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insurance exchanges

An awful lot of Texans could lose health insurance

It sure will suck to be them.

It's constitutional - deal with it

It’s constitutional – deal with it

New public-health studies warn that hasty congressional action toward repealing the Affordable Care Act could have dire consequences for the poor and uninsured both in Texas and nationwide.

The dismantlement of portions of the law, known as Obamacare, without a comparable substitute could mean 2.6 million more Texans would be uninsured, raising the total to 6.9 million by 2019, the Urban Institute, a Washington, D.C.-based think tank for economic and social policy, said Wednesday in a new report.

Texas already leads the nation in the number of uninsured.

“There is good deal of fear,” said Vivian Ho, a health economist at Rice University’s Baker Institute of Public Policy, who has tracked the health care law’s implementation in Texas. “The uninsured rate will be going up under any scenario.”

The fallout from even a partial congressional repeal through a process known as budget reconciliation could also nearly double the national uninsured rate to 21 percent by 2019, the report found. That would be higher than the rate before the ACA went into effect.

[…]

“The rush for repeal, certainly without replacement, is a huge risk for the health and financial stability for Texas. Not just for the poor but for everyone,” said Stacey Pogue, a senior policy analyst for the Center for Public Policy Priorities.

“We don’t just go back to the uninsured rate before the Affordable Care Act,” she said, “the entire individual market becomes destabilized.”

There are two things you can be sure of. One is that any replacement scheme will cover fewer people than are covered now. That’s because Republicans want to cut taxes, and if that means a bunch of people lose access to health care, well, too bad for them. And two, our state government does not care at all about the uninsured population. They’ve had fifteen years to do something about it, and the only thing they have ever done is make cutbacks. If this is what you voted for, then congratulations, you’re gonna get it.

From the “Don’t know what you’ve got till it’s gone” department

People are signing up for health insurance plans while they still can.

It's constitutional - deal with it

It’s constitutional – deal with it

For years the backers of the Affordable Care Act have fretted over how best to stimulate insurance enrollment on the exchanges so the law could work as designed. They might have finally found a way from the unlikeliest of sources: the election of Donald Trump as president.

During the campaign, Trump and Republicans in Congress vowed to immediately “repeal and replace” the health care law known as Obamacare, calling it a failure. Yet now that dismantlement is possible and maybe even likely, people across Houston and the nation are rushing to lock in coverage for next year.

A record 100,000 Americans signed up the day after the election and one company offering plans in Houston said business continues to be “brisk.” The enrollments continued Monday at places like the Ahmed and Roshan Virani Children’s Clinic in west Houston.

“He wants to get rid of it, so that’s why I’m here,” Dishae Wimbush, a self-employed mother of three young sons, said just after 9 a.m.

[…]

Enrollment for 2017 began Nov. 1, a week before the election. It will end Jan. 31, 11 days after Trump is inaugurated. At times he has promised to completely repeal the ACA on his first day in office, although most experts say that is unlikely and probably not even possible.

Advocates and even some critics of the Affordable Care Act are urging people to go ahead and sign up for a plan for next year despite the fiery campaign rhetoric.

“It is virtually certain that people who sign up now will remain insured through the end of 2017,” said Dr. J. Mario Molina, president and CEO of California-based Molina Healthcare, a Fortune 500 company that has had a strong presence on the exchanges. His is one of three insurance carriers offering plans on the exchange in Houston and said signups have been “brisk” since Nov. 9.

On Monday he said he was sympathetic to the nervousness among those wanting policies. About 11 million people currently get their coverage through the exchange.

“They have good reason to be worried,” Molina said, noting the irony that it took the election of someone who wants to kill the law to get people to sign up for it.

After reporting that 100,000 people signed up for a plan under the ACA the day after the election, U.S. Health and Human Services Secretary Sylvia Burwell tweeted, “Best day yet.”

At the same time, a Facebook group called “Saving Affordable Health Insurance” bubbled up out of another group populated with self-employed writers and editors. The national invitation-only group was created by one woman on Thursday night. By Monday it had more than 1,800 members.

Part of the anxiety is being fueled by the fact no one knows what the replacement piece of repeal and replace will look like, with some wanting a quick and complete gutting while others preferring a slower, piecemeal approach.

“I’m not sure they know,” Molina said about Trump and Congress.

In recent days Trump has softened his stance on the ACA and said he favors keeping certain parts, such as allowing young adults to remain on their parents’ policies until age 26 and prohibiting insurers from denying anyone for a pre-existing condition.

The latter could prove the thorniest since he and others have also vowed to discard the individual mandate, which forces nearly all to buy health coverage. The requirement for universal coverage was baked into the law to expand the risk pool and make it possible to cover people no matter their health. It may be difficult to achieve one without the other.

Sure is gonna suck when millions of people lose their insurance, isn’t it? On the bright side, maybe Texas won’t lead the nation in the percentage of uninsured people once Obamacare has been repealed. Hey, you have to find your silver linings where you can. Political Animal has more.

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.

Yet another record year for Obamacare signups in Texas

It’s like a trend or something.

It's constitutional - deal with it

It’s constitutional – deal with it

A record 1.3 million Texans signed up for health coverage during the 2016 Affordable Care Act’s enrollment period, topping last year’s number by more than 100,000, according to the U.S. Health and Human Services Department final tally released Thursday.

Houston enrolled 346,822 for 2016 during the three-month sign-up period which began Nov. 1 and ended Jan. 31. Dallas-Forth Worth enrolled 382,669 and San Antonio enrolled 120,351.

Texas has long been the focus of concentrated outreach efforts by federal officials as the state continues to lead the nation in both the number and rate of uninsured. There were an estimated 5 million uninsured Texans when enrollment began, or roughly 20 percent of the state’s population.

In the final week of enrollment the pressure was on in the state, especially in south Texas. Health and Human Services officials said Thursday the blitz of marketing appeared to pay off as eight of 10 markets in the nation that had the fastest rate of growth were in Texas. Those markets are Corpus Christi, Harlingen, Laredo, El Paso, Odessa-Midland, San Antonio, Abilene-Sweetwater, and Lubbock.

[…]

Health and Human Services Secretary Sylvia Burwell said Thursday during a press call that she was especially pleased not only with the increase but that the numbers included about 4 million new customers. Prior to enrollment kickoff, Burwell had tamped down expectations, saying that 2016 might prove difficult to reach those still uninsured.

Adding new customers, especially younger ones who presumably are healthier, “refreshed the risk pool,” said Kevin Counihan, CEO of Health Insurance Marketplace during the same call.

And just remember, Greg Abbott and Dan Patrick and Ken Paxton and Ted Cruz and John Cornyn would like nothing more than to take that health insurance away from all 1.3 million Texans. Remember also that we could double the number of people who are finally able to get affordable health care if we expanded Medicaid. And even though not many people talk about it, we could then double THAT number if the Affordable Care Act were extended to include all people, including undocumented immigrants. If you think that’s a bridge too far, then you need to work on your bridge-building. Trail Blazers has more.

One million plus Texas Obamacare enrollments

It keeps going up.

It's constitutional - deal with it

It’s constitutional – deal with it

Just over one million Texans had signed up on the federal health insurance exchange as of last Saturday, signaling a steady drumbeat of interest and giving local advocates a chance for some celebration.

“I will take it,” Ken Janda, president and CEO of Community Health Choice, a Houston-based non-profit health plan offering insurance plans through the Affordable Care Act’s federal marketplace, said Tuesday when he heard the numbers.

The 1,040,246 Texas enrollees included those signing up for the first time and people renewing existing coverage, according to U.S. Department of Health and Human Services statistics released Tuesday.

Nationally, 8.2 million had signed up as of last week, topping last year’s numbers for the same time period by about 2 million, she said, the agency announced.

“We have never seen this level of activity,” HHS Secretary Sylvia Burwell said during a conference call with reporters and community groups across the country. Calling the demand “unprecedented,” she added: “This is what we wanted to see.”

For comparison, the numbers were 734K in 2014, and 850K for 2015. They won’t change the mind of anyone whose mind needs to be changed, but this law has made a big difference in a lot of people’s lives. People can believe whatever BS they want to believe, but a million people who can see a doctor and who can not have to worry about being bankrupted by an illness know better. Kevin Drum, who looks at the national numbers, has more.

Health insurance exchange open enrollment, Year 3

The challenge, in a nutshell.

It's constitutional - deal with it

It’s constitutional – deal with it

In rural Borden County, 12 people signed up for Obamacare this year.

Livid over the government telling them they must buy something and loath to take anything that looks like a “handout,” the uninsured here are likely to stay that way. As Obamacare’s third open enrollment season began Sunday, this rock-solid conservative community of about 650 people offers a window into the challenges health law advocates face to expand coverage around the country.

“Health care is fine, if you can afford it,” said Brenda Copeland, a middle-aged woman who works at the Coyote Country Store and café, along with her two grown daughters, all of whom are uninsured. Copeland has had health insurance only once in her life, and opted to pay Obamacare’s tax penalty earlier this year rather than buy a plan.

“I hope Obamacare goes down the toilet,” she added.

[…]

Outreach workers who are supposed to educate people here and in other parts of west Texas must travel huge distances to find small pockets of the uninsured — people like Copeland and her daughters, Becky Justice and Rika Law, both married women with children. And all of them think the Affordable Care Act is anything but affordable.

Copeland said her income fluctuates but she made about $19,000 last year; she didn’t know that she would have qualified for significant subsidies to lower her monthly insurance premiums, as well as for lowered co-pays and out-of-pocket costs. A plan for the coming year in the mid-priced, most popular tier would cost about $200 a month, after subsidies are figured in.

When she did learn about the subsidies, she softened her stance slightly and said she might look into it. But she said she’s done just fine without health insurance most of her life and is still angry that the federal government can mandate she has to buy it.

“At this point, I don’t mind them penalizing me,” she said.

Law, her daughter, did take a look at the federal enrollment website HealthCare.gov, but said the plans cost too much for her family of four. She too was unaware that she might qualify for tax credits to lower her premiums.

Her family previously had job-based coverage that cost about $1,000 a month — her husband works in the oil fields, but when oil prices dropped, his hours were cut and the Laws decided they didn’t have the money to cover premiums. The plans she looked at on HealthCare.gov cost even more, about $1,350 a month.

“I understand the benefit of having it,” she says of health insurance. “When you’re trying to juggle everyday bills, that’s when it becomes a problem.”

