It’s been more than six years since President Barack Obama signed the Affordable Care Act, or Obamacare – a term the president himself ended up embracing. His two terms are almost up, and the legacy of Obamacare that’s left behind in Texas is complex.
More people in Texas have signed up for health insurance plans on the federal marketplace than any other state, except Florida. But there are many people who still can’t afford insurance, even with subsidies.
Charles Begley, professor at Houston’s University of Texas School of Public Health, says the law is like a three-legged stool. The public has a mandated duty to get either public or private insurance, or receive a tax penalty. The government has a responsibility to increase the affordability of health care. And private insurance industries have a commitment to make coverage available to people who can’t afford premiums.
Begley says Texas has all three legs, but some of those legs are coming up short.
“What’s missing is the government responsibility part,” he says. “We have the individual marketplace exchange, but we do not have Medicaid expansion.”
Texas’ lack of Medicaid expansion has caused a wide gap between the number of people who are uninsured in the state versus in states who did accept the Medicaid expansion.
Begley says in states with Medicaid expansion the number of uninsured people has dropped by half and those targeted by the law – low- and middle-income families that make between $30,000 to $100,000 per year – have gotten much better access and medical care bills. But in Texas uninsurance rates have dropped by about a third, and there are still problems for low- and middle-income families.
More than 1.3 million Texans have signed up for marketplace plans this year on the federally run insurance exchange HealthCare.gov – a 78 percent increase in enrollment since 2014. The state has the second-highest number of enrollees in the nation, trailing Florida. But Begley says that’s because we’re a large state.
The legacy the Affordable Care Act will leave behind in Texas depends on who you talk to, Begley says. For low- and middle-income families, the law’s affect is “very favorable.” But for others, it’s not so great.
“For people who have not directly benefitted from some of the provisions of Obamacare, the feelings are not so supportive. There is definitely divisiveness,” Begley says. “Time will tell as to whether or not these two viewpoints come together.”
One bump in the road for the upcoming enrollment period – which opens in November – is that the number of plans on HealthCare.gov has gone down. Insurance companies are dropping out.
“There seems to be a concern that there won’t be as much participation in the marketplace in this enrollment period coming up,” Begley says. “So will that lead to a meltdown? I doubt it. I think it will lead to a mid-course correction. Which is needed. There are lots of things that need to be done to improve Obamacare. This is one of them.”
Post by Beth Cortez-Neavel.