Texas tops the nation in Obamacare sign-ups
The pandemic has exacerbated economic disparities in America, taking a heavier toll on women, people of color and those who don’t have a college education.
But millions without health insurance have benefited during the public health emergency — by getting new coverage, paying less for it or simply not being thrown off their existing Medicaid plan.
Through August, just over 1.4 million Texans had enrolled and paid for insurance through HealthCare.gov, the federal marketplace for individuals and families. That’s an increase of nearly half a million customers since 2019, and it is easily the state’s highest enrollment yet.
Over the past two years, Texas’ percentage gain in enrollment was more than double the increase nationwide — and was higher than any other state.
So what has Texans embracing Obamacare like never before?
Start with higher federal subsidies, which make it cheaper for people to enroll — and cheaper to stay with their existing plans. The extra funding to cut the cost of coverage was part of the pandemic relief package put together by the Biden administration this year, and it included more money for marketing and assistance with navigating the application process.
The administration added a special enrollment period
that stretched from February to August and made it easier to sign up.
More people were looking for coverage because the pandemic led to a surge in layoffs and the loss of employer-sponsored insurance. The relief package includes generous premium subsidies for those who received unemployment benefits.
“It’s a combination of factors that really changed the ballgame,” said Stacey Pogue, senior policy analyst at Every Texan, an Austin advocacy group formerly known as the Center for Public Policy Priorities. “There’s a whole bunch more financial help, and the doors were opened wide for people to come in. The federal government made an effort in marketing, in enrollment
assistance and in making coverage more affordable.”
The results were dramatic here: In August, the number of Texans on HealthCare.gov was nearly 50 percent higher than before the pandemic.
“When we work to address the barriers (to coverage), it makes a big difference,” Pogue said.
The gains mean a lot in Texas, where over 5.2 million residents didn’t have health insurance in 2019 — easily the worst showing in the country. Texas had over 2 million more uninsured than runner-up California, a state with 10.5 million more residents.
During the six-month special enrollment period ending in August, 417,000 Texans were newly enrolled,
the most since 2015, the year after the Affordable Care Act took full effect.
More than half the new Texas enrollees got a plan for no more than $10 a month, Pogue said. Across the nation, median deductibles for new customers were $50, down from an average deductible of $750 last year.
An additional 855,000 Texans, who already had coverage on the exchange, qualified for more savings — a premium cut of 46 percent on average, Pogue said.
What’s the biggest takeaway from the surge in Texas enrollment?
“People want health insurance, people value health insurance — it just has to be affordable to them,” said Elena Marks, CEO of the Episcopal Health Foundation
in Houston, which focuses on improving community health. “If it’s not affordable and you have to pay rent, buy food and take care of your kids, it’s not the first priority. Once it’s affordable, it becomes a priority.”
The health law includes generous federal funding for the expansion of Medicaid, which was designed to provide health coverage for working adults with lower incomes. But Republican lawmakers in Texas have refused to expand Medicaid, most recently in this year’s Legislature. That places Texas among 12 states that rejected expansion.
Despite that posture, Texas’ Medicaid rolls have soared by over 1 million people. They’re projected to hit 5.33 million in the fourth quarter, up from 4.16 million in the early months of the pandemic, according to projections in a report by researchers at the Urban Institute, a nonprofit research organization in Washington.
Medicaid enrollment surged throughout the country, and one reason is that so many were laid off that they qualified for coverage. But in Texas, very few able-bodied adults receive Medicaid benefits, so there’s another explanation: The first COVID-19 relief bill prohibited states from throwing residents off their Medicaid programs during the public health emergency.
“People are gaining Medicaid eligibility and losing it every month, and the federal change essentially prevented disenrollment for those losing eligibility,” said
Matthew Buettgens, a senior fellow at the institute and co-author of the report. “People who aren’t categorically eligible — like childless adults, for example — none of them gained eligibility, regardless of their income. Texas would have to expand Medicaid for that to happen.”
He expects the number of Texans on Medicaid to decline sharply after the health emergency ends. By the middle of next year, he projects over 1 million Texans being pushed off the program.
So what to read into the big increase?
“It certainly shows that people are seeking coverage,” Buettgens said. “It shows the demand.”
It also reveals a glaring weakness in Texas’ GOP leadership. They’re unwilling to meet the great demand for health coverage, whether through expanding Medicaid or promoting more sign-ups on HealthCare.gov.
Texas leaders often mock California, but the Golden State has done a far better job at getting people covered. From 2010 to 2019, California reduced the number of uninsured by almost 3.8 million, while Texas cut its uninsured by just 657,000.
But when Washington stepped forward — protecting those on Medicaid, boosting subsidies for exchange coverage and extending the enrollment period — participation in Texas surged to a record high.
If the state isn’t willing to help, maybe it’s all up to the feds.