Her sister Becky Justice, who owns this one-room store on the only road through town, said she had health insurance until mid-2014. She doesn’t agree with Obamacare and, unlike her sister, never even window-shopped for plans. If she needs to see a doctor, she says she’ll go to a community health clinic outside the county and figure out how to pay the bill.

On the one hand, it’s hard to feel sympathy for people who refuse to help themselves. On the other hand, when people’s heads get filled with poison for a long time, it’s hard to overcome that. Keep this in mind when you hear poison producers like the shills at the TPPF talk about the “failure” of Obamacare to cover as many people as it should, as if they had nothing to do with it.

But challenge or no, the work proceeds, and as we go forward I do expect the uninsured rate in Texas to continue to decline. Of course, what could make it take a huge step down remains off the table, at least for now.

The uninsured rate in Texas is 19 percent. There are multiple reasons: the number of low-wage jobs in Texas that don’t offer benefits, cultural and language barriers, and political opposition to health reform. Another reason is that Republican leaders have not expanded Medicaid to more poor people, as 30 other states have done. That part of the law is optional, but by declining the expansion, Texas loses out on billions of dollars in federal funds every year.

There is growing pressure for Texas to expand Medicaid, and supporters are now looking for the right political message that could bring the parties together.

For the moment, Republicans still consider the Affordable Care Act to be political kryptonite. Senator Ted Cruz continues to criticize it. Attorney General Ken Paxton just filed another lawsuit attacking part of it. Governor Greg Abbott has said he won’t consider the Medicaid expansion, because he considers Medicaid a dysfunctional entitlement program that should not be allowed to expand.

In Houston, local leaders want the expansion. Harris County Judge Ed Emmett, a moderate Republican, has supported it for years. The CEO of the taxpayer-supported Harris Health System, George Masi, says he needs the revenue that Medicaid expansion would bring. He’s had to lay off more than 100 employees, and cut back on charity care.

“What is even more profound is that money is going to other states that expanded Medicaid, like New York, California, Connecticut,” Masi said. “And so the taxpayer of Texas is being penalized, if you will, for not taking advantage of that option.”

By emphasizing the impact on taxpayers, Masi and others are framing the issue in terms of economics rather than humanitarian concerns.

“We call it a paradigm shift,” Masi added. “It’s a different way of thinking.”

[…]

In 2013, the Texas legislature took no action on Medicaid expansion. The same thing happened this year.

But more voices are starting to push for change, according to Ken Janda, who runs Community Health Choice, a not-for-profit insurance company in Houston.

Janda said the Texas Medical Association and the Texas Hospital Association are both being more vocal on the issue, as is the Texas Association of Business. The federal Medicaid funds would help the state budget, and inject revenue into the medical sector of the economy.

“Doctors’ offices are able to hire more people. Pharmacies are able to hire more people. That becomes an economic multiplier,” Janda said.

County budgets would benefit as well, because they support safety-net clinics and public hospitals such as Ben Taub, part of the Harris Health system.

“If Texas expanded Medicaid, we would be able to look at reducing local property taxes across the board in all counties, or use those dollars for something besides healthcare,” said Janda.

Janda says the new emphasis on economics could eventually bring the parties together.

“There is some interest now by some Republican state senators because of the potential to reduce local property taxes,” he added.

Janda isn’t naming names yet. He also says don’t expect to see any movement on this issue until after the 2016 presidential election. But he says he is “guardedly optimistic” that Republicans will be willing to discuss a possible Medicaid expansion after that.

Color me very skeptical of that. The Senate has gotten worse, from a problem-solving, get-things-done perspective, in the past couple of elections, and I’m hard-pressed to think of any Republican Senators that will be in the Lege in 2017 that I can imagine having interest in Medicaid expansion. I’d be delighted to be wrong about this, but I sure wouldn’t bet on it. I’ve said this about multiple issues, from things like equality to immigration and Medicaid expansion – things won’t change until someone loses an election over it. I’m sure Ken Janda knows that the Texas Medical Association and the Texas Hospital Association both endorsed Greg Abbott and Dan Patrick in 2014. I know why they did, and I know why the Texas Association of Business did as well, but this is as clear an example of the canonical definition of insanity you’ll ever see. Nothing will change until someone loses an election over this sort of thing. In the meantime, other states will continue to receive the money that we’re turning away in the name of ideology.

We’re still #1!

In uninsured people.

It's constitutional - deal with it

It’s constitutional – deal with it

For the first time in more than a decade, Texas’ uninsured rate dipped below 20 percent, analysts said [recently] following the release of U.S. Census data.

Slightly more than 5 million Texans were uninsured in 2014 — a 700,000 decrease from the year before. That represented a 3-point dip in the percentage of Texans without health insurance, to 19 percent — the largest gain in health care coverage in Texas since 1999, according to the left-leaning Center for Public Policy Priorities.

The data released Wednesday marked the first government-provided snapshot of the uninsured rate since the rollout of Healthcare.gov, the health insurance marketplace created by President Obama’s signature health law.

Texas remains the state with the highest rate of uninsured people, according to the federal survey. Nationwide, the uninsured rate fell from about 15 percent to 12 percent.

And it’s not just in the rate where we lead, it’s also in sheer numbers.

Texas’ decrease was just 40 percent of the size of California’s shrinkage of its uninsured population. It reduced the number of uninsured by 1.73 million folks. That’s out of proportion to population. The bureau’s latest estimates show California has about 1.4 times as many people as Texas — 39 million versus 27 million. California has expanded Medicaid and runs its own online health insurance marketplace.

For many years, the Golden State has had the largest uninsured population. No longer. Texas does.

The Lone Star State has not just the highest percentage but the biggest raw number of uninsured — 5,047,000. In 2013, California had 6.5 million uninsured residents, while Texas had 5.75 million. But last year, California’s number dipped below 4.8 million.

“California has seen robust increases in both private insurance coverage under the [federal law’s] marketplace and public coverage through Medicaid coverage for working poor adults,” said Obamacare supporter Anne Dunkelberg, a veteran health-policy analyst at the center-left think tank the Center for Public Policy Priorities. She noted that California posted a nearly 5 percentage point decrease in its uninsured rate. It dropped from 17.2 to 12.4 percent, compared with only 3-point drop in Texas from 2013 to 2014.

But hey, at least we surpassed California in something, amirite? Woo hoo, high five!

All five of the states with the highest uninsurance rate have one thing in common: They failed to expand Medicaid. Well, two things in common, that and having Republican Governors and legislatures. But if you knew the first part, you could have guessed the second.

Harris Health wants more people to enroll in Obamacare

Who can blame them?

Harris County’s public health care agency, responding to a budget crisis, will eliminate more than 19,000 people next year from eligibility for free or nearly free services, hoping most of these patients will obtain coverage through the Affordable Care Act.

The board of the agency, Harris Health, voted Thursday to reduce its income threshold for subsidized care from 200 percent of the federal poverty level to 150 percent, saving the system a projected $21.3 million in fiscal year 2017.

Of those losing coverage, more than 15,000 would be eligible to purchase insurance plans through Healthcare.gov, the health insurance exchange created by the federal law widely known as Obamacare. Most would qualify for large subsidies that would lower the cost of their premiums, deductibles and co-payments.

“We know the seriousness of what is about to take place, but something is going to have to take place for us to survive” in the face of a $53 million budget deficit, board chairman Elvin Franklin said before the vote. “We have to make some hard decisions from time to time, and sometimes those decisions are not going to reflect what everybody wants.”

Under the revised guidelines, an individual making more than $17,655 annually or a family of four with income exceeding $36,375 would no longer be eligible for subsidized care. The change would affect an estimated 19,527 patients, about 6 percent of the 325,000 clients the agency serves.

[…]

Harris Health and local advocacy groups will have a major challenge in helping people, like Walker, understand their options and how health insurance works.

Plans sold through the exchange are arranged into four tiers – platinum, gold, silver and bronze. Platinum and gold plans generally have higher premiums but lower deductibles and copayments. Bronze plans have the lowest premiums but high deductibles and copayments.

Federal subsidies, provided through tax credits, and cost sharing help are only available through silver plans. Often, paying a higher monthly premium for a silver plan will be less expensive in the long run for an individual patient.

“We’re talking to people who have never had health insurance before,” said Tiffany Hogue, policy director for the Texas Organizing Project, an advocacy group for the poor that has been conducting enrollment outreach. “Unless they’re sick, this is not their top priority or concern. And it’s complicated to show them the value of why they need it now.”

The education effort may get a significant boost from the federal government. Health and Human Services Secretary Sylvia Burwell announced Tuesday that Houston was among the five areas the agency will target with expanded enrollment outreach because they have high levels of uninsured people.

“We’ve found that costs are still a big concern – about half of the people who are uninsured have less than $100 in savings,” Burwell said. “And people are worried about fitting premiums into their budgets. Almost 60 percent of people who are uninsured are either confused about how the tax credits work or don’t know that they are available.”

While their monthly costs may increase, patients who enroll in the exchanges will have other benefits of health insurance. For example, they can seek care from doctors and hospitals outside the Harris Health System. And their plans can provide coverage when they travel out of the area.

This has been under discussion for several weeks now, as Harris Health has tried to deal with its deficit. They could apply some of the savings they’ll get from 15,000 people signing up for Obamacare to help the 4,000 or so that don’t qualify for subsidies, and still come out way ahead. It’s going to be hard on a lot of people, and some will unfortunately fall through the cracks, but it doesn’t make sense for Harris Health to not do this. Let’s put the blame for any problems that arise – indeed, for the shortfalls that are forcing this in the first place – where it belongs: on the state, particularly Greg Abbott and Dan Patrick and the Legislature, for refusing to expand Medicaid. That would have provided coverage to a large number of the people that will still be serviced by Harris Health. Medicaid expansion would also provide coverage to many people who suffer from mental illness, including a significant portion of the homeless and the people who make frequent trips to the local jails. Our state leadership isn’t interested in any of that. They want to push those costs down to the local level, where they don’t have to take responsibility for it, and they want to arbitrarily cut costs despite the huge negative effects that has. That is the root cause of these problems, and it will remain so until we have different leadership. I hope I live long enough to see it. KUHF and the Chron editorial board have more.

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.

Abbott would like to restore the uninsured rate

It’s what he does.

