Rep’s case part of trend in health coverage
WASHINGTON — News this week that U.S. Rep. Joaquin Castro is undergoing cancer treatment drew renewed attention to congressional health insurance plans — gold-level Affordable Care Act coverage similar to that gaining popularity in Texas.
Though Texas is one of a dozen states that have declined to fully implement the 2010 Affordable Care Act, federal subsidies and changes to state law have made it cheaper for Texans to get gold-level plans, under which insurance companies cover about 80 percent of costs.
Changes in Texas have also made $0 premium gold-tier plans available to more consumers — 73 percent of those who purchase their coverage on the Affordable Care Act marketplace can now get zero-premium gold plans. Just 43 percent of people purchasing insurance through the marketplace were eligible for the same $0 premium coverage in 2022, according to Stacey Pogue, a senior policy analyst at Every Texan.
Because of that, experts expect that far more of the record 2.4 million Texans who enrolled in 2023 opted for the higherquality gold plans, though details on the plans Texans picked are not yet available. In 2022, about 173,500 of the 1.8 million Texans who enrolled for coverage through the ACA selected a gold-tier plan.
Members of Congress, including Castro, 48, D-san Antonio, who revealed Monday that he underwent surgery in Houston for a type of cancer that experts say is rare but manageable with treatment, receive gold-level health insurance through the ACA marketplace in the District of Columbia.
The federal government covers about 70 percent of the premium, and members pay the rest.
“The coverage members of Congress get is much more similar to what someone who works for a very large employer would get than what people think of,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.
The shift to gold plans comes as Texas — the state with the highest rate of uninsured in the nation — has seen the highest ACA enrollment growth rate in the nation for three years in a row. Enrollment in the Texas marketplace has more than doubled in three years, with an additional 570,000 Texans enrolled in 2023, the largest net increase of any state, Pogue said.
The rapid rise in enrollment was already underway after Congress offered more generous federal subsidies during the pandemic, which have since been extended through 2025.
Those subsidies are now available to those earning up to 400 percent of the federal poverty level, or about $54,360 for an individual and $111,000 for a family of four.
But in 2021, the Republican-led Legislature passed a law aimed at making gold plans more affordable for many Texans, despite the lawmakers’ long-espoused resistance to expanding Medicaid coverage in the state.
Because most people rely on silver plans, which are more affordable than gold and cover some outof-pocket costs for low-income buyers, most insurers compete to offer the lowest cost for those plans. That was driving up the cost of other plans, including gold.
So Texas joined a growing list of states that instituted a so-called focused rate review aimed at forcing insurers to more accurately price their plans.
An analysis of the focused rate review by the nonpartisan think tank Texas 2036 found that it would cover an additional 216,000 Texans at no net cost to the state and would bring in $1 billion more in federal marketplace subsidies for Texans.
State Sen. Nathan Johnson, a Dallas Democrat who authored the law, said that was the basis of his pitch to Republicans who long have resisted Medicaid expansion that Johnson and other Democrats have pushed.
By doing its own rate review, he told them, Texas was taking control back from the federal government. It wasn’t expanding any kind of government health care but rather boosting consistency and honesty in pricing of private insurance offered on the ACA exchanges.
“It’s to make sure prices reflect reality so the market can function,” he said. “We were really improving the market.”
Johnson called the fix a “thing of its own kind” and said he does not know of another opportunity like it that would be “so unthreatening to conservatives.”
“But I do think it signals a desire among Republicans to address the problem we have with the uninsured rate,” he said.
And, Johnson said, “it looks like the law is doing exactly what we hoped it would.”