Four new carriers join Texas exchange
Open enrollment for 2015 begins on November 15 and continues through February 15. Applicants in Texas will be using a much-improved HealthCare.gov to complete their enrollment or make changes to their existing exchange coverage.
Rates have not yet been released for 2015, but the exchange will have 16 carriers offering plans in Texas for 2015, up from 12 this year. This puts Texas tied for first place (with Michigan and Ohio) in terms of the total number of carriers participating in the exchange.
No renewal for grandmothered plan
In November 2013, the federal government announced that states could allow non-grandfathered, pre-2014 health plans (dubbed “grandmothered” plans) to renew again and remain in force in 2014. In March 2014, they issued another extension for these transitional policies, allowing states to let them continue to renew as late as September 2016. The majority of the states have accepted that proposition, but Texas regulators simply didn’t issue any guidance whatsoever on the matter (in interviews with insurance officials in each state, Texas was alone in this regard – every other state took a position either for or against renewal of grandmothered plans).
Because Texas didn’t issue any guidelines for renewal of grandmothered plans, those policies are not allowed to renew in Texas in 2014. At what would have been their renewal date, they must instead be replaced with ACA-compliant coverage.
ACA making coverage affordable
There is no doubt that Obamacare has expanded access to affordable health insurance 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 percent reduction from the $305/month “retail” price).
And 84 percent 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.
2014 enrollment exceeds 7o0,000
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.
According to a Gallup poll released last summer, 27 percent of Texas residents were uninsured in 2013 — the highest rate in the nation. That rate fell slightly during the first half of 2014, but remained at an alarmingly high 24 percent by mid-2014.
A report prepared by the Hobby Center for the Study of Texas at Rice University estimated that 3 million people could gain coverage in 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.
Rates and carriers
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 in 2014, compared with a national average of $249/month.
Twelve carriers are offering a total of 95 different health plans in the Texas exchange in 2014 (this is increasing to sixteen in 2015), 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.
There has been some concern that not enough doctors are accepting health plans purchased through the exchange, but in many cases it’s impossible for medical offices to know whether a plan was obtained in the exchange. But a USA Today article published in late October notes that doctors in Texas are pushing for a requirement that insurance id cards indicate whether a plan was purchased through the exchange, and what metal level coverage it is.
Exchange history and legislation
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.”
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.
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, 2013 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).
The Texas High Risk Pool (a health plan for people with pre-existing conditions that pre-dates the ACA) remained open for the first three months of 2014, after originally being scheduled to cease operations at the end of 2013.
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.
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
Federal Health Care Reform Resource Page
From the Texas Department of Insurance
State Exchange Profile: Texas
The Henry J. Kaiser Family Foundation overview of Texas’ progress toward creating a state health insurance exchange.