It's constitutional - deal with it

It’s constitutional – deal with it

Greg Abbott on Monday urged his fellow Republicans not to “rescue” President Barack Obama’s signature health care law if it is torpedoed by the U.S. Supreme Court, an unusually public stance that could make the first-term Texas governor a leading voice on a national issue dividing the GOP.

Abbott’s position, announced in an opinion article published on the conservative National Review magazine’s website ahead of an expected high court decision, puts him in a group, including U.S. Sen. Ted Cruz, that hopes a ruling against the Affordable Care Act’s subsidies to help poor residents buy health insurance ultimately would undo the entire law. Others, including U.S. Sen. John Cornyn and former Texas Gov. Rick Perry, say the government should patch the problem by replacing the subsidies for the nearly 1 million Texans and 5 million other Americans now receiving them, at least temporarily and with some changes to the law.

Abbott’s piece also suggested what he intends to do if the justices throw out the subsidies and Congress fails to replace them: nothing.

“Now is not the time to throw Obamacare a lifeline,” Abbott wrote, “it is time to sound its death knell.”

Now is apparently the time to make sure that everyone who didn’t have insurance before the passage of the Affordable Care Act goes back to not having insurance if the Supreme Court strikes down the subsidies. Because that’s how we keep score in this state. Abbott’s article was typically full of the usual lies and distortions about Obamacare, which the Chron story to its credit points out. It also includes the same warmed-over Republican proposals for increasing health care access that Abbott would totally push for if only his party had any control in Texas. Oh, wait.

This is usually the place where liberal/Democratic types like me bemoan low turnout and lost opportunities and the like. I am instead going to point out that groups like the Texas Association of Business and the Texas Medical Association, both of which support the full implementation of Obamacare via Medicaid expansion and also supported Greg Abbott’s gubernatorial campaign, have a role in this as well. Yes, yes, I know – Wendy Davis was a lousy candidate, the Democratic Party in this state is feckless and impotent, there’s no point for these groups in supporting someone who can’t win, blah blah blah. These things may be true, but they’re also self-fulfilling. TAB and TMA supported Abbott for their own reasons – tax cuts and tort “reform”, to be specific – but there are plenty of other things they support that they aren’t ever going to get from him or his partymates. At some point they need to decide when doing the same thing and hoping for a different result starts to become more crazy than it’s worth to them.

UPDATE: Sorry (not sorry), Greg.

Lots of people will lose insurance if SCOTUS takes it away from them

Just a reminder.

It's constitutional - deal with it

It’s constitutional – deal with it

With a U.S. Supreme Court decision looming this month on a point of law that could dismantle the Affordable Care Act, a series of new reports offer a grim glimpse at the toll on Texas should the court decide against the Obama administration.

An estimated 1 million in Texas could lose their health insurance if the high court strikes down a provision in the Affordable Care Act that allows people to get tax subsidies that make their premiums more affordable through the federal insurance exchange, according to a study commissioned by the Texas Association of Community Health Centers and the Texas Academy of Family Physicians.

Those people could soon rejoin the millions in Texas who are already without health care coverage. Texas leads the nation in the number of uninsured with a rate of about 17 percent. Before the implementation of the health care law, the rate was 24.6 percent.

The pain is especially acute in Texas, the report says, because state leaders chose not to expand Medicaid, which left another 1.5 million people who were eligible without coverage.

“This is unconscionable. … What do you tell the million people in Texas who about to lose their coverage? That they didn’t deserve it in the first place?” said Ken Jandra, president and CEO of Community Health Choice, a HMO with 300,000 members is Houston.

[…]

In Texas, 85 percent of those insured through the federal marketplace receive an average tax credit of $247 a month. Without the subsidy, premiums could climb 305 percent, according to a study released last week by the Kaiser Family Foundation.

The most recent figure I saw for Texas was 1.2 million enrollments on the exchange; eighty-five percent of that – the share of folks who have subsidized coverage – yields the one million at risk number. The number of uninsured Texans dropped by eight percentage points this year versus what it was pre-Obamacare. We’re still at twice the national rate because our shortsighted and pound-foolish Republican leadership stubbornly refuses to expand Medicaid, but it’s still big progress. Which can be taken away by the whim of five Supreme Court justices, if they decide to do that. Anyone who thinks either Congress or those same state Republicans will do anything to fix this in that event probably thinks swimming in the bayou during a heavy rain is a good idea. For now at least, all we can do is hope for the best. Kevin Drum, Daily Kos, Better Texas Blog, and KUHF has more.

House chubfest kills several bad bills

Some good news, though as always at the end of a session, the outcome isn’t clean and the details are very murky.

Squalius cephalus, the official mascot of talking bills to death

As the clock struck midnight, the failure of an anti-abortion initiative — dear to the hearts of the far right — marked the end of a tumultuous day on the floor of the Texas House that saw the passage of sweeping ethics reform and a version of legislation allowing concealed carrying of handguns on college campuses.

On the last day that it could approve major legislation that began in the Senate, the lower chamber embarked on an all-day procedural waltz, with Democrats attempting to kill bills by delaying them past midnight, and Republicans looking for openings to move their legislation.

Early in the day, Democrats narrowly shot down an attempt to essentially change the order of the calendar, moving big-ticket items up for faster consideration. They then used every parliamentary trick in the book to slow the pace, delaying consideration of mostly uncontroversial bills.

But after huddling in a secret meeting in a room adjacent to the House floor, Democrats let the action get moving again.

For hours, the House debated an ethics reform bill, dissolving into angry tirades and raunchy debate about the reach of a drug-testing provision for lawmakers.

The passionate debate pitted Republicans against each other — over lifting the veil on “dark money” and restricting people from recording or videotaping politicians without their permission.

With the clock ticking, a few Republicans at one point even sought to postpone debate over ethics legislation — deemed a priority by Republican Gov. Greg Abbott — so the House could take up campus carry and an abortion bill that would have prohibited coverage of the procedure on certain health insurance plans.

Republican state Rep. Matt Schaefer of Tyler asked state Rep. Byron Cook, R-Corsicana, the House sponsor of the ethics legislation, to temporarily pull down the measure so that it did not chew up the time left on the clock.

After Cook declined, Democrats took to the mic to reiterate that ethics reform was declared an emergency item by the governor and was supposed to be prioritized over the rest of the calendar.

The House eventually passed the ethics bill, including the dark money provision, then went back to an innocuous agency-review bill, also known as a Sunset bill, to reform the Department of Family and Protective Services.

[…]

The biggest victim of the midnight deadline was Senate Bill 575 by Republican Sen. Larry Taylor, which would have banned abortion coverage on plans sold on the federal Affordable Care Act’s marketplace.

Originally, SB 575 would have banned abortion coverage on both ACA plans and private health insurance plans. But the House State Affairs Committee amended the bill to mirror a measure filed in the House by state Rep. Marsha Farney, R-Georgetown, and approved by the committee this month before dying on a House bill deadline.

Republicans had said they intended to amend it on the floor to bring back the private insurance ban.

The bill — passed in the Senate earlier this month — died in the House after a turbulent ride in the lower chamber.

It was cleared by the State Affairs Committee on Saturday in a last-minute vote on the last day the committee could clear Senate proposals.

Killing SB575 was a big one, and one of the Democrats’ main goals for deadline day. They also succeeded in preventing an amendment allowing child welfare agencies to discriminate against LGBT families to a sunset bill for the Department of Family and Protective Services, another main goal. What did get passed was a somewhat watered-down version of campus carry that will allow university trustees to designate certain “gun-free zones” as long as there isn’t a blanket ban on carrying firearms by those with concealed handgun licenses. The campus carry bill could possibly have been stopped, though (this is where we get into the messy and murky stuff) that could have had effects that would make the victory a lot more pyhrric. The Morning News hints at some of what might have happened.

Late Tuesday, the House was debating the gun measure, though it was unclear if it would pass.

Several Republicans said that after the initial slowdown, Speaker Joe Straus intervened in the early afternoon, to get things moving. There were conflicting accounts, though, of precisely how Straus, a San Antonio Republican, did so.

House Republican Caucus Chairman Tan Parker of Flower Mound said that in conversations with individual Democrats, “the speaker was firm that he would use everything,” meaning parliamentary “nuclear options,” to shut down debate and force votes.

Straus, though, was coy.

“I didn’t talk to Democrats,” Straus told a reporter. “But I intend to get through this,” he added, referring to the House’s agenda.

One consideration may have been that the campus carry bill is part of a grand bargain on tax cuts, border security, guns and ethics. The deal may allow lawmakers to finish their work Monday, as scheduled, instead of having a special session.

As passed by the Senate, the campus carry measure would allow the licensed concealed carrying of handguns in most public university buildings. There were rumblings the House might restore a campus-by-campus opt-in provision, as it did two years ago, or let the measure die when the clock struck midnight.

Whether Lt. Gov. Dan Patrick and his GOP allies in the Senate would consider that a breach of the grand bargain remained unclear.

[…]

Rep. Terry Canales, D-Edinburg, said he was upset that some senior Democrats relented.

“We’ve given away too much leverage,” he said.

There was talk that Martinez Fischer and other long-serving Democrats were worried the minority might be asking for too much, especially after gaining key House GOP leaders’ cooperation in squelching bills aimed at unions and stopping hailstorm damage lawsuits.

[Rep. Trey] Martinez Fischer, though, called that too facile.

“You can’t view everything as a quid pro quo,” he said. “It’s not personal. It’s all about business.”

Martinez-Fischer had a point of order that could have killed the campus carry bill, but he pulled it down after some intense discussion, and thus it went to a vote. How you feel about all this likely correlates directly to your opinion of his dealmaking ability and trustworthiness in making such deals. It’s also the case that this isn’t the end of the story, as the Statesman notes.

Cutting off debate ended a daylong Democratic effort to avoid a floor vote on the campus carry legislation before a drop-dead midnight deadline to have an initial vote on Senate bills.

After the vote, Rep. Trey Martinez Fischer, D-San Antonio, said Democrats voluntarily pulled down their amendments after winning a key concession with an approved amendment allowing colleges and universities to have limited authority on banning guns in certain campus areas.

In addition, he said, Republicans were prepared to employ a rarely used maneuver to cut off debate with a motion that had already lined up agreement from the required 25 House members.

[…]

The bill-killing tactics appeared headed for success late Tuesday, until Speaker Joe Straus abruptly called for a vote on SB 11 about 20 minutes before the deadline.

