By Ted Shaw, President/CEO, Texas Hospital Association
Texas is leading the case that landed the Affordable Care Act in the hands of the U.S. Supreme Court. The state argues that the ACA is unconstitutional because the U.S. Congress eliminated the penalty for not complying with the individual mandate—the part of the law that requires people to maintain a minimum level of health insurance.
For a state with the most uninsured residents in the nation and a looming budget deficit, the consequences of the Supreme Court’s decision are high.
The 1.1 million Texans who relied on the federal marketplace for health insurance in 2020 could be at risk. The state’s ability to draw down more than $5 billion in federal funds to increase health care coverage to an additional 1.2 million low wage working Texans also is in jeopardy.
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Amid the ongoing uncertainty in our daily lives is the fact that the fate of the ACA also is completely beyond our control. The pandemic has taught us to focus on what is within our control. Health care providers need to exercise that muscle yet again. Promote the health insurance marketplace and encourage uninsured Texans to get covered and get the care they need, despite the uncertainty.
Having health insurance is often the difference between successfully managing an illness and relying on hospital emergency departments for chronic disease management when a condition worsens or becomes potentially life-threatening.
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With the COVID-19 pandemic steering the political conversation and news media coverage, health is top of mind for many. Hospitals and health care providers need to build on this momentum and encourage uninsured Texans to purchase comprehensive health care coverage from the federal health insurance marketplace. The open enrollment period, which runs now through Dec. 15, is an opportunity for consumers to check their health coverage status, enroll in a health plan or make any changes for 2021.
Right now, Texans can purchase affordable health insurance whether they are employed or not. Many Texans will qualify for subsidies to lower monthly premiums; nearly 90% of marketplace enrollees qualified for a subsidy in 2020. The Centers for Medicare & Medicaid Services estimates that 30% of the current, subsidy-eligible enrollees who shop for a 2021 health plan within their current “metal level” can pay a monthly premium that is $10 or less. And more than 70% can pay a monthly premium that is $75 or less. Residents of Harris, Fort Bend, and Montgomery Counties also will have a choice of five or more insurance carriers, up from last year.
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Because health care coverage is so important and can be confusing to navigate, it’s crucial that all health care stakeholders commit to making the enrollment process easier and more accessible for all Texans. For as long as we have the ACA, Texas hospitals and health care providers have a responsibility to help inform uninsured individuals about open enrollment and direct them to the available tools so they can enroll in the plan that best meets their needs.
When we work together as a health care industry, we can help more uninsured Texans get covered and set them on a more secure path to a healthy, productive life.