New EHF report: Despite an initial drop in enrollment, new numbers show more Texans with active ACA plans in 2018 than in 2017

More than 1 million Texans have activated their 2018 Affordable Care Act health insurance and 90% currently receive federal subsidies to lower premium costs.

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Despite initial reports showing a drop in enrollment numbers, more than 1 million Texans have activated their Affordable Care Act (ACA) health insurance in 2018 – a 5 percent increase from 2017. That’s just one of the findings of an Episcopal Health Foundation analysis of new ACA health insurance enrollment data released by the Centers for Medicare & Medicaid Services (CMS).

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The report found that 9 in 10 Texans who signed up for ACA health insurance during open enrollment last fall then activated their plan by paying premiums in 2018. In 2017, 78 percent of Texas enrollees activated their ACA plans.

CMS says it releases “activation” data to provide “a more accurate picture of enrollment trends for the Exchanges than indicated by the number of individuals who simply selected a plan during Open Enrollment.” Previous CMS reports on 2018 enrollees only looked at those who signed up for a plan. Those reports showed that around 100,000 fewer Texans had enrolled in 2018 ACA plans compared to the year before. Nationally, the same reports found there were almost 1 million fewer ACA enrollees in 2018 than in 2017.


“The new numbers show that despite all the debate and confusion about the ACA, Texans are even more committed to having an effective, working health insurance plan,” said Elena Marks, EHF’s president and CEO and co-author of the report. “This is further evidence that Texans want affordable health insurance and the ACA is providing that for many Texans.”

Along with showing more active ACA health insurance plans, the new report also found that more Texans are receiving federal financial assistance to pay their premiums in 2018. The report discovered that 90 percent of Texans who have activated their ACA plans now receive federal subsidies to help pay their premiums. The total number of active ACA enrollees in Texas receiving financial help jumped from 829,374 in 2017 to 908,650 in 2018 – a 10 percent increase.

EHF’s analysis shows the average ACA health insurance premium price in Texas jumped 32 percent in 2018 — from $409 to $538 per month. But most Texans didn’t have to pay for that increase out of their pocket. The report found that the average premium cost for Texans with subsidized ACA plans has dropped from $85 to $63 a month.

That’s because federal financial subsidies increase as premiums increase. So as premiums rose from 2017 to 2018, the report shows average monthly financial assistance also jumped – from $337 to $475. That’s a 41 percent increase from 2017 to 2018.

“The bottom line is the ACA continues to provide affordable health coverage for more than 1 million Texans,” Marks said. “But Texas still has the highest uninsured rate in the nation. The way the ACA is used in Texas still doesn’t directly address the health coverage needs of the remaining 4.6 million uninsured people across the state.”

EHF’s analysis was co-authored by Marks and Shao-Chee Sim. Data and figures presented in the report are based on analysis of 2018 effectuated enrollment data published by the Centers for Medicare & Medicaid Services (CMS) compared with Texas and national data on effectuated enrollment for both the 2017 and 2018 Open Enrollment Periods.