The move avoided a bitter blow for Lt. Gov. Dan Patrick and state Sen. Brian Birdwell, R-Granbury.

Based on assurances from House leaders that campus carry would get a floor vote in their chamber, Patrick and Birdwell declined last week to add the school gun bill as an amendment to House Bill 910, a measure to allow openly carried holstered handguns that is now one small step away from Gov. Greg Abbott’s desk.

Before approving SB11, the House voted overwhelmingly to allow each college and university to regulate where guns may be excluded, as long as firearms are not banned campus-wide. Each plan would have to be approved by two-thirds of the board of regents under the amendment by Rep. John Zerwas, R-Richmond, that was approved 119-29.

The House also adopted an amendment by Rep. Sarah Davis, R-Houston, to exempt health care-related institutions and the Texas Medical Center from campus carry.

“Never assume the Democrats gave up on campus carry. Democrats did not give up on campus carry,” said Rep. Sylvester Turner, D-Houston. “The Zerwas amendment waters it down. The bill will go to conference and we will continue to have our input in the process.”

Here’s a separate Trib story on the campus carry bill, an Observer story about the ethics reform bill that was a main vehicle for Democratic stalling tactics, and a Chron story on the overall chubbing strategy as it was happening. Newsdesk, RG Ratcliffe, and Hair Balls have more on the day overall, and for the last word (via PDiddie), here’s Glen Maxey:

LGBT people are finally, FINALLY free from all types of mischief and evilness. The Senate gets to debate the Cecil Bell amendment by Sen. Lucio put on a friggin’ Garnet Coleman bill tomorrow. It’s all for show. Garnet Coleman is one of the strongest allies of the LGBTQ community. They could amend all the anti-gay stuff they want on it and he’ll strip it off in conference or just outright kill the bill before allowing it to pass with that crap on it. This is for record votes to say they did “something” about teh gays to their nutso base.

And lots of high stakes trading to make sure that other stuff didn’t get amended onto bills today (labor dues, TWIA, etc.) and making sure an Ethics Bill of some sort passed. We didn’t want that to die and give Abbot a reason to call a special session.

Campus carry got watered down… no clue what happens in conference. And the delaying tactics kept us from reaching the abortion insurance ban.

Four good Elections bills passed today. Three on Consent in the House, three in the Senate all will be done by noon Wednesday.

And Lastly: Pigs have flown and landed. HB 1096 the bad voter registration bill is NOT on the Calendar for tomorrow and is therefore DEAD. I am one proud lobbyist on that one. With it’s demise, no major voter suppression bills passed (well, except for Interstate Crosscheck which is only bad if implemented badly, and we have to stay on top of it to make sure it’s not), and over forty good ones survived.

Just a few technical concurrences, and we’re done. Thank the goddess and well, some bipartisanship for once.

As someone once said, for every action there is an equal and opposite reaction. See the next post for more on that.

There’s still time for bad bills to be passed

Bad bill #1:

Never again

Never again

After four hours of debate and more than a dozen failed amendments offered by Democrats, the Senate on Monday gave preliminary approval to far-reaching restrictions on minors seeking abortions in Texas without parental consent.

On a 21-10 vote, the upper chamber signed off on House Bill 3994 by Republican state Rep. Geanie Morrison of Victoria to tighten the requirements on “judicial bypass,” the legal process that allows minors to get court approval for an abortion if seeking permission from their parents could endanger them.

The vote was along party lines with one Democrat, Sen. Eddie Lucio Jr. of Brownsville, joining Republicans to pass the measure.

[…]

After it reached the Senate, [Sen. Charles] Perry did some rewriting on HB 3994 to address two of the bill’s most controversial provisions on which both Democrats and some conservatives had raised concerns.

As expected, he gutted a provision that would have required all doctors to presume a pregnant woman seeking an abortion was a minor unless she could present a “valid government record of identification” to prove she was 18 or older.

The ID requirement — dubbed “abortion ID” by opponents — raised red flags because it would apply to all women in the state even though the bill focused on minors.

Under Perry’s new language, a physician must use “due diligence” to determine a woman’s identity and age, but could still perform the abortion if a woman could not provide an ID. Doctors would also have to report to the state how many abortions were performed annually without “proof of identity and age.”

Perry said the revised language “gives physician more latitude” to determine a woman’s age.

But Democratic state Sen. Kirk Watson of Austin, who spoke in opposition to the bill and questioned Perry for almost an hour, questioned the ID requirement altogether.

“I can’t think of another instance where we presume women are children,” Watson said. “I certainly can’t think of any situation where we presume a man is a child.”

Perry also changed course on a provision that would have reversed current law such that if a judge does not rule on the bypass request within five days, the request is considered denied. Under current law, the bypass is presumed approved if a judge does not rule.

Perry cut that denial provision from the bill, saying it is now “silent” on the issue. But that did little to appease opponents who pointed out a judge’s failure to rule effectively denies the minor an abortion.

“In essence, the judge can bypass the judicial bypass by simply not ruling,” Watson said, adding that the appeals process is derailed without a denial by a judge.

HB 3994 also extends the time in which judges can rule on a judicial bypass case from two business days to five. Perry said this was meant to give judges more time and “clarity” to consider these cases.

But Democratic state Sen. Sylvia Garcia of Houston, who also offered several unsuccessful amendments, questioned whether Perry’s intentions were rooted in a distrust of women and judges.

“I’m not really sure who it is you don’t trust — the girls, the judges or the entire judicial system?” Garcia asked.

See here for the background. The Senate version is not quite as bad as the original House version that passed, but as Nonsequiteuse notes, it’s still a farce that does nothing but infantilize women. It’s a cliched analogy, but can anyone imagine a similar set of hoops for a man to jump through to get a vasectomy or a prescription for Viagra? The only people who will benefit from this bill are the lawyers that will be involved in the litigation over it. Oh, and Eddie Lucio sucks. Good Lord, he needs to be retired. TrailBlazers, the Observer, and Newsdesk have more.

Bad bill #2:

In a dramatic turn of events, the House Calendars Committee on Sunday night reversed course and sent a controversial bill prohibiting health insurance plans sold on the Affordable Care Act’s marketplace from covering abortions to the full chamber for a vote.

Earlier in the night, the committee voted not to place Senate Bill 575 by Republican Sen. Larry Taylor on the lower chamber’s calendar for Tuesday — the last day a Senate bill can be passed by the House. After fireworks on the House floor instigated by a lawmaker who believed he had entered into an agreement to get the bill to the full chamber, the committee reconvened and reconsidered its vote.

Under SB 575, women seeking coverage for what Taylor has called “elective” abortions would have been required to purchase supplemental health insurance plans.

On Saturday, state Rep. Jonathan Stickland, R-Bedford, had threatened to force a House vote to prohibit abortions on the basis of fetal abnormalities by filing an amendment to an innocuous agency review bill. But Stickland later withdrew the amendment, telling the Austin American-Statesman that he had agreed to pull it down in exchange of a vow from House leadership that they would move SB 575 forward.

The bill did make it out of the House State Affairs Committee, chaired by state Rep. Byron Cook, R-Corsicana. But when it got to Calendars, that committee voted it down, leading Stickland to go after Cook on the House floor. Stickland had to be separated from Cook, and House sergeants immediately ran over to prevent a lengthier tussle.

Again, infantilizing women. And speaking of infants, what more can be said about Jonathan Stickland? I know there’s a minimum age requirement to run for office. Maybe there needs to be a minimum maturity requirement as well. Hey, if we can force doctors to assume that women seeking abortions are children, we can assume that any first-time filer for office is a callow jerk. We sure wouldn’t have been wrong in this case.

Bad bill #3:

Senate Republicans on Monday voted to move the state’s Public Integrity Unit out of the Travis County District Attorney’s Office. The action was spurred in part by last year’s indictment of former Gov. Rick Perry.

The legislation by Sen. Joan Huffman, R-Houston, would move key decisions about investigating public officials to the Texas Rangers and away from the Democratic-controlled Travis County District Attorney.

The bill was approved in a 20-11 vote, with Democrats casting all the no votes.

[…]

Under the proposed law, any district attorney looking at suspicious activity by a state official would refer the matter to new Public Integrity Unit within the Texas Rangers. That office would then use a Texas Ranger to further investigate the allegation, with expenses handled by the Texas Department of Public Safety.

If confirmed, the recommendation for further action would be sent to the district attorney in the home county of the public official. That district attorney could pursue or drop the investigation.

See here for the background. As I said before, I don’t think this is the worst bill ever, but I do think it’s a guarantee that some future scandal will result from this. And as others have pointed out, it sets up legislators to be treated differently than every other Texan in this sort of situation. That’s never a good precedent to set.

And finally, bad bill #4:

Gays and same-sex couples could be turned away from adopting children or serving as foster parents under an amendment filed by a social conservative House member and expected to be heard Tuesday.

The measure also would allow child welfare providers to deny teenagers in foster care access to contraception or an abortion under a wide umbrella of religious protections for the state contractor.

Rep. Scott Sanford, R-McKinney, has filed the measure that gives state contractors for child welfare services the right to sue the state if they are punished for making decisions based on their religious beliefs.

The state could not force contractors to follow policies providing for contraception or allowing same-sex couples to adopt, for instance. If the state tried to terminate a contract or suspend licensing for the state contractors’ failure to abide by such polices, the contractor could sue, win compensatory damages, relief from the policy and attorneys fees against the state, according to the proposal.

Sanford tried to pass as separate bill earlier in the session, but it failed. The proposal now has resurfaced as an amendment to the sunset bill that would reconstitute the Department of Family and Protective Services.

I’m just going to hand this one off to Equality Texas:

TUESDAY, MAY 26TH, Rep. Scott Sanford will try again to pass an amendment allowing child welfare agencies to discriminate against LGBT families

Tell your State Representative to oppose the Sanford amendment permitting discrimination in Texas’ child welfare system.

Rep. Scott Sanford has pre-filed an amendment that he will seek to add to SB 206 on Tuesday, May 26th. This cynical “religious refusal” amendment would authorize all child welfare organizations to refuse to place a child with a qualified family just because that family doesn’t meet the organization’s religious or moral criteria.

If enacted into law, the Sanford Amendment would allow child welfare providers to discriminate against not just gay and transgender families, but also against people of other faiths, interfaith couples and anyone else to whom a provider objects for religious reasons.

