As HealthCare.gov opens, a DFW outlook

Health Insurance

HealthCare.gov and the state health insurance exchanges created by the Affordable Care Act (ACA) will be open for business again from Nov. 15 until February 15.

Some policy experts say it will be difficult to duplicate last year’s roughly 10 million signups. Attrition brought that number closer to 8 million, based on how many actually paid their premiums.

Dallas-Fort Worth had the most participation of the four largest Texas metropolitan areas. DFW had nearly 220,000 enrollments on the exchange. Houston, despite having a similar population, had about 163,000 signups. Austin and San Antonio had about 96,000 and 84,000, respectively.

DFW set the pace, despite having the highest prices on the exchange compared with the other three Texas cities.

A person making $35,000 a year in DFW would pay $80 more each month for the highest-level plan than if that same person lived in San Antonio, according to a report by the Episcopal Health Foundation and Rice University’s Baker Institute for Public Policy.

Researchers speculated that insurers adjusted rates by city based on the health status of the local population.

The premiums for bronze plans (or cheapest) were similar across the four cities. A DFW 30-year-old could expect to pay $165 a month, or about $26 more than in Houston, for a bronze plan. However, the DFW 30-year-old would pay $288 for a gold (or most expensive) plan, which was $80 more than in San Antonio.

The more money individuals make, the more they pay for exchange insurance plans, as the law intended. For example, a DFW resident making $17,000 a year paid $50 a month for a silver (second lowest-cost) plan. A local resident who earns $23,000 paid $114 a month for the same plan and a person making $35,000 paid $235.

Scott & White Health Plan, which is owned by Baylor Scott & White Health, will enter the DFW market this year featuring an array of ACA plans that center around the Baylor Scott & White Quality Alliance (BSWQA) provider network. BSWQA is the system’s accountable care organization.

Marinan Williams, Scott & White Health Plan’s interim president and CEO, said, “We are excited to be offering 13 different ACA Metal plans both off and on the exchange for 2015. We know there was a lot of confusion surrounding the exchanges and ACA last year, so we will be offering prospects a consumer shopping guide that will explain the basics of insurance, the available subsidies and how to avoid the tax penalties associated with failure to obtain coverage.”

In an earlier report, the same Rice researchers found that the percentage of uninsured adult Texans dropped by a little more than 2 percent since the exchange began. They estimate 378,000 more Texans had health insurance in June 2014 than in September 2013.

“In previous research, we reported almost half of the target population for the ACA in Texas didn’t buy a policy because costs were too high or they said they didn’t have enough money to spend on a plan,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine, in a written statement. “As we move toward the second year of the marketplace, penalties rise if you don’t buy health insurance. For someone making $35,000, the new penalty would be $700. We’ll be interested to see whether more in the target population purchase plans when those penalties rise.”

The majority of the remaining uninsured adult Texans are Hispanic and low-income. Half of those uninsured are employed.

An estimated 20 percent of uninsured adult Texans are undocumented and unable to enroll in Medicaid or exchange plans.

Ho said, “The way to make the biggest improvement in covering the uninsured population in Texas is through Medicaid expansion. In states like Texas that have not expanded Medicaid, the opportunity to reduce the percent of uninsured adults through the ACA without Medicaid expansion is limited.”

About the author

Steve Jacob
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Steve is a senior marketing and public relations consultant for Baylor Scott & White Health. He spent nearly four decades in newspaper and magazine editorial and business management and is the author of two books on healthcare reform. He was also the founding editor of D Magazine's D Healthcare Daily.

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As HealthCare.gov opens, a DFW outlook