COVER STORY: EHF report shows one million Texans may be eligible NOW for health insurance, cost savings under Affordable Care Act

See how financial assistance could help more than 80% of eligible Texans cut their health insurance premiums by 75%.

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When open enrollment for the Affordable Care Act (ACA) health insurance marketplace begins November 1, more than one million uninsured Texans may be eligible for federal tax credits that could help them buy health plans. That’s just one of the conclusions of a new EHF analysis of ACA health insurance enrollment data since 2013.

EHF’s analysis cited two national reports showing between 700,000 and 1.1 million Texans are currently uninsured but eligible for tax credits that would help cut their health insurance premium costs by an average of 75 percent.

Researchers found the majority of the eligible uninsured Texans live in six major metropolitan areas: Dallas/Fort Worth, Houston, San Antonio, Austin, El Paso and Brownsville/McAllen/Harlingen.

“The numbers clearly show that the ACA has dramatically reduced the number of uninsured across Texas,” said co-author Elena Marks, EHF’s president and CEO. “But they also demonstrate that if we don’t take the next steps and strengthen enrollment strategies and policies, then millions of Texans will remain uninsured and the entire state will continue to pay the price.”

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Texas enrollment in ACA health insurance plans nearly doubled since 2013
The analysis found the number of Texans signed up for ACA health insurance plans has almost doubled since the first open enrollment period. The number of Texans enrolled in ACA marketplace plans jumped from approximately 730,000 in 2013 to more than 1.3 million for the open enrollment period that ended in February 2016. Researchers say those numbers helped the state’s uninsured rate drop by 30 percent since the ACA went into effect, cutting the rate below 1999 levels.

EHF’s analysis found 86 percent of Texans signed up with ACA health insurance receive federal tax credits to help pay their premiums. On average, those credits cut insurance costs by 75 percent, the analysis found.

“Not only are Texans enrolling in large numbers, but they’re also keeping their health insurance coverage over time,” said Shao-Chee Sim, co-author and vice president for applied research at EHF.

Young adults, Hispanics in Texas are most likely groups to remain uninsured
Despite the large drop in the state’s uninsured rate, Texas still has the highest rate and the most uninsured residents in the country.

EHF’s analysis found Hispanic Texans continue to make up a large percentage of the state’s uninsured, but a much smaller percentage of Texans enrolled in ACA marketplace health plans. Studies estimate half of uninsured Texans eligible to buy ACA health insurance plans are Hispanic. But ACA marketplace enrollment numbers show only 35 percent of enrollees are Hispanic, the analysis found.

“These ACA enrollment numbers reaffirm what EHF research has shown again and again — strengthening outreach and enrollment to Hispanics in crucial in Texas,” Sim said. 

Researchers also found that young adults in Texas also are more likely to be without health insurance. The analysis found Texans ages 18 to 34 make up 43 percent of Texans eligible to buy ACA health insurance, but only 29 percent of current ACA marketplace enrollees are young adults.

Lack of Medicaid expansion in Texas continues to leave low-income Texans without health insurance 
EHF’s analysis found that 94 percent of Texans with ACA health insurance plans had household incomes between $16,000 and $47,000 a year. All of those low-to-moderate income Texans receive federal financial assistance to purchase ACA health insurance.

However, the analysis shows only 4 percent of Texans with ACA health insurance plans make less than $16,000 annually.  That’s despite the fact that these lowest-income Texans make up 40 percent of uninsured Texans eligible to buy ACA plans.

“Our analysis confirms that the ACA as implemented in Texas offers little hope for Texans with the lowest incomes,” Marks said. “Ironically, they don’t earn enough money to qualify for the financial help other Texans receive to help pay for their premiums. The ACA was designed to use Medicaid expansion by the states to cover this lowest-income group. So, unless Texas expands Medicaid or comes up with another system of coverage, they will remain uninsured. This is an issue that the state legislature must address to expand health coverage in Texas.”

EHF researchers cite several reports showing the lack of Medicaid expansion leaves between 760,000 and 860,000 low-income Texans without health insurance.

EHF’s analysis was co-authored by Marks, Sim, and Robiel Abraha.  The report provides an overview of the experiences of the past three ACA marketplace open enrollment periods in Texas. Data and figures presented in the report are based on analysis of data published each year by the Office of Assistant Secretary for Planning and Evaluation (ASPE). EHF researchers summarized the demographic characteristics and geographic distribution of marketplace enrollees in Texas and at the county level. In addition, the analysis examines the availability and affordability of Texas marketplace plans as well as patterns in enrollment and plan selection across the enrollment periods.