The only consideration of a child welfare agency should be the best interest of the child – not proselytizing for a single, narrow religious interpretation.

SB 206 is not objectionable. However, adding the Sanford Amendment to SB 206 must be prevented.

Urge your State Representative to OPPOSE the Sanford Amendment to SB 206.

Amen to that.

Texas’ uninsured rate drops dramatically

Amazing what can happen when a government actually tries to solve a problem, isn’t it?

It's constitutional - deal with it

It’s constitutional – deal with it

The rate of Texans without health insurance has fallen 8 percentage points since enrollment in the federal Affordable Care Act began, according to a new study.

Texas’ sky-high rate of adults without health coverage — previously about 25 percent, the highest rate in the nation — was down to 17 percent in March, according to a report from the Episcopal Health Foundation and Rice University’s Baker Institute for Public Policy.

But Texas remains the state with the highest percentage of uninsured people, the study found, and for the first time, the state has the largest raw number of uninsured residents in the country.

The amount of change was unequal among income levels. The poorest Texans saw a less dramatic improvement — the uninsured rate for people earning less than $16,000 fell by 20 percent, while the uninsured rate for people earning more income fell by 45 percent.

In a statement, Vivian Ho, one of the study’s authors, said the survey showed a widening “coverage gap” among poor and middle-income Texans. Texas leaders have declined to expand the state’s Medicaid program to provide health insurance to impoverished adults — a central tenet of President Obama’s signature health care law — criticizing the public program as “inefficient.”

“Unless Texas participates in an expanded Medicaid program or develops some other mechanism for covering the lowest income Texans, the number who remain uninsured is not likely to change,” Ho said. “Right now, those at the lowest incomes must rely on health care that is highly subsidized by county and state tax dollars, or get by without needed health care.”

The 31 percent decrease in the rate of uninsured Texans was similar to drops in other states that did not expand Medicaid coverage. For expansion states, the average decrease in the rate of uninsured was 53 percent, according to the study.

We know how that goes. I’ve skipped the typically dishonest quote from the TPPF’s designated hack, who always manages to get quoted uncritically in this kind of story despite the fact that all he does is spread misinformation. The numbers are out there if you want to look. We also know that people like having health insurance, for reasons that should be obvious to anyone who isn’t a professional liar. It will really suck if it all gets taken away by the Supreme Court, won’t it? The Chron has more.

Texans like having health insurance

Who knew?

It's constitutional - deal with it

It’s constitutional – deal with it

A first-of-its-kind survey asking Texans if health insurance is necessary found an overwhelming majority believe having coverage is critical for them and their families, with 50 percent calling it “absolutely essential.”

The Texas Medical Center commissioned Nielsen to survey attitudes surrounding health insurance ranging from its importance, what you would give up to pay for insurance, and whether people with bad health habits should be required to pay more.

The Houston Chronicle obtained advance results from the online poll posed to 1,000 Texans over 18 between Jan. 27 and March 3. The complete results will be unveiled Monday at the Medical World Americas 2015 conference in Houston.

Most striking was that 83 percent of those surveyed – a rate that held steady across age, race, income, education and insurance status categories – said having health insurance was either “very important” or “absolutely essential.” Only 5 percent said it was “not important at all.”

“That includes the all-important 25-to-35 demographic. It flies in the face of those groups who have been saying that young people don’t need or want health insurance,” said Dr. Arthur “Tim” Garson, director of the Health Policy Institute at Texas Medical Center.

[…]

Currently, Texas leads the nation in the number of uninsured with roughly 22 percent, or about 5.7 million people. And while it is not unusual for people living on the edge to experience periods without insurance, in Texas more than half of uninsured adults have been uninsured for five years or more, including 31 percent of the uninsured who have never had coverage in their lifetime, according to a 2014 Henry J. Kaiser Family Foundation analysis of the state’s uninsured.

I can’t find a copy of the study anywhere – a description of it is here – so you’ll just have to take the story’s word for it. Not really sure what there is to say other than I don’t know why anyone would be surprised by this. And in case you’re wondering, people who bought plans via the Obamacare exchanges are pretty happy with them, too. So yeah, health insurance good. Film at 11.

A different push for health care expansion

This ought to spark some interesting conversations.

It's constitutional - deal with it

It’s constitutional – deal with it

Two Democratic lawmakers called Wednesday for Texas leaders to explore a new type of Medicaid waiver that they say could provide health coverage to many of the state’s millions of uninsured.

The waiver, characterized by the legislators as the kind of block grant that Republicans favor, is not predicated on a Medicaid expansion and would allow Texas to avoid many provisions of the Affordable Care Act unpopular with the leadership in the Legislature – including the individual and employer mandates. The waiver, known as 1332, takes effect in 2017.

“Based on where we are now in this state, (the waiver) probably is the best chance or possibility of an agreement… toward coverage expansion,” Rep. Garnet Coleman, D-Houston, said at a news briefing with Sen. Jose Rodriguez, D-El Paso.

In a letter sent to colleagues earlier this week, Coleman added that the waiver must not reduce access to care, increase costs to the federal government, or make insurance more expensive than under the current law. The waiver effectively tells states that “if they know a better, more efficient way to provide health care, then have at it,” Coleman wrote.

[…]

Arlene Wohlgemuth, executive director of the Texas Public Policy Foundation, a conservative Austin think tank, said she had spoken to Coleman Wednesday morning about developing a 1332 waiver aligned with the principles laid out by the foundation.

“Of course, we are interested in reform of the program that truly gives flexibility to the states to provide for better health outcomes in a way that is affordable for the taxpayer,” Wohlgemuth said. “Thus far, the federal government has been unwilling to give exception to the requirements in the Social Security Act (the law that embodies Medicare) that have hamstrung true reform. We are interested to see what Representative Coleman has in mind through a 1332 waiver.”

Vivian Ho, a health care economist at Rice University’s Baker Institute for Public Policy, said there are so many unknowns about the waiver that it’s hard to know what to conclude.

“I can’t believe any waiver is the answer unless the state agrees to some sort of Medicaid expansion, and I don’t see how 1332 is going to help that,” said Ho. “It’s unclear how much money it would actually supply and whether it would provide access to tax credits for people below 100 percent of the federal poverty level.”

Ho added that block grants are a questionable idea unless the amount of money increases with population growth, given Texas’ continual migration and growing uninsured pool.

But Ken Janda, CEO of Community Health Choice, a nonprofit health care organization, called the suggestion “a very good idea” and said it “definitely seems worth talking about.” He said it answers a lot of concerns raised about Medicaid expansion and presents a possible solution to the health-care crisis that’s caused the closure of some private hospitals and threatens the existence of safety-net hospitals.

Rep. Coleman and Sen. Rodriguez filed bills this session to pursue this waiver and the reforms that it would allow. Here’s the letter they sent to fellow legislators outlining what this waiver would mean. Here’s the key bit:

However, there is a catch – the waiver must not reduce access to care, increase costs to the federal government, or make insurance more expensive than it is under the current law. The 1332 Waiver effectively tells states that if they know a better, more efficient way to provide healthcare, then have at it. Texas should take the federal government’s offer and consider ways to reform both Medicaid and private marketplace coverage in this state.

Basically, this is a put-up-or-shut-up challenge to Greg Abbott and the Republicans that have dug their heels in so fiercely against Medicaid expansion, the insurance exchanges, and every other aspect of the Affordable Care Act. You think you can do better? Prove it. My guess is that this will be roundly ignored, since Abbott and Rick Perry before him have shown zero interest in doing anything about the millions of uninsured Texans. Abbott appears to be perfectly willing to set fire to billions more dollars in his continued quest to not do anything about health care. But who knows, maybe someone will rise to the challenge. I agree that it’s at least worth exploring to see what might be possible.

Cruz may go on Obamacare

Go ahead, laugh it up. You know you want to.

Not Ted Cruz

Not Ted Cruz

Ted Cruz, one of the loudest critics of Obamacare, will soon be using it for health insurance coverage.

“We will presumably go on the exchange and sign up for health care and we’re in the process of transitioning over to do that,” Cruz, a Republican candidate for president, told The Des Moines Register Tuesday.

Cruz’s wife, Heidi, is going on an unpaid leave of up absence from her job at Goldman Sachs to join Cruz full time on the campaign trail, Cruz told the Register.

Bloomberg was first to report that Heidi Cruz has taken the leave. CNN noted that Cruz, who has boasted about not needing to receive government health care benefits, would no longer be covered under his wife’s health insurance plan.

[…]

Cruz, as an employee of the government, will use the exchange to choose his employer-provided insurance. Iowa U.S. Sen. Chuck Grassley pushed through an amendment on the Affordable Care Act that requires members of Congress to obtain their coverage via the exchanges. Congress pays most of the premium. But Cruz won’t be getting any extra benefit under the Affordable Care Act that a member of Congress wouldn’t have gotten before the ACA became law.

Asked if it chafes at all to have to rely on Obamacare, Cruz told the Register: “Well, it is written in the law that members will be on the exchanges without subsidies just like millions of Americans so that’s – I think the same rules should apply to all of us. Members of Congress should not be exempt.”

But, Cruz added, he’d still like to see Obamacare repealed in its entirety.

Wonkblog notes that Cruz will not be taking any of the contribution money that legislators and their staffers are entitled to, so in that sense he’s sticking to his principle. I say if he really wants to be true to his vision, he should make like Louie Gohmert and forgo health insurance altogether. That’s the kind of freedom from tyranny he wants all those newly-insured people (and lots of not-so-newly-insured people, I expect) to have once he becomes President and repeals the Affordable Care Act, right? Well, then now is not the time for half-Measures. Now is the time to show us what you’re really made of and boldly go uninsured, Ted. Hell, just the opportunity to do a little civil disobedience by refusing to pay the tax penalty should have you licking your lips and twirling your mustache, if you had one to twirl. If Louie can do it, Ted, so can you. Anything less would be a sellout.

Lots of newly insured folks in Texas

Thanks, Obamacare!

More than half of 1.2 million Texans who enrolled in private health insurance plans through the federally operated marketplace this year were new customers, according to a government report released Tuesday.

The analysis from the U.S. Department of Health and Human Services said 57 percent of Texans who enrolled in 2015 – about 681,500 people – were first-time consumers, who did not buy health insurance through the HealthCare.gov platform last year.

