Facing challenges from Texas and D.C., a new Affordable Care Act enrollment period begins

This year, there's no penalty for people who don't sign up for insurance, and the federal government isn't spending as much to promote enrollment.

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For the first time since the Affordable Care Act became law, Texans don’t have to sign up for insurance unless they really want to — but those who do can start Thursday.

Texans can go to Healthcare.gov, the federal health exchange website, to enroll in a health insurance plan between Nov. 1 and Dec. 15.

The sign-up period comes months after a U.S. Census report showed Texas still has the largest percentage of uninsured residents in the country at 17.3 percent, nearly twice the national rate. It also comes as Texas and 19 other states await a federal judge’s decision on whether to end the Affordable Care Act, known as “Obamacare,” after arguing in September that the law is no longer constitutional after Congress ended the individual mandate.

This open enrollment period is the first time Texans won’t face a penalty if they decide to not sign up for coverage. The federal tax bill zeroed out the individual mandate under the 2010 health law for plans that start coverage on Jan. 1, 2019.

Stacey Pogue, senior policy analyst for the Center for Public Policy Priorities, a left-leaning policy organization, said she worries what will happen to the insurance market as more people realize they don’t have to sign up for coverage anymore. She said sick people who need coverage the most will always know when open enrollment is and how to sign up.

“Having only sick people covered is not going to be stable over time,” Pogue said. “Premiums will rise and the marginally healthiest will drop out each year.”

In addition, Texans can purchase short-term insurance plans that can provide up to a year of coverage and are potentially renewable for up to three years. Those plans won’t be sold on the Healthcare.gov website, but experts say they expect those plans to be heavily marketed. Meanwhile, the Trump administration has continued with a shorter enrollment period compared to other years and reducing funding for outreach.

Health insurance premiums have increased minimally across the market compared to last year. But Texans still have access to help paying for coverage if they need it. Last year, Texas residents received an average of $477 in tax credits to help pay for their health insurance, according to U.S. Department of Health and Human Services data. They paid an average of $79 per month after subsidies. But some residents make too much money to qualify for subsidy help.

Dr. Deane Waldman, director of the conservative Texas Public Policy Foundation’s Center for Health Care, said that there’s often too much focus on Texas’ uninsured rate and who is and isn’t getting health insurance. He said there should be more focus on access to care regardless of health insurance status.

Waldman pointed to the case of Deamonte Driver, a 12-year-old boy in Maryland who died in 2007 of an infected tooth. He was insured under Medicaid, the joint federal-state health insurance program for the poor and disabled, but there were no dentists available and the family had lost their coverage.

“We have to pay less attention to the number of people insured and more attention to are people getting timely care,” Waldman said.

Health advocates have also expressed concern that underrepresented communities won’t be reached during the sign-up period after several community groups didn’t get federal funding. In September, the Centers for Medicare and Medicaid Services announced more funding cuts nationwide for navigators, which help people sign up for health insurance. At the time, agency officials said the number of people enrolling in health insurance did not justify the amount spent on the program, which targets hard-to-reach populations. Between 2016 and 2018, the agency has dropped funding levels by $52 million, according to the Kaiser Family Foundation, a nonpartisan health policy group.

In Texas, that funding went down by 85 percent over two years to just $1.4 million in 2018. Only two community organizations statewide — Change Happens, a clinic based in Houston and MHP Salud, a community health group in the Rio Grande Valley, Laredo and El Paso — received funding for the navigator program.

That’s why health insurance companies like Community Health Choice, a nonprofit health insurance plan based in Houston, are stepping up their outreach efforts and working closely with insurance brokers to reach new people, said Ken Janda, president and CEO of the company.

He said the company isn’t anticipating a drop in enrollees even without the individual mandate, pointing to how they were able to keep their numbers steady despite a 30 percent premium increase last year. Simply put, Janda said, “once people have insurance, they like having insurance” and don’t want to go back to being uninsured.

“What worries me more is the people that should have insurance that are uninsured,” Janda said. “If there was more outreach to them and someone to explain to them what’s going on, we'd get more of those people to sign up. … The negativity around the Affordable Care Act in Texas and lack of tax penalty will mean we're not going to see a lot of growth.”


Disclosure: The Center for Public Policy Priorities, the Kaiser Family Foundation and the Texas Public Policy Foundation have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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