The Affordable Care Act in Texas
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Transcript of The Affordable Care Act in Texas
The Affordable Care Act in Texas
Elena M. Marks, JD, MPHHealth Policy Scholar
Initial objective: Expand Access• 50 million uninsured—insurance equals
access• Insurance industry regulations• Mandated coverage for people and
businesses– Insurance exchanges to facilitate purchase– Subsidies for some people and businesses
• Expansion of Medicaid
Predicted Coverage Changes
13%
57%
9%
21%
2013
Medicaid and CHIPEmployerNongroup and OtherUninsured
17%
56%
8%
9%10%
2023
Medicaid and CHIPEmployerNongroup and OtherExchangesUninsured
Feb. 2013, CBO estimates that 30 million will gain insurance by 2023.90% of Americans will be insured.
Insurance Regulatory Changes
In Place Already
• Children < 26 • No pre-X for children• 80% MLR; rebates• No lifetime limits• Preventive services• Rate increase reviews• Temporary pre-X plan
Coming
• No pre-X; guaranteed issue
• Individual mandate• Large employer mandate• Exchanges/subsidies• No annual limits• Essential Health Benefits
Beginning in 2014………
(ALMOST) EVERYONE MUST HAVE INSURANCE
And if you don’t………
YOU (MAY) HAVE TO PAY A TAX
In 2014, the tax is the greater of 1% of total family income or $95 per adult and $47.50 per child up to $285 per family rising to 2.5% of total family income or $695 per adult and $347.50 per child up to $2,085 per family in 2016
Health Insurance Exchanges
• Online marketplace for individuals and small businesses to shop for “qualified” plans
• Texas exchange is operated by the federal government
• Individuals: Citizens, legal residents• Businesses: Up to 50 or 100 employees• Plans: Four levels based on scope of coverage• Essential health benefits in all plans
Essential Health Benefits
Ambulatory patient services Prescription drugs
Emergency services Rehabilitative and habilitative services and devices
Hospitalization Laboratory services
Maternity and newborn care Preventive and wellness services and chronic disease management
Mental health and substance use disorder services, including behavioral health treatment
Pediatric services, including oral and vision care
Plan Levels of Coverage
Levels of Coverage
Plan Pays on Average
Enrollees Pay on Average
(In addition to themonthly plan premium)
Bronze 60 percent 40 percent
Silver 70 percent 30 percent
Gold 80 percent 20 percent
Platinum 90 percent 10 percent
Limited Enrollment Periods
• Initial period is October 1, 2013 to March 31, 2014
• October 1, 2014 to December 24, 2014 for coverage on January 1, 2014
• Limited exceptions include– Loss of coverage– Marriage/birth/adoption– Relocation– Change in eligibility status
Premium SubsidiesIncome as a Percentage of the Federal Poverty Level
Premium as a Percentage of Income
Up to 133% FPL 2%
133-150% 3-4%
150-200% FPL 4-6.3%
200-250% FPL 6.3-8.05%
250-300% FPL 8.05-9.5%
300-400% FPL 9.50%
Federal Poverty Guidelines, 2013
Household Size 100% 200% 300% 400%
1 $11,490 $22,980 $34,470 $45,960 2 15,510 31,020 46,530 62,040 3 19,530 39,060 58,590 78,120 4 23,550 47,100 70,650 94,200
Household Size
100% 200% 300% 400%
1 $11,490 $22,980 $34,470 $45,960
2 15,510 31,020 46,530 62,040
3 19,530 39,060 58,590 78,120
4 23,550 47,100 70,650 94,200
Sample Premiums and Subsidies
27 Year Old, $25,000 Income Family of 4, $50,000 Income
Tax Credit
$
Lowest Bronze
$
Lowest Bronze
with Tax Credit
Tax Credit$
Lowest Bronze
$
Lowest Bronze with Tax Credit, $
Texas 56 139 83 445 502 57
Houston 57 138 81 446 498 52
Dallas 79 153 74 526 600 74San Antonio 51 138 87 428 510 73
RG Valley 10 109 99 278 395 11736 state average 70 163 93 492 587 95
Texans’ Insurance Coverage, 2010
ESI45%
Individual4%
Medicaid16%
Medicare10%
Other Public1%
Uninsured Total 24%
Source: KFF
24% Uninsured Texans, 2010
201276036%
78274014%
134184024%
83865015%
61501011%
Exchange eligible Medicaid eligible in 2010
Medicaid expansion Undocumented
No ACA plan
Source: HHSC presentation, 7/12/12
Current Texas Medicaid eligibility
Medicaid Expansion
16
Texas Medicaid growth tracks population growth
17
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
21 million
25 million
35% of population
41%
23%25%
9%14%
Total <200% FPL Uninsured Medicaid
Popu
latio
n (M
illio
ns)
19%
40%
79%
26%
Potential ACA Beneficiaries in Texas
• Insurance Exchange/Subsidy Eligible 2,012,760
• Medicaid Eligible 1,341,850 Expansion population 782,740 “Welcome mat” population
Total: 4,137,350
Source: HHSC presentation, 7/12/12