[…]

The vast majority of shoppers qualified for tax credits to help pay their insurance premiums. In Texas alone, more than a million people – 86 percent of those who enrolled – were granted tax credits. The average tax credit seen in Texas was $239 per month, Dr. Meena Seshamani, director of the federal Health and Human Services’ Office of Health Reform, said during a conference call with reporters Tuesday.

Before tax credits were applied, the average monthly premium in Texas would have been $328, the report showed. Once the tax credits took effect, the average monthly premium for marketplace plans across the state was $89.

There was indeed a data dump this week, because sites like Daily Kos, which points to Medium, and Wonkblog, which points to the Kaiser Family Foundation, are highlighting the state of play and what the effect would be if the Supreme Court buys the ridiculous argument in King v. Burwell (which the plaintiffs’ own lawyer agreed was BS) and throws out the subsidies for healthcare.gov recipients. The effect in Texas would be substantial, perhaps finally big enough to get people like Erin Meredith to pay attention. Regardless of that, follow those links and look at those charts and remind yourself that this law has helped a lot of people, and anyone who says otherwise is at best misinformed or (in the case of elected officials and hacks from outfits like the TPPF) lying. Ask the people who have insurance now when they didn’t before and who stand to lose it if the Supreme Court decides to take it away from them.

From the “Be careful who you vote for” department

Because you never know when the consequences of your voting actions will directly affect you.

It's constitutional - deal with it

It’s constitutional – deal with it

Erin Meredith, a fifth-generation Republican who lives in Austin, was no fan of President Obama’s Affordable Care Act, which she considered just another wasteful government handout. She didn’t sign up for a health plan until late last year, when she felt she had no other choice.

By then, Meredith, who is 37 and has two children, had gotten divorced and lost the insurance provided through her husband. Her new job, as an office manager for a roofing company, didn’t offer benefits. About the same time, she learned that her headaches and fatigue were the result of a rare condition that affects the oxygen level in her blood. She couldn’t afford to spend thousands of dollars on doctor’s visits, and her desperation slowly turned to panic.

In November, at a friend’s urging, Meredith looked for a health plan on the federal online marketplace. With an income of about $30,000 a year, she discovered she qualified for a government subsidy of $132 a month. Her premium would be $89 a month.

Now that she has coverage, she doesn’t want to lose it. “I can still feed my kids and put gas in my car,” she said. “I’m not trying to go to Cancun or carry a Michael Kors bag. I drive a 2009 Mazda, and I’m just trying to make it in my little apartment and not be on government assistance.”

Meredith is one of about 6 million people whose subsidized insurance hangs in the balance as the Supreme Court takes up a case that poses the most serious challenge to the Affordable Care Act since the court found the law constitutional more than two years ago.

[…]

“If they’re not going to participate in Obamacare and I’m not going to have these financial benefits, which will force me to pay $220 a month for coverage, do you know if Greg Abbott, our governor, has any plan to offer something comparable?” Meredith asked in an e-mail. “I understand and support his efforts to put Washington back in its place. I just don’t want that to come at the cost of hard-working Texans and their ability to maintain medical coverage.”

Dear Erin Meredith,

The answer is no, he does not. Although this is the rare lawsuit against the Obama administration for which Greg Abbott is not among the plaintiffs, it is his fondest wish for Obamacare to die a bloody death, and if this lawsuit helps make that happen, then nothing will make him happier. If that means that you and your family will suffer as a result, well, that’s just too bad. Greg Abbott doesn’t care, and doesn’t have any intention of helping you. You’re on your own, as far as he’s concerned. Neither do Dan Patrick or Ken Paxton, and neither did Rick Perry while he was Governor. In fact, Rick Perry recently claimed that the reason people like you didn’t have health insurance before now is because that the way you wanted it. It’s his justification for why he never pushed to provide anything like the subsidies for insurance you now receive. Greg Abbott feels the same way. It’s your fault, and you don’t deserve any assistance for it. Hope this answers your question. Daily Kos has more.

(There are more stories about Texans who wold be very badly affected by an adverse SCOTUS ruling on subsidies, in Vox and the Sunday Houston Chronicle. Greg Abbott doesn’t care about any of these people, either, though those stories don’t say if any of them were foolish enough to have voted for him in November.)

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.

SCOTUS could really screw Texas on Obamacare

You know how all those Texans have been signing up for health insurance via the Healthcare.gov exchange? Every single one of them stands to lose if the Supreme Court decides to play politics.

It's constitutional - deal with it

It’s constitutional – deal with it

Nearly 1 million Texans have now signed up for health insurance on the federal marketplace, known as healthcare.gov. But Texas, and 33 other states that did not create their own exchanges, will be the most vulnerable if the U.S. Supreme Court rules against the Obama administration in the latest lawsuit challenging the Affordable Care Act, health policy experts say.

[…]

Oral arguments in the case are scheduled for March, and the high court’s decision could come as early as June. If the high court rules that subsidies are not allowed for Texans and others in states without their own exchanges, the ripple effects could be striking. One insurance industry group, in a court brief supporting the subsidies, said eliminating them would trigger a “death spiral” of premium increases and market destabilization.

Without assistance from the federal government, many young and healthy enrollees “are simply going to drop” their health plans, while the sickest people would remain in the market, said Nicholas Bagley, a professor at the University of Michigan Law School. That would expose insurers to greater risk, causing them to hike their rates for all customers, not just those who entered the system through Obamacare plans.

“Holy shit, that’s chaos,” said Robert Laszewski, a health policy consultant in D.C. “What’s ironic here is not only will the Republicans be screwing up the insurance for poor people on the Obamacare exchange, they’ll be screwing up health insurance for rich people in Texas who happen to be in the individual market.”

[…]

So far, state leaders have been tight-lipped about what, if anything, they are doing to prepare for a high court ruling. John Greeley, a spokesman for the Texas Department of Insurance, referred questions about King v. Burwell to “state leadership.”

“We’re not gonna weigh in,” he said. As for the state’s decision to create an insurance exchange, he said, “that has not been our call, from the very beginning.”

Representatives for Texas’ largest health insurers also declined to comment.

“Blue Cross and Blue Shield of Texas is waiting for further guidance from the federal government as this situation plays out,” company spokeswoman Margaret Jarvis said in a written statement, though a trade group representing the insurer has written to the Supreme Court in support of the subsidies.

Like I said, a whole lot of Texans are on the chopping block, with a state government that will be happy to let them get sick and die in the name of ideology. (Rep. Chris Turner has filed a bill to establish a state exchange, but – with all due respect – if Rep. John Zerwas couldn’t get anywhere with that, there’s no way a Dem like Turner will.) Having said all that, it’s possible that for all their bluster and BS, the state leadership is quietly hoping for a loss on this one.

States on both side of the issue have filed briefs with the Supreme Court. But only six red states—Oklahoma, Alabama, Georgia, Nebraska, South Carolina, and West Virginia—joined a brief on behalf of the petitioners. Conspicuously missing are deeply conservative states like Texas, with large beneficiary pools, or any swing states under GOP control. Republican senators from many of those states—including Wisconsin, Ohio, and Florida—are in cycle in 2016.

I’ll be honest, it hadn’t occurred to me that Texas hadn’t signed onto this effort. An opportunity to sue the federal government – over the hated Obamacare, no less – and we passed? Did Greg Abbott sleep in the day the other plaintiffs came around looking for amicus briefs? I’m stunned. True, this lawsuit is a steaming pile of baloney with little to no establishment support, but since when has that ever slowed Abbott down? We’ll see how this goes.

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.

Texas Obamacare enrollments top 850K

And counting.

It's constitutional - deal with it

It’s constitutional – deal with it

Officials at the Department of Health and Human Services Wednesday announced nearly 860,000 Texans so far have enrolled in health insurance marketplace coverage with a month left still left to go until the 2015 open enrollment period ends.

It’s unclear how many of those signups are new marketplace customers. Last year, nearly 734,000 Texans, many of whom had never been insured, signed up for coverage. About 198,000 of them were in the Houston area.

“As of Jan. 9, 859,377 Texans have access to quality, affordable health coverage for 2015 through the Health Insurance Marketplace,” said Health and Human Services Secretary Sylvia Burwell in a written statement.

Good to hear. National enrollments have been strong as well. It seems eminently reasonable to me that Texas could top one million signups by February 15, given the likelihood (as was the case last year) of some number of people waiting till the last minute to get it done.

There’s also an intensified focus on the Latino community.

Officials plan more than 600 enrollment events nationwide, including a few in the Houston area, that target Hispanics in an effort to get more signed up for coverage under the Affordable Care Act. In the meantime, grass-roots organizations and the Department of Health and Human Services are spreading the word about the marketplace by using webinars, Twitter, advertising and Spanish television telethons.

“We’re doubling down,” Health and Human Services Secretary Sylvia Burwell told reporters Wednesday, noting that the agency has dedicated a third of its advertising budget to Spanish speakers. “The Latino community is one of the fastest growing communities in the country. We’re specifically focused on this community because of the health disparities that exist for them and we think having insurance will help.”

[…]

Researchers have found Texas Latinos were more than twice as likely as Anglos to enroll in marketplace coverage. They also discovered Hispanic adults in Texas have more difficulty affording health care and are three times as likely to be uninsured.

Burwell repeatedly has said Spanish speakers would be targeted for more outreach this enrollment period. Insurers and enrollment organization trained more application assisters to accommodate Latino applicants and marketplace officials simplified the insurance application process, expanded the number of documents people could use to verify their identities and income and made it easier for applicants to use hyphenated names, which are common in Latino communities.

“We’re working to meet Latino consumers where they are, whether that’s online, over the phone or in person,” Burwell said.

There’s a lot of potential there, and one thing we learned from the first round of enrollments was precisely that these customers needed more engagement to get signed up. I hope this has the desired effect, and that we can learn more for the next time.

What would happen to all these people if SCOTUS takes the opportunity to gut subsidies for the national exchange? My guess is that as are the million or so folks that would qualify for Medicaid under a normal expansion plan, they’d be SOL. Oh, I’m sure that Rep. John Zerwas will put forth a bill to create a Texas state exchange, as he has done before. He’ll have the support of all the Dems, a few honorable Republicans, every non-crazy local official, and the business establishment, but it won’t be enough. Nothing will change till we start to win more elections. I wish I had a sunnier outlook than that, but I don’t. Sorry.

