Enrollments are up and the number of uninsured are down, though both could have been a lot better.
It’s constitutional – deal with it
The sky-high rate of Texans without health insurance has dropped only slightly since the launch of the federal Affordable Care Act’s online health insurance marketplace, according to a new report from Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.
During the open enrollment period from September through March, the rate of uninsured adults in Texas fell to 23.5 percent from 24.8. And most of that change was attributable to an increase in employer-sponsored health coverage, the report found, rather than new signups in the federal marketplace.
Texas’ decline in the rate of its uninsured was commensurate with those in other Republican-led states that elected not to expand Medicaid to cover poor adults. But while the number of Texans applying for coverage in the online marketplace — about 746,000, according to the report — pales in comparison to the more than 5 million who lack insurance, ACA proponents may see reason for optimism, the authors wrote. The 746,000 figure represents a significant increase in Texas enrollments from the 295,000 reported by the federal government as of March 1.
“You look at the absolute numbers and say, ‘Wow! This is a good start,’” said Vivian Ho, a co-author.
The report, which draws its conclusions from survey data rather than figures that are gradually being released by the U.S. Department of Health and Human Services, offers new insight into what kinds of people are signing up for insurance under the ACA.
For example, only about 30.2 percent of those seeking coverage in the online marketplace were previously uninsured, researchers found. Employer-provided health insurance seemed to be responsible for the biggest drop in the uninsured.
“If I had to guess, a large portion of that is just the upswing in the economy,” Ho said. “There are more people getting jobs.” But she added that some businesses are also preparing to comply with the upcoming coverage mandate for their employees, offering low-cost insurance options for low-wage workers, a trend that may be reflected in the data.
We also now have some specific information about Houston enrollments.
Meanwhile, in an unrelated report, the Associated Press found more than 177,000 Houston residents signed up for health coverage, exceeding expectations and indicating a last-minute enrollment push just before the March 31 deadline might have helped Texas meet projected targets despite months of lagging.
The news service, citing an email by Marjorie McColl Petty, the Department of Health and Human Services’ Dallas regional director, and obtained by the Associated Press, reported that as of April 5, some 177,825 Houston residents signed up for coverage. A previous email by Petty said that as of March 29, 149,273 Houston residents had signed up for insurance, the AP said.
The expectation had been that 138,000 Houston residents would sign up.
You can see the Baker Institute report here. This answers some of the questions raised in my earlier post, though the Kaiser numbers have not yet been updated. As noted, there’s no official tally of who does or does not have health insurance in Texas. We’ll have the healthcare.gov enrollment totals, and I presume HHSC has Medicaid and CHIP numbers, but beyond that it’s all estimates and speculation.
We all know how this has gone down in Texas, where the party line from the Republican leadership has been one of unrelenting hostility and obstacles. Not surprisingly, in states like Texas the ranks of the uninsured decreased at a lower rate than in states that are not run by heartless assholes. With the grace period for people who began but were unable to complete the enrollment process now over, the official tally for healthcare.gov enrollees is eight million. That doesn’t count state exchanges, Medicaid expansions, the under-26 set that can be on their parents’ insurance, or people who will now have insurance through their employers; the grand total is at least 14 million, and counting. And it could have been so much more.
Opponents of the ACA said the report spelled bad news for President Obama’s signature health law. John Davidson, a policy analyst for the conservative Texas Public Policy Foundation, called the number of previously uninsured people who signed up for coverage on the exchange a “drop in the bucket” compared to Texas’ total uninsured population.
“I believe that cost is driving these numbers,” Davidson said. “Coverage on the exchange is very expensive, and it’s expensive even if you get a subsidy, in many cases.” He compared the report’s projection that 746,000 Texans had enrolled in the marketplace to a recent HHS brief that estimated that 2.2 million Texans could qualify for subsidies.
“Something’s going on there,” Davidson said. “Why so few?”
I’m going to be charitable and not assume that the oft-quoted token Davidson is sufficiently stupid as to be genuinely baffled. The organization for which he is employed is a malignant force in Texas, but they are quite clear-eyed about their goals. He knows what the truth is, and he knows what his role in relation to it is. The real question is why the Tribune, or any self-respecting news organization, thinks there is value in including his disinformation. Why do you think it’s a good idea to let someone lie to your readers, Evan Smith? I can’t think of a good reason for that. The LA Times has more.