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Kaiser Family Foundation

Harvey’s lingering health effects

It’s going to be a long time before we can really say we have put Hurricane Harvey behind us.

Three months after Hurricane Harvey, local health officials now are beginning to see the storm after the storm.

In Harris County and the other hardest-hit regions of Texas, 17 percent of those who had houses damaged or suffered income loss report that someone in their household has a new or worsening health condition. A sweeping new survey by the Kaiser Family Foundation and Houston-based Episcopal Health Foundation shows a similar proportion feels their own mental health has worsened.

“We’re not anywhere near the end yet,” cautioned Dr. Cindy Rispin, a family physician with the Memorial Hermann Medical Group in League City.

Researchers surveyed more than 1,600 Texans in 24 affected counties to gauge their personal recovery. The report released Tuesday found a region still reeling in ways obvious and hidden.


More than four in 10 residents surveyed for the “Early Assessment of Hurricane Harvey’s Impact on Vulnerable Texans in the Gulf Coast Region” report said their homes had hurricane damage. Three percent reported their homes were destroyed.

Among those whose homes were damaged, nearly half said they had homeowners’ or renters’ insurance, but only 23 percent had flood insurance.

“We’re going to see foreclosures hit. It will probably be people that financially were in a tight spot already,” real estate agent Matthew Guzman said in a recent interview.

Perhaps most ominous is the quiet toll Harvey is still taking, months later, on people’s physical and mental health.

Worse, many storm victims were already uninsured in a state that leads the nation in those without coverage. Even those with coverage complained they cannot afford health care, especially as longtime doctors are no longer nearby when people become displaced. About six in 10 say they have skipped or postponed needed treatment, cut back on medication or struggled to get mental health care.

An executive summary of the poll, with links to all the poll data, is here. Some sobering facts from the summary:

About half of those who have applied for disaster assistance from FEMA or the SBA say their application is still pending or has been denied, and many of those who were denied say they were not told the reason for the denial and were not given information on how to resubmit their application. About a quarter of those whose homes were damaged say they had any flood insurance. Four in ten of those who were affected say they expect none of their financial losses to be covered by insurance or other assistance.

The financial situations of most people affected by Harvey are tenuous. About half of affected residents say they have no savings whatsoever, and another quarter say that if they lost their job or other source of income, their savings would be exhausted in less than 6 months.

Nearly half of affected residents say they are not getting the help they need to recover from the hurricane. Particular areas that stand out where residents say they need more help include applying for disaster assistance and repairing damage to their homes.

Local, county, and state governments receive high marks from residents for their response to Hurricane Harvey so far. Residents are more mixed in their views of how the U.S. Congress has responded, and responses tilt negative when it comes to President Trump’s response. Four in ten affected residents are not confident relief funds will benefit those most in need.

I wish I could say people are being needlessly pessimistic, but I can’t. ThinkProgress and the Trib have more.

Fewer Texans having trouble paying medical bills than pre-Obamacare

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

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

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

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

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

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

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

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

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

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

Last minute health insurance enrollment help

From the inbox:

It's constitutional - deal with it

It’s constitutional – deal with it

The Houston Department of Health and Human Services (HDHHS) will open four of its multi-service centers on Sunday and extend their business hours next Monday to help people sign up for a health insurance plan by the Affordable Care Act’s March 31 deadline.

HDHHS will open Acres Homes, Denver Harbor, Northeast and Southwest multi-service centers on Sunday, March 30, from 12 p.m. to 6 p.m. It will also extend the four multi-service centers’ business hours on Monday, March 31, until 10 p.m., setting the last ACA enrollment appointment for 8 p.m.

Approximately 99,000 Houston-area residents have enrolled in one of the more than 40 low-cost ACA health plans available in the region. Those without health insurance have only one week left to sign up.

Residents can set up an appointment for one-on-one help from certified application counselors at HDHHS by calling 832-393-5423. The counselors are able to help residents compare health plans and find one that fits their budget and health care needs.

The phone number connects residents to an ACA call center that HDHHS set up as part of the Gulf Coast Health Insurance Marketplace Collaborative, a group of 13 agencies helping people obtain insurance coverage through the ACA.

Certified application counselors and outreach staff with HDHHS and the other agencies in the collaborative have met face to face with more than 151,500 area residents since the enrollment period began in October. They have also reached out or distributed ACA brochures and information to approximately 538,000 people.