Bringing health insurance to the customers

It’s learning from experience.

It's constitutional - deal with it

It’s constitutional – deal with it

The federal government and insurers learned from the last year’s inaugural open enrollment period under the Affordable Care Act that it takes more than low premiums to persuade the uninsured to buy federally mandated health coverage, especially in a state like Texas, where leaders oppose the health care law.

These consumers, many of whom have never been insured, want more in-person, one-on-one help from someone who speaks their language to explain how deductibles, out-of-pocket costs, premiums and subsidies can affect a plan’s total value. That assistance also must be convenient because many people don’t have the time or means to travel to find the help they need.

In response, insurers are meeting the uninsured where they typically go for medical care, social services and shopping – health centers, neighborhood multiservice centers and grocery stores. They also have extended call center hours, increased their social media presence and improved websites to make insurance education and enrollment information, in English and Spanish, more accessible. Additionally, pharmacists at CVS Health, H-E-B, Kroger, Walgreens and Wal-Mart are helping customers find enrollment assistance and holding sign-up events.

[…]

“Last year, we learned a lot about the need to provide people the information they need,” said Dr. Bob Morrow, the Southeast Texas chief medical officer for Blue Cross Blue Shield of Texas, one of the state’s largest insurers. “Buying insurance can be confusing. We really learned how important it is to get information to people on their terms.”

The strategy makes perfect business sense, said Partha Krishnamurthy, marketing professor at the University of Houston’s Bauer College of Business. The marketplace’s first year was an experiment for insurers, who wanted to ensure that they could make a profit before investing a lot of money in products and marketing, he said. Obviously, the marketplace proved it could work because this year more insurers are offering plans and increasing their marketing efforts to attract new customers and retain current ones.

“If the first year had not been successful, they would have fled the market,” Krishnamurthy said. “They have a great deal of incentive to attract and retain as many people as they can before the market gets flooded.”

Nationwide, more than 8 million people signed up for 2014 coverage, including nearly 734,000 in Texas. Still, about 6 million Texans, or 25 percent of the state’s population, remain uninsured. The state has the highest rate of un-insured residents nationwide.

Experts estimate more than 1 million in the Houston area are uninsured, even though nearly 200,000 residents enrolled in 2014 coverage.

The national enrollment rate has been ahead of projections so far, thanks to a functioning website and a broad array of affordable plans. Funny how you don’t hear much talk about death spirals and insurance companies going under any more, isn’t it? The Supreme Court could still throw a major monkey wrench into things, but there’s no point worrying about that now. What I’m looking for is to see how Texas’ numbers, and Harris County’s numbers, look when all is said and done. If there’s one thing that might get me to accept some of the happy talk about Greg Abbott possibly being open to Medicaid expansion, it would be some words and action from him about the importance of getting everyone who is eligible for federal subsidies through the exchange enrolled in a plan. Needless to say, I’m not going to hold my breath waiting for that to happen.

Obamacare 2.0

The open enrollment period for the Obamacare insurance exchanges is going on right now. This year, the feds are taking a more direct approach to getting people to enroll.

It's constitutional - deal with it

It’s constitutional – deal with it

Secretary for Health and Human Services Sylvia Burwell, whose appearance at Monday’s news conference [in San Antonio] is part of a national tour to talk up marketplace successes, reported that of those who signed up during the first enrollment period this year, 7 out of 10 had premiums under $100. Nationwide, 65% of applicants qualified for subsidies, she said. In Texas, 84% of Texans got financial help, according to the Center for Public Policy Priorities in Austin.

“We as a people have a moral obligation to see that everybody has access to quality and affordable health insurance,” said Mayor Ivy Taylor who joined Burwell at the news conference. “A community prospers when its citizens are healthy.”

Burwell urged people without insurance to visit HealthCare.gov, choose the best plan among many options, and sign up by Dec. 15 to have coverage starting Jan. 1. Enrollment for 2015 will remain open until Feb. 15.

To those who signed up last time, Burwell emphasized that even if they are happy with the plan they already have, they need to re-enroll. About 90% of the information entered last time will appear on the form so people don’t have to re-enter it. Burwell said it’s important to make sure the information remains accurate and that the plan individuals previously chose is still the best one to meet their needs; 25% more plans were added this time.

The Health Insurance Marketplace enrolled 734,000 Texans in 2014. Bexar County accounted for 77,000 of those newly insured, a number that far exceeded the goal of 46,000, which remains the goal for the current enrollment period. Bexar County Judge Nelson Wolff, in attendance on Monday, has helped lead this effort, but in Bexar County, 27% of the population remains uninsured. Of those, 75% identify themselves as Hispanic, according to Andrea Guajardo, speaking for Enroll SA, a coalition of 40 organizations and 176 trained volunteers in Bexar County trained to help people sign up for insurance.

Asked about HHS’s outreach to Hispanic uninsured residents, Burwell pointed to several initiatives.

  • Spanish language call service. “In the early days of enrollment, out of 200,000 calls to our call center, 20,000 were using our Spanish-speaking call service.”Burwell said.
  • Spanish language equivalent of HealthCare.gov: CuidadodeSalud.gov.
  • Increased the number of Spanish speakers providing in-person assistance to help with online sign-up.
  • Improved interface for mobile users. “The Latino population has a deeper penetration of mobile use than the population as a whole.”

“One of the things we learned from the initial enrollment was the importance of trusted voices,” Burwell said. “I’ve had a chance today to talk with the leadership of the community and the stakeholders about their work and to hear their feedback, so we can make things better.”

Secretary Burwell was in Houston the week before that.

With some 6 million Texans still uninsured, Burwell’s early appearance this go-round shows a renewed fight to increase the health care law’s impact in Texas, where the governor’s office has refused to create a state-run marketplace or accept billions of dollars in federal funding to expand Medicaid to extend coverage to millions more people.

State and local organizers say the first insurance sign-up period helped them become more organized and strategic as they prepared for the 2015 open enrollment period.

They intend to hold multiple enrollment events, provide additional one-on-one application assistance opportunities and include more grass roots organizations and community leaders in educating the uninsured about marketplace coverage. They have data showing where the uninsured live. The key is deploying the appropriate organizations and people to reach target areas and groups, including Hispanics and young people.

“We learned about the importance of follow-up and the need for a lot of outreach,” said Mimi Garcia, the Texas state director for Enroll America, a national insurance advocacy organization. “There’s a lot of work to do in Houston. That’s going to be a big focus area.”

Organizers learned from last year’s open enrollment that the more conversations they have with uninsured residents, the more likely they are to convince someone to buy health coverage, Garcia said by telephone from a conference in New Orleans. She said the goal is for people to view purchasing health insurance as routine a practice as paying taxes or auto insurance.

[…]

The state’s uninsured rate dropped about 2 percent this year, but Elena Marks, president and CEO of Houston’s Episcopal Health Foundation, a philanthropy that will fund health care providers, said many Texans gained employer-based insurance as the economy created more jobs.

In comparison, California’s uninsured rate dropped nearly in half, from 22 percent to a little less than 12 percent, in large part to the state’s decision to expand Medicaid coverage to cover more of its low-income, working residents.

Marks said it makes sense for Burwell and other officials to bypass Texas’ political leadership and instead work with local governments, agencies and organizations, including those in the Houston area, to find the uninsured and enroll them in health coverage.

“Having her show up brings attention to the issue,” said Marks, who also is a non-resident health care fellow at Rice University’s Baker Institute.

Marks, who did not attend Burwell’s news conference, said new carriers are making the Texas marketplace more competitive this year.

Risha Jones, deputy director of Houston’s Department of Health and Human Services, said her agency’s goal is to directly contact 100,000 uninsured residents and reach another 400,000 through community and educational outreach. She said federal officials recognize the Houston area needs assistance in reaching its uninsured residents and has pledged to help. They haven’t yet set an enrollment goal.

“They are making us a priority,” Jones said, who introduced Burwell at the news conference. “We’re on the radar.”

It was a nice surprise seeing my friend David Ortez in the story, as an example of someone who was able to get health insurance through the Affordable Care Act and the exchanges. Ortez is a recent law school graduate and one of many people under the age of 30 who stands to benefit from the ACA. There’s a separate effort to get those folks, known as the Young Invincibles, to enroll. Unlike last year with the healthcare.gov meltdown, the first week of the enrollment period saw half a million people sign up, with about that many fill out applications. About half of those enrollees are first-timers. It would be awesome if this year Texas could top the one million mark for coverage. Imagine what it could be if anyone in state leadership had any interest in helping make this happen. Daily Kos has more.

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.

Expanding Medicaid the hard way

A lot smaller than it should have been, but it’s still something.

It's constitutional - deal with it

It’s constitutional – deal with it

More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall despite Republican state leaders’ decision not to expand eligibility to poor adults, according to federal figures.

The 80,435 new enrollees as of May — mostly Texans who already qualified for coverage but did not previously seek it — represent a 1.8 percent increase over pre-Obamacare figures. That places Texas, which has the nation’s highest uninsured rate, in the middle of the pack among states that chose not to expand access to those programs to everyone under 138 percent of the federal poverty line under the president’s signature health law. The expansion, a key tenet of Obamacare, was deemed optional by the U.S. Supreme Court.

This “woodwork effect” or “welcome mat effect” — in which people hear about Medicaid expansions around the country and learn they qualify in Texas — has not been huge. Roughly 874,000 Texans eligible for Medicaid or CHIP have still not enrolled, according to Kaiser Family Foundation estimates. That includes more than 700,000 children, said Christine Sinatra, state communications director for Enroll America, a group seeking to get the uninsured covered under the federal health law.

Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, said her agency started seeing enrollment rates rise a couple of years ago, when the conversation on Obamacare was heating up. After the act took effect, and parents took to the federal marketplace to purchase private insurance plans, many discovered that their children were eligible for Medicaid, Goodman added.

[…]

Get Covered America and Enroll America, which are leading the charge to bring more people into the coverage fold across the country, also cited the Affordable Care Act’s simplification of the sign-up process as a driver of Texas’ recent enrollment growth, which took off in the spring.

And though Texas leaders did not expand Medicaid, the criteria for eligibility here and elsewhere did broaden slightly: The act raised from 21 to 26 the age at which people formerly in the foster care system have to give up their Medicaid coverage.

