic, middle-aged, with low incomes and without a college degree, according to a continuing study tracking the implementation of the health care law in Texas by Rice University’s Baker Institute and the Episcopal Health Foundation.

But even as Hispanics still represent the majority of those without insurance in Texas, theirs was the ethnic group that also showed the biggest gains.

Between the opening of the marketplace in September 2013 and the close of the second enrollment period in March 2015, the uninsured rate among Hispanic adults in Texas dropped to 57.1 percent from 61.2 percent – a bigger drop than any other ethnicity.

“It is not really surprising since they had the farthest to go, and still do,” said Elena Marks, president and CEO of the Episcopal Health Foundation and co-author of the study. She added: “We’re very encouraged,” crediting the improvement among Hispanics to vigorous outreach efforts to enroll people in marketplace plans.

[…]

Still, Thursday’s report also showed the percentage of the lowest income uninsured Texans continues to climb. The percentage of the poor in the state without insurance has grown to 66.9 percent from 63.2 percent in September 2013.

The report’s co-author Vivian Ho, the Baker Institute’s chair in health economics, has said the number of uninsured among the state’s poorest residents is not likely to change or could even grow in coming years. Under the law, the poor who were not eligible for subsidies were to be covered under a widening net of Medicaid. But Texas is one of 20 states that chose not to participate.

It is estimated about 1.5 million in the state would be eligible for coverage under an expanded Medicaid.

The report is here, and more information including previous reports in this vein is here. None of this is going to change the minds of those that can do something about this, but I have to hope that some day, with enough of this information and enough people visibly being helped by it, the voters may eventually do something about it. I hope I live long enough to see it happen.

One point two million Obamacare signups in Texas

Not too shabby.

It's constitutional - deal with it

It’s constitutional – deal with it

McCarter was one of nearly 1.2 million Texans who signed up or were re-enrolled in health coverage before open enrollment ended Sunday. The newly released numbers show Texas ranking behind only Florida in the number of people it signed up or re-enrolled in coverage among the 37 states that rely on the federal health insurance marketplace to sell insurance plans, federal officials said Wednesday. Florida signed up or re-enrolled about 1.6 million people.

“When was the last time this many people became insured?” asked Elena Marks, president and CEO of Houston’s Episcopal Health Foundation and a nonresident health policy fellow at Rice University’s Baker Institute. “It is almost double the number who signed up last year.”

[…]

About 150,000 consumers who were waiting to buy marketplace coverage and those who had technical problems while completing their applications as open enrollment ended Sunday will have until Monday to finish enrolling. Burwell said she hasn’t decided whether to open a special enrollment period for consumers who realize they face a penalty for being uninsured as they file their 2014 federal income taxes.

Texas’ enrollment figure indicates about 500,000 residents might have bought marketplace insurance for the first time. Last year, nearly 734,000 Texans bought coverage during the marketplace’s inaugural open enrollment period.

According to the national insurance advocacy group Get Covered America, more than 317,000 Houston-area residents bought or were re-enrolled in 2015 marketplace insurance coverage.

“The fact that more than 180,000 Texans enrolled in the final nine days of the open enrollment period shows that people want and need an affordable and quality health care plan,” Mimi Garcia, Get Covered America’s Texas director, said in a written statement.

That’s over 11 million nationally, or 19 million if you count Medicaid expansion. Not too shabby for a program that the hacks at the TPPF claims is broken, or for a population that Rick Perry swears wasn’t interested in getting coverage. Imagine what these numbers could be if everyone cared about doing something about the uninsured problem.

Approaching a million Obamacare signups in Texas

We are well ahead of last year’s pace.

It's constitutional - deal with it

It’s constitutional – deal with it

More than 256,000 Houston-area residents have selected plans or been re-enrolled in coverage through the health insurance marketplace mandated by the Affordable Care Act, and federal and local health officials and experts believe a last-minute surge could significantly increase the numbers before the 2015 open-enrollment period ends later this month.

There have been about 75,000 more local sign-ups than in 2014, during the inaugural year of the marketplace. About 1 million Houston-area residents remain uninsured.

During a conference call with reporters on Wednesday, Marjorie Petty, the U.S. Department of Health and Human Services regional director overseeing Texas, released updated sign-up data showing nearly 969,500 residents statewide selected coverage or were automatically re-enrolled between Nov. 15 and Jan. 30.

The latest update was the first to include local figures. The Houston area recorded 256,982 plan selections and re-enrollments for the period, up from the estimated 180,000 residents who enrolled in coverage last year.

“These numbers would not be as strong as they are without local leadership,” Petty said. “We are making progress across the country and in Texas.”

[…]

Despite Petty’s optimism, millions of Texans and thousands of Houstonians will remain uninsured because state leaders have not come up with a way to expand Medicaid to cover them. Since California expanded the program to cover more of its residents, Texas has overtaken it as having both the highest rate and highest number of uninsured residents.

