New EHF report: Despite growing uncertainty, more than 1 million Texans enroll in Affordable Care Act health insurance for 2019

March 27, 2019

More than 1 million Texans enrolled in Affordable Care Act (ACA) health insurance for 2019 despite ongoing uncertainty, a federal court ruling invalidating the law, and massive funding cuts for navigators to help consumers sign up for a plan. That’s one of the findings of an Episcopal Health Foundation (EHF) analysis of new ACA health insurance enrollment data released by the Centers for Medicare & Medicaid Services combined with data from previous ACA enrollment periods.

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EHF’s analysis found that more than 7 in 10 Texas enrollees in 2019 were returning consumers (71%). That’s consistent with the percentage of Texans who were returning consumers in 2018 (69%).

“Once again, the high rate of returning enrollees shows that Texans who received health insurance through the ACA want to keep it,” said Elena Marks, EHF’s president and CEO. “For many of the more than 1 million Texans who signed up, the ACA is the one way they can get health coverage that’s affordable. These numbers illustrate the crisis that would happen if the ACA went away without a similar plan in place.”

The analysis found that 1,087,240 Texans enrolled in ACA health insurance in 2019, down from just more than 1.1 million in 2018. The slight enrollment decline happened during a six-week enrollment period and a 78 percent federal government cut ($6 million to $1.3 million) to navigator funding designed to help consumers find an ACA health insurance plan.

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Read the complete analysis report



As in the previous ACA enrollment periods, the vast majority (81%) of Texas enrollees for 2019 have household incomes between 100% and 250% of the Federal Poverty Level (FPL) – $12,490 - $31,225 for individuals/ $25,700 -  $64,375 for a household of four.

The analysis found that 88 percent of ACA enrollees in Texas receive federal financial assistance to help pay for their ACA health insurance premiums.  Texans who earn less than 100% of the FPL ($12,490 for individuals/$25,700 for household of four) are not eligible for financial assistance because the ACA’s plan for covering this low-income group was through Medicaid expansion. Texas lawmakers have opted not to expand Medicaid or create a similar program that would provide coverage. Texas remains the state with the highest uninsured rate in the nation (19%) and the most uninsured residents (4.7 million). 

“A majority of Texans have consistently said that state government should do more to help low-income Texans get needed health care,” Marks said.

A recent EHF 2019 Texas Health Policy Poll showed that 59 percent of Texans said state government is not doing enough to help low-income adults access they health care they need. The poll also found 57 percent of Texans say increasing access to health insurance should be a top health priority for the state legislature and 88 percent said they think health insurance companies should be required to provide coverage for people with pre-existing medical conditions, a requirement under the ACA.

In 2019, EHF’s analysis found that federal financial assistance in the form of tax credits cut monthly premium costs for Texas enrollees by an average of 78% -- from $544 to $118. In 2018, federal financial assistance cut monthly premiums by 85%  -- $543 to $79.

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Other findings from EHF’s analysis of 2019 Texas ACA enrollees
:

  • 55% are women
  • 87% live in non-rural areas
  • 25% are adults ages 55 to 64
  • 20% are adults ages 45 to 54
  • 62% selected a Silver health insurance plan

EHF’s analysis was co-authored by Marks and Shao-Chee Sim, EHF’s vice president for applied research.  The report provides an overview of the experiences of the past six ACA marketplace open enrollment periods in Texas. Data and figures presented in the report are based on analysis of 2019 data published by the Centers for Medicare & Medicaid Services (CMS) compared with data from Office of Assistant Secretary for Planning and Evaluation (ASPE) for previous open enrollment periods.


To schedule an interview, contact Brian Sasser, EHF’s chief communications officer at [email protected] or 832-795-9404.