Documents needed to enroll during an appointment include:

  • Proof of U.S. citizenship: social security number or copy of U.S. passport for all family members
  • State residency: driver’s license, housing lease or utility bill
  • Income:  W-2 forms or pay stubs; unemployment or disability; social security, pension and retirement income; or copy of 2012 tax return
  • Current health insurance: policy numbers for any current health insurance and information about job-related health insurance
  • Immigration status or legal residency: Immigration document status numbers.

The press release is here, and Stace was also on this. There are going to be a number of rallies and other events aimed at getting people signed up while they still can. Another event, via State Rep. Jessica Farrar, will be Saturday, March 29th from 9:00 a.m. – 1:00 p.m. at the Harris County Department of Education Conference Center, 6300 Irvington Blvd. Anyone who has questions about the exchange or is currently without health insurance is encouraged to attend. Here’s a Trib story about the pre-deadline push.

The Affordable Care Act requires most individuals to purchase health insurance by 2014, specifically by March 31, which will mark the final day of canvassing and enrollment outreach by nonprofits, local governments and community organizations.

At the start of March, 295,000 Texans had selected a coverage plan in the federal marketplace, but the number of total enrollees represents a small fraction of the uninsured in Texas.

National advocates for health reform have homed in on Texas’ enrollment in recent weeks, including U.S. Secretary of Health and Human Services Kathleen Sebelius, who was in Texas last week to promote enrollment efforts, including a final push to mobilize young adults to sign up for insurance through the marketplace.

Enroll America, a nonprofit group promoting the federal health reform law, launched a six-city bus tour through Texas last week to help people enroll in the exchange. Anne Filipic, president of the group, said it has focused on Texas because of the amount of people “who stand to benefit” from the federal health reform.

The organization has also set up a series of enrollment events throughout the state, including the one Donnell attended, as part of the final week of enrollment and is following up with individuals who started their process at one of the events to help them complete their enrollments.

Locally, state Democratic legislators have hosted their own enrollment efforts or have worked with entities like the Texas Organizing Project, a group that advocates for low-income Texans, to host regular enrollment events in Dallas, Bexar and Harris counties.

Federally qualified health centers in Texas also received more than $15 million federal grants to help individuals enroll in the marketplace. Lone Star Circle of Care clinics was among the top recipients in the state, receiving a combined $600,000 in grants to provide enrollment assistance.

Lone Star spokeswoman Rebekah Haynes said its 35 certified application counselors have seen an uptick in demand for enrollment assistance in the last few weeks, and they are working with hundreds of individuals to verify whether they qualify to purchase health insurance through the marketplace.

Texas could have delivered half of the enrollees the Obama administration is banking on. The Kaiser Family Foundation estimates that 3,143,000 Texans are potential marketplace enrollees, but only 9.4 percent of that population has enrolled. (Potential enrollees include uninsured Texans who are U.S. citizens and have incomes above the amount needed to qualify for Medicaid.)

You have to wonder what might have been if anyone in the Republican leadership cared even a little bit about the vast number of uninsured people in Texas. Be that as it may, if you know someone who needs coverage but still hasn’t signed up yet, do whatever you can to encourage them to get it done now. Time is very much running out.

Another way Obamacare is helping Texas right now

Insurance rebates.

Texas consumers and businesses are poised to receive an estimated $186 million in rebates from health insurers under a requirement of the Affordable Care Act, according a study released today by the Kaiser Family Foundation.

The health care act’s medical loss ratio provision requires insurers to issue rebates if their total administrative expenses and profits are relatively higher than those permitted under the act. The Kaiser study estimates that 92 percent of Texas consumers in the individual insurance market will receive rebates, the highest figure for any state in the country.

The provision, which went into effect in January 2011, requires that insurance companies covering individuals and small businesses spend at least 80 percent to 85 percent of insurance premium dollars on health care and improving care quality. The provision is designed to curb spending on administration costs and profit. When insurers don’t meet the 80/20 ratio, they are required to distribute rebates, as they will be doing come August. The Kaiser Family Foundation estimates those rebates based on 2011 data will total $1.3 billion nationally.

Sarah Kliff has more on this. I propose that if SCOTUS does strike down Obamacare that Greg Abbott and all of the other Attorneys General who litigated against it be required to cover the cost of the lost refund to consumers. Who’s with me?