Elena Marks, president and CEO of Houston’s Episcopal Health Foundation, said Wednesday’s updated numbers are encouraging – until one considers that about 6 million Texans are uninsured.

“If you look at the glass as half full, more adults are becoming insured at a faster rate and in a shorter period of time,” she said. “We ought to be proud we’ve made this much progress.”

See here for the last update. Local leadership is definitely to be applauded for this, since Lord knows the state leadership is doing exactly nothing to help. The goal for Texas this year is 1.25 million signups, which would be an increase of over 60% from 2014. The latest national figure has enrollments at ten million. And there’s still more than a week to go till the deadline. KUHF has more.

918K and counting

Obamacare enrollment numbers in Texas keep going up.

It's constitutional - deal with it

It’s constitutional – deal with it

More than 7 million people, including 918,890 Texans, have selected a plan or were automatically re-enrolled in coverage in the federal health insurance marketplace under the Affordable Care Act, according to government data released Wednesday.

[…]

But the figures released Wednesday aren’t separated between new enrollments and renewals. The figures indicate more Texans have bought 2015 coverage than they did on 2014. We just don’t know how many. We also don’t know how many previously were uninsured.

“You’d have to know that to assess the impact on the uninsured rate,” said Elena Marks, President and CEO of Houston’s Episcopal Health Foundation, in a recent email. She also is a non-resident fellow of health policy at Rice University’s Baker Institute. Marks and Vivian Ho, the Baker Institute’s health economics chair, began studying the effects the health insurance marketplace could have on Texas’ uninsured rates long before the marketplace’s October 2013 launch.

Texas has the largest percentage of uninsured residents nationwide. About 6 million Texans are uninsured.

“If there were about 6 million uninsured (statewide) before, if even half of these are newly insured, that would be a big dent in the number,” she said. “Perhaps, most importantly, it reverses a decade of flat or declining rates of insurance in this state.”

Karen Love, senior vice president of Community Health Choice, the Houston area’s largest managed care organization and a marketplace health insurance provider, said Wednesday the updated numbers show new consumers bought coverage. With a month of open enrollment left, more will continue to do so, she said.

“We will easily top the 1 million mark,” Love said, adding that most people who needed to maintain continuous coverage into 2015 probably renewed by Dec. 15. That was the deadline to ensure coverage on Jan. 1. “Anyone enrolled in January and February is bound to be new.”

I felt pretty good about topping one million at the last update. At this point, who knows what the limit is. At a national level, ten million is not out of the question. I can’t wait to see the full final numbers.

Where Texans got their Obamacare information

The Baker Institute tells us.

While most Texans used healthcare.gov earlier this year to get information or to enroll in a health insurance plan under the Affordable Care Act (ACA), larger percentages of Texans found talking to the call center or a navigator was the most helpful. Those are just some of the lessons learned in a report released today by the Episcopal Health Foundation and Rice University’s Baker Institute for Public Policy.

The report found 62 percent of Texans used the healthcare.gov website to learn about ACA Marketplace health plans during the first open-enrollment period, which concluded earlier this year. However, perhaps because of the early problems with the government website, many Texans turned to the toll-free call center or used navigators to sign up for a plan. More than 90 percent of Texans who used navigators said the personalized assistance was helpful, compared to 70 percent who said the website was helpful.

“It’s important to understand what Texans found most effective and where improvements are needed,” said Elena Marks, CEO of the Episcopal Health Foundation and a nonresident fellow in health policy at the Baker Institute. “With the second enrollment period just weeks away, it’s important for each enrollment method to be at peak performance to help the hundreds of thousands of Texans who are eligible for subsidized health insurance plans, but remain uninsured.”

Marks said the Texas survey results that found personalized service most helpful are supported by national results showing people assisted by enrollment professionals were more likely to enroll in coverage.

No matter which enrollment method they tried, many Texans found it difficult to determine whether they were eligible for a subsidy under the ACA, the report showed. Without that information, consumers can’t make informed decisions on whether to purchase a plan. The difference in the price of a subsidized plan versus a nonsubsidized plan can be hundreds of dollars each month.

“This is an important step because the cost of a plan depends on the amount of subsidy available,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “We know from previous research that many who were eligible for a subsidy didn’t purchase a plan. If clearer eligibility and financial assistance information had been available, more people might have enrolled in coverage.”

The majority of Texans who used the website said the top way to improve the process would be to have better information available to determine eligibility for financial assistance. For those who used the call center, their top suggestion was shorter wait times. Texans who visited with navigators believed having more navigators available to help would most improve the enrollment process.

The report is the ninth in a series on the implementation of the ACA in Texas co-authored by Marks and Ho.

Here’s the Chron story for this. The study can be found here, and links to previous reports are at the link above. I don’t have anything to add to this, I just like that someone is asking and trying to answer these questions.