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Affordable Care Act Brings Greater Health Coverage to Texas

"The Affordable Care Act was designed so that the lowest-income families would be covered by Medicaid, [but] the Supreme Court made [Medicaid expansion] optional."

By Vera Gruessner

- The Patient Protection and Affordable Care Act may have done its job in one particular state with regard to expanding health coverage options and providing federal subsidies on the health insurance exchange. A study from Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation (EHF) found that people from the state of Texas have had less issues with paying their medical bills in 2015 when compared to 2013, according to a news release from Rice University.

Medical Bills in Texas

The results show that the rates of nonelderly Texas adults who had trouble paying medical bills dropped from 25.8 percent in September 2013 to 22 percent in September 2015. A large factor that can be attributed to this finding is the fact that more Texans now have health insurance. Out of all uninsured Texans, 30 percent had trouble paying their medical bills in 2015, which dropped from the 35 percent found in 2013.

“On the whole, uninsured Texans reported fewer problems with affording health care in 2015,” Elena Marks, EHF’s president and CEO, and a nonresident health policy fellow at the Baker Institute, stated in the release. “While our data doesn’t explain exactly why that is happening, the Texas economy improved during that time, which might have helped the uninsured pay for care.”

The report from Rice University’s Baker Institute for Public Policy also found variation in the utilization of healthcare services in Texas between 2013 and 2015. For instance, more insured Texans have sought primary care in 2015 when compared to 2013 while more Texans used dental care services in 2013 when compared to 2015.

While this particular report found that difficulty paying medical bills is decreasing in Texas, the Henry J. Kaiser Family Foundation and The New York Times released a survey showing that at least one in five people around the nation enrolled in health insurance plans struggle with paying out-of-pocket costs.

READ MORE: ACA Health Insurance Exchanges Bring Challenges for 2017

For more information about the report from the Episcopal Health Foundation (EHF) and Rice University’s Baker Institute for Public Policy, HealthPayerIntelligence.com interviewed Elena Marks.

When asked about some of the biggest drivers that led fewer Texans to struggle with paying their medical bills in 2015, Marks declared, “For those who were previously uninsured and got insurance, the obvious answer is they became insured. Where they had been paying 100 percent of their cost, if you’re insured, somebody is paying some of that.”

“I think that’s an important thing to say,” she continued. “There is a lot of consternation about high deductibles and narrow networks which are of concern, but you have to remember that we have about one million more people who have insurance over the last two years than previously.”

 “While there is a lot of room for improvement in the coverage they have, compared to no coverage, it’s a huge opportunity for many, many families,” Marks explained. “Much of the insurance data that came from HHS a week or so ago shows 1.1 million Texans [are enrolled] in marketplace plans and, obviously, those plans didn’t exist more than two years ago in the Texas individual market.”

“There was a very weak individual market in Texas before the Affordable Care Act. While one million of those who bought Marketplace plans in 2015 were not necessarily uninsured previously, a chunk of them were. The other thing that’s happened, not just in Texas but in the country, is that the economy has improved. When the economy improves, people generally have less trouble paying for a lot of things whether they’re insured or not insured.”

READ MORE: Top 3 Difficulties Facing State Health Insurance Exchanges

“I don’t think our data can back up the claim that it is totally because of the Affordable Care Act that people are reporting fewer difficulties in covering their cost, but I think between many more people being insured and a stronger economy, that accounts for what’s going on.”

The Affordable Care Act

When asked about any specific provisions within the Affordable Care Act that have led to fewer problems with paying medical bills, Marks answered, “The fact that all of the plans now are required to cover a basic set of preventive services means that, even if you have a high-deductible plan, those services are covered with payment of the premium.”

“So you have people getting check-ups and routine age- and gender-appropriate screenings for cancer and other conditions,” she explained. “You have women getting contraceptives without any copays or charges against the deductible. So even if you have a high-deductible plan or a plan with significant copays, the way the plans are set up now, there is a set of benefits you get just for being enrolled and paying the premium.”

“People were paying for many things before, and they are not paying for some of those same services now. They’re not paying out-of-pocket the same way they may have been before. Even if you were insured, there may have been copays or deductibles applied to some of those preventive services that are now required by law to be included in the basic premium coverage.”

READ MORE: How the Affordable Care Act Impacts First Quarter Earnings

Texas declined Medicaid expansion

When asked what steps the state government can take to assist low-income individuals and families that are still struggling to pay their medical bills in Texas, Marks responded, “They can expand Medicaid. That’s the short and easy answer. For those who are below 100 percent of the poverty level, they can’t get a subsidy in the marketplace so they are faced with nothing or paying 100 percent of the premium.”

“The people who have higher incomes are eligible for subsidies, but those with lower incomes are not. The Affordable Care Act was designed so that the lowest-income families would be covered by Medicaid. When the Supreme Court made [Medicaid expansion] optional, it meant that it was up to each state to make that decision.”

“Texas is one of an increasing minority of states that has not expanded Medicaid. For a significant number of Texans estimated to be a minimum of one million, there is nothing that will change for them outside of a Medicaid expansion.”

Kaiser and New York Times study

The President and CEO of the Episcopal Health Foundation also commented on the Kaiser and New York Times study regarding how many insured people are still struggling to pay their medical bills.

“What Kaiser reported is also true for Texas. Texans are still reporting difficulty in paying for health care. What we found is that they are reporting less difficulty than they had two years ago, but there are still challenges,” Marks discussed. “The Kaiser data is true for Texas as well. Their data looked at a particular point in time – right now. Our report looked at a trend. What we’re excited about is that the trend is moving in the right direction. It doesn’t mean the problem is solved. It means that things are moving in the right direction.”

“It may be that things were so bad in Texas before that modest improvement looks magnificent. In states that did not have as many uninsured as Texas had before, complaining about out-of-pocket costs is almost a luxury that we can’t yet afford. We’re happy with getting to where other states were years ago. That is an improvement for us and we’re excited because it’s in the right direction,” Marks concluded.

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