Remember these health insurance ghosts from Christmas past?

This post originally appeared in the Houston Chronicle

It’s that time of year. We’re watching “A Christmas Carol” and “It’s a Wonderful Life” and thinking about how things might have turned out differently but for one person — or, for 2018, one healthcare bill.

In the spirit of the season, I’ll play the parts of Jacob Marley and Clarence the Angel and show you what access to health insurance looked like in Texas before the Affordable Care Act, also known as Obamacare. That way, you can decide whether we’re better off with or without it.

In 2010, when the ACA was enacted, nearly one-third of non-elderly adult Texans were uninsured. By 2013, the rate dropped to 25 percent, then to 19 percent in 2016. As the new federal administration began chipping away at the ACA in 2017, the rate rose to 20 percent. Early indications from the 2018 open enrollment period in the ACA Marketplace indicate a further rise is likely.

The state’s uninsured rates say a lot, but those numbers don’t tell the whole story about how the ACA has improved access to health insurance, and therefore health care, for all Texans. Top of mind for the roughly half of us who have high blood pressure, cancer, diabetes, asthma, heart disease, depression or other health problems should be whether we’ll be able to get health insurance without the protections of the ACA. In 2018, more than 1 million Texans purchased comprehensive plans, including coverage for pre-existing conditions, in the ACA-created Marketplace. This option didn’t exist before the ACA.

What about the young adults between 19 and 26 who are on their parents’ health plans? No guarantee for them without the ACA.

Are you a woman? Prior to the ACA, insurers commonly charged women more than men for the same coverage, even when maternity care was excluded.

If you’re thinking about having a baby, you should know that without the ACA, you might not be able to buy an individual plan that included coverage for maternity care. In 2013, the year before the ACA required health plans to cover maternity care, there was not a single plan for sale in the individual market in Texas that did so.

Maybe you’re covered by a plan you like, and you think the ACA doesn’t affect you. Well, if you’re covered by Medicare, it is only because of the passage of the ACA that the “doughnut hole” in your prescription drug benefit was closed, saving Texans millions of dollars.

Are you covered by a plan offered by your employer? If so, you’re accessing preventive services without a copay, and you have caps on your out-of-pocket expenses and protections against lifetime and annual limits on insurance benefits because of the ACA. Texas law does not provide these protections, so if the ACA goes away, these protections go away with it.

Texas leaders say they look forward to developing a Texas plan. This is great news and marks the first time the state has taken responsibility for developing a plan to enable all Texans to obtain affordable health insurance to cover their needs. As we look back on our eight-plus years since the passage of the ACA and wonder what life would have been like without it, this is what we know: More Texans have health insurance. People with pre-existing conditions are covered. The Medicare “doughnut hole” is closed. And women can buy basic health plans that cover maternity care.

Although the ACA is far from perfect, it seems to me that the health insurance situation of today is preferable to the ghosts of Christmas past.