Absent the Medicaid expansion that Texas chose not to join, Medicaid and CHIP eligibility in the state is generally limited to members of several vulnerable groups, including children under 200 percent of the federal poverty line and some low-income seniors, pregnant women and parents, Sinatra said.

Texas has historically put up a lot of obstacles to enrollment in Medicaid and CHIP. In addition to the exceedingly stingy income requirements, there has been a six-month enrollment period at times, meaning you have to sign up twice a year. The state, and in particular the Republican leadership, does all this in a deliberate effort to keep enrollment down, since that allows for less spending. By the state, anyway – sucks to be you, counties and hospital districts. I for one would consider it justice if every currently eligible person managed to get themselves enrolled, however much it wound up costing the state. We’d be far better off overall regardless of the price. Texas Leftist has more.

Don’t sweat that court ruling on Obamacare tax credits just yet

It’s too soon to say what effect, if any will be felt in Texas.

It's constitutional - deal with it

It’s constitutional – deal with it

Opposing rulings from two federal courts Tuesday left unclear the future prospects of federal financial aid to Texans who qualify for assistance to purchase health insurance under the Affordable Care Act.

The U.S. Court of Appeals for the D.C. Circuit ruled that the ACA legislation made federal subsidies available only to individuals who purchased insurance through state-run exchanges. That would make federal subsidies illegal in the 36 states, including Texas, that use the federally facilitated insurance marketplace.

That announcement was followed by a decision from the 4th Circuit Court of Appeals in Virginia, which ruled that individuals who enroll using federally facilitated exchanges are eligible to receive subsidies.

Texas, like dozens of other states with Republican leaders, declined to create its own state-based insurance exchange under the ACA. Instead, Texas relies on a federally managed marketplace. More than 730,000 Texans enrolled for health coverage through the federal marketplace during the first period of open enrollment.

[…]

Individuals whose annual incomes range from one to four times the federal poverty level — $11,490 to $45,960 for an individual and $23,550 to $94,200 for a family of four — typically qualify for the subsidies.

Christine Sinatra, state spokeswoman for Enroll America, which has worked to enroll individuals in the federal marketplace, said the availability of financial assistance was “obviously a big factor” for that encouraged many in Texas to get insurance.

“What’s most important at this stage is for consumers to know that no one will lose their coverage or their financial help while this judicial process plays out,” Sinatra said. “And today’s decision isn’t making anyone newly uninsured.”

As noted in the story, some 734K people signed up for insurance via the federal exchange, and they generally got a good deal when they did. Put that aside for now, because as Josh Marshall suggests, the en banc reviews are likely to result in both courts agreeing, in which case there’s no dispute for the Supreme Court to resolve. But they could still take the case, or maybe something goes sideways with the en banc reviews. What happens if the adverse ruling is ultimately upheld? Kevin Drum suggests one possibility.

The key point here is that people respond much more strongly to losing things than they do to not getting them in the first place. For example, there are lots of poor people in red states who currently aren’t receiving Medicaid benefits thanks to their states’ refusal to participate in Obamacare’s Medicaid expansion. This hasn’t caused a revolt because nothing was taken away. They just never got Medicaid in the first place.

The subsidies would be a different story. You’d have roughly 6 million people who would suddenly lose a benefit that they’ve come to value highly. This would cause a huge backlash. It’s hard to say if this would be enough to move Congress to action, but I think this is nonetheless the basic lay of the land. Obamacare wouldn’t be destroyed, it would merely be taken away from a lot of people who are currently benefiting from it. They’d fight to get it back, and that changes the political calculus.

Six million people nationwide, 734,000 in Texas. Remember, while it would take Congress to fix the national problem if it comes to that, there’s nothing stopping Texas or any other state from setting up their own exchange, as the law (as interpreted by two federal judges in Washington, DC) says. State Rep. John Zerwas tried to pass a bill in 2011 to establish an exchange in Texas, on the very reasonable grounds that a state-run exchange would be a better fit than a national one would. Sadly, though not surprisingly, it went nowhere, thanks in large part to Rick Perry’s fanatical opposition. My point is that if Drum is right then any pressure on Congress to fix this would also translate to the state Legislature. Who knows what effect that might have in 2016, or even 2018? Or for that matter, how about this year, too? Seven hundred thousand people losing something that they now have, that sure is a lot. Surely there’s something we can do with that.

The people who signed up for insurance via Obamacare got themselves a pretty good deal

It worked the way it was supposed to work, in other words.

It's constitutional - deal with it

It’s constitutional – deal with it

Texans who received financial assistance to purchase health coverage through the federal insurance exchange are paying less in monthly premiums than individuals in most other states using that online marketplace, according to a new report by the U.S. Department of Health and Human Services.

Texas, like dozens of other states with Republican leadership, declined to create its own state-based insurance exchange under the Affordable Care Act, relying on a federally managed marketplace instead.

Texans who receive tax credits to help them purchase health coverage through the federal marketplace pay $72 on average in monthly premiums for their plans — the seventh-lowest monthly premium among the 36 states using the federal marketplace.

The national average for subsidized enrollees in the federal marketplace is $82 a month, with individuals in states like New Mexico, Wyoming and New Jersey paying more than $100 a month on average.

[…]

On average, subsidized enrollees — who make up 84 percent of Texans who purchased coverage through the federal marketplace — have received $233 in monthly tax credits in Texas.

You can see the report here – the breakdown of subsidy amounts by state is on page 23. There are still things that need to be fixed with Obamacare, as with any large new program, but they’re all doable given a non-insane Congress and some time. The best news so far is that premium increases will be modest for next year, and more insurers want in. As Kevin Drum says, it’s time to acknowledge that it’s working pretty well overall.

Not that this will make any of the usual suspects shut up already, of course.

Opponents of the health reform law have attributed low overall enrollment rates to the fact that low premiums often mean high deductibles. Despite the subsidies offered by the federal government, Texas’ total enrollment numbers have not made a big dent in the state’s sky-high rate of uninsured.

John Davidson, a health policy analyst at the conservative Texas Public Policy Foundation, has said that Texans’ reluctance to purchase insurance through the marketplace in bigger numbers stems from the cost of the health plans, even subsidized ones.

He added that individuals are also apprehensive about accepting the subsidies because they might be faced with paying them back if their annual income increases.

I look forward to the day when a story about Obamacare can be written without reporters feeling compelled to include some “on the other hand” quotes by shills like John Davidson. He has no useful insights or criticisms to offer, he’s just here for the FUD. If you must quote a hack like Davidson, then the least you should do is make it clear that his objections have nothing to do with numbers and everything to do with plain old politics. Matt Yglesias lays out what the argument really is.

One of America’s political parties doesn’t like that idea in any non-health context and they don’t like it for health care either. They think the money it costs to provide those subsidies should be taken away, and it should be given to high-income households in the form of tax cuts.

This is an excellent and important policy debate to have. One of the great ideological issues not just of our time and place, but of democratic politics across eras and countries. Should economic resources be distributed more equally or less equally?

But thus far to an amazing extent we haven’t been having that debate. Instead we’ve been having a debate over whether Obamacare works, over death panels, over enrollment numbers, over income verification procedures, and over the minutia of premiums and payments. It’s time to put that debate behind us. It’s clear — as it always should have been — that if you offer people large subsidies to go buy health insurance, lots of people will happily take the money and go buy some health insurance.

It’s time to start debating the real issue: should we do that, or is it more important to keep taxes on high-earners low than to give low-earners comprehensive health insurance?

So to be clear, John Davidson and his overlords absolutely support cutting their taxes so they don’t have to help pay for anyone to get health insurance. That’s what you should read when you see someone like him quoted in one of these stories.

Two million Texans used healthcare.gov

Yeah, we had lots of demand for health insurance. That’s what happens when you have so many uninsured people in a state.

It's constitutional - deal with it

It’s constitutional – deal with it

Almost all adult Texans knew of the Affordable Care Act’s health insurance marketplace before its open enrollment ended March 31, new research shows.

In a report released Wednesday, Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation discovered about 2 million Texans who looked for marketplace information found the healthcare.gov website helpful. Almost half of those who went to the site wanted to buy insurance or check premium subsidy eligibility.

Wednesday’s report was based on responses from 1,595 Texans in September and 1,538 in March. The poll is part of the Urban Institute’s Health Reform Monitoring Survey, a national project on the 2010 health law’s implementation and changes in health insurance coverage and related health outcomes. The Baker Institute and the Episcopal Health Foundation are focusing on factors about Texans from an expanded survey sample of Texas residents. The report is the fifth on Texas’ health law implementation.

“In our previous report, we estimated that 746,000 Texans purchased insurance through the marketplace,” Vivian Ho, chair in health economics at the Baker Institute and a report author, said in written statement. “Given that 2 million Texans looked for coverage through the Marketplace, a strikingly high percentage of them elected to enroll in a health insurance plan.”

Here’s the report. More reports from the same group, which I’ve blogged about before, can be found here. Just imagine how many more visits and signups there could have been if our Republican state leaders weren’t so zealously committed to keeping people unhealthy.

Nearly 200,000 ACA signups in Houston area

Not too shabby.

It's constitutional - deal with it

It’s constitutional – deal with it

Like the rest of the country, the Houston area appears to have benefited from a last-minute surge in people signing up for federally mandated health insurance. At least 197,650 local residents enrolled in the program, figures released Wednesday show.

The Houston sign-ups represent almost 27 percent of Texas’ 733,757 enrollees, the Houston nonprofit health organization Gateway to Care said in a written statement. The federal government announced the overall numbers last week.

Wednesday’s announcement represents the first time Houston-specific insurance enrollment information related to the Affordable Care Act has been released publicly.

Gateway to Care was among several area organizations that helped residents sign up for coverage.

“This result could only have occurred because everyone worked so well together,” executive director Ron Cookston said in a statement.

Of the Houston area’s estimated 1 million uninsured population, half were predicted to be eligible for coverage.

“That last push must have had an effect,” said Vivian Ho, James A. Baker III Institute health economics chair at Rice University.

See here for the background. At the time that the Texas enrollment numbers were released, the estimate was 177K Houston-area folks had signed up. Before that, when the Baker Institute released its report, we learned that the expected number for the region had been 138K. Still not nearly enough – if 200K signed up and 500K were eligible, that’s a lot of folks left behind – but given the constraints, it not bad and clearly better than people thought it would be. We’ve got to aim to make it better next time. Having a better Governor would go a long way towards that.