Lessons in Texas from this year’s record ACA health insurance enrollment

Brian Sasser

By Brian Sasser
EHF’s Chief Communications Officer

Texas just set a new record for enrollment in Affordable Care Act (ACA) health insurance. More than 1.8 million people signed up for coverage this year, up 42% from last year. That means more than half a million additional Texans will have access to potentially lifesaving care and preventive health services in 2022.

Not only will this record-breaking enrollment period allow hundreds of thousands of Texans to get the care they need, but it also tells us some important things about health insurance coverage expansion and the value of legislation like the ACA. 

First, affordability is key. Financial assistance provided by the federal American Rescue Plan Act meant more people at more income levels were eligible to get needed help to pay their monthly health insurance premiums. Stacy Pogue, health policy expert at EHF grantee Every Texan, found that an individual in Houston earning $25,000 a year could buy a plan for $32/month with a $200/year deductible. Many with lower incomes often had no out-of-pocket costs. Plus, for the first time, Pogue explains that people with higher incomes – about $51,500/year for an individual and $87,000/year for a family of three – could get financial assistance to buy an ACA plan.

The open enrollment period also demonstrated the importance of clear and expanded messaging about the options, costs, and benefits of ACA coverage. Thanks to the hard work of nonprofits and government agencies in Texas, this year there was greater enrollment help and navigation services across the state to help consumers select the plan best for them. Insurance coverage can sometimes be complex and difficult to navigate, but that doesn’t mean the need for coverage does not exist. If the resources are affordable and easy to access, people will use them. Putting time and money into implementing these programs pays off.

It’s crucial to build on these efforts as we work to get ALL Texans the health insurance coverage they need. The Centers for Medicare and Medicaid Services recently committed $49+ million to this effort across the country, with funding going toward reducing the uninsured rate among children and boosting Medicaid enrollment for parents. But that effort still won’t be enough.

We’ve seen the positive impact of increased ACA enrollment efforts this year — but in the state with the highest uninsured rate in the country, the work is far from over.  Increased financial assistance from the American Rescue Plan Act spurred the record sign-ups across Texas, but that will be temporary if federal funding for financial assistance expires as planned at the end of the year. Without Medicaid expansion, increased affordable ACA coverage options for Texans under the Build Back Better plan, or some sort of Texas-specific proposal to increase health insurance access and affordability, there’s a serious risk that we’ll be right back where we started. 

Health insurance isn’t the magic pill to improved health, but it’s an important piece of the puzzle. The record ACA enrollment proves that Texans want health insurance, it just has to be affordable and simple to enroll. But without crucial action by federal and state leaders, health insurance coverage will remain a missing puzzle piece for Texans with the least resources who need that coverage the most.