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Vivian Ho

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

I mean, duh.

Right there with them

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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.

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.

Fewer Texans having trouble paying medical bills than pre-Obamacare

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

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

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

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

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

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

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

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

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

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

The demography of the uninsured in Texas

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

It's constitutional - deal with it

It’s constitutional – deal with it

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

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

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

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

[…]

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

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

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

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

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.

918K and counting

Obamacare enrollment numbers in Texas keep going up.

It's constitutional - deal with it

It’s constitutional – deal with it

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

[…]

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

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

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

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

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

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

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

Where Texans got their Obamacare information

The Baker Institute tells us.

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

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

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

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

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

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

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

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

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

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.