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Texas health insurance exchange

Texas premium average is $72 for subsidy-eligible enrollees

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There is no doubt that Obamacare has made health insurance much more affordable for most people in Texas.  A study released by HHS on June 18 found that the average net premium for people receiving tax credits in the Texas exchange was just $72/month (a 76% reduction from the $305/month “retail” price).  And 84% of Texas residents who have enrolled through the exchange have qualified for tax credits.  The $72/month after-subsidy premium in Texas is the seventh lowest out of the 36 states where HHS is running the exchange – the average across all 36 states is $82/month.

Enrollment in the Texas exchange skyrocketed to 733,757 by April 19.  As of March 1, private plan enrollment in the Texas exchange had been at 295,000.  The increase during March and the extension period in the first half of April was the largest of any state in the country.  That followed January and February enrollment of more than 90,000 new enrollees per month in Texas.  Total enrollment in Texas was the second highest of the states where HHS is running the exchange, trailing only Florida.  Although general open enrollment for private plans is now closed until November 15, enrollment has continued to grow during May and June as a result of qualifying events that trigger special open enrollment periods. HHS will release official “off-season” enrollment data in November.

An additional 141,494 exchange applicants had enrolled in Medicaid, despite the fact that Texas is not expanding Medicaid under the ACA (those applicants were already eligible under existing rules).  Total enrollment – including private plans and Medicaid – was just over 875,000 people as of April 19.

The significant enrollment numbers in Texas are testament to a law that is working well, and its success is being praised by Texas Democrats.  But Republicans in the state legislature have vowed to continue their fight against the ACA in the 2015 legislative session.

CMS announced on November 22 that Texas applicants can enroll in QHPs directly through insurers – bypassing the exchange website entirely –  with premium and cost-sharing subsidies available for eligible enrollees (the federal data hub is used to verify identity and determine subsidy eligibility for enrollments that go directly through insurance carriers).

Amid concerns over the problems that beset HealthCare.gov in the first several weeks of open enrollment, Texas Insurance Commissioner Julia Rathgeber announced on November 22 that the state-run high risk pool would remain in existence until March 31, 2014.  It had originally been scheduled to close at the end of December, but it was unclear whether all 23,000 members of the pool would be able to secure coverage through the exchange in time to have January 1 effective dates.  The Texas high risk pool did close on March 31, and all remaining policies were terminated at that time.  The program’s website has information for members, including a reminder that they qualify for a 60 day special open enrollment window for an ACA-compliant plan following the loss of their high risk pool coverage.

Texas Gov. Rick Perry formally notified the Department of Health & Human Services (HHS) in July 2012 that Texas would not implement a state-run health insurance exchange. In his notification letter, Perry —a long-standing opponent of the Affordable Care Act — called the ACA provisions “brazen intrusions into the sovereignty of our state.”  In early January, the Perry Administration’s efforts to make it more difficult to be a navigator in Texas drew criticism from ACA supporters and Democratic lawmakers, who claim that Perry is simply trying to impede enrollment in the Texas exchange.

Texas State Representative Eric Johnson, a Democrat from Dallas, did introduce bills in early 2013 that would have created a state-run exchange and expanded Medicaid, but neither was successful.  HHS is running the exchange in Texas, and the state is not expanding Medicaid.

Premiums in the Texas exchange are less than the national average.  Averaged for all age groups, the lowest cost bronze plan in the Texas exchange is $211/month, compared with a national average of $249/month.  That’s good news for Texas residents, but the technological problems that have plagued HealthCare.gov throughout October have hampered enrollment.  Twelve carriers are offering a total of 95 different health plans in the Texas exchange, so residents have many options from which to choose and competition among carriers is helping to keep the rates below the national average.  Not only are there a wide range of plans available in Texas, but there are also several big-name health insurance carriers participating in the Texas exchange, including Aetna, Cigna, Blue Cross Blue Shield of Texas and Humana.

According to the U.S. Census Bureau, 25% of people in Texas are uninsured — the highest rate in the nation. A report prepared by the Hobby Center for the Study of Texas at Rice University estimated that 3 million people could gain coverage by 2014 if the state implemented the provisions of the Affordable Care Act.  But with the state’s current refusal to expand Medicaid, approximately one million of those people will fall into a “coverage gap” (and likely remain uninsured) because they earn too much to qualify for Medicaid but too little to qualify for subsidies in the exchange.

According to a Kaiser Health News article, Blue Cross Blue Shield of Texas is playing a major role in educating state consumers about the federal health insurance marketplace. The Blues plan is using many strategies to reach consumers: creating a website, launching a texting campaign, and engaging churches, community clinics, nonprofits, and other community organizations.

Texas health insurance exchange links


Be Covered Texas

Federal Health Care Reform Resource Page
From the Texas Department of Insurance

Texas Health Options

State Exchange Profile: Texas
The Henry J. Kaiser Family Foundation overview of Texas’ progress toward creating a state health insurance exchange.