President Obama may be leaving office, but his landmark healthcare legislation is still law of the land. Enrollment for the fourth year under the Affordable Care Act began on Tuesday. We traced Obamacare in Texas through the story of one family.
Before Obamacare, Bob Flood and his wife, Amy, were spending a fortune on health insurance: $3,000 a month. Because Bob had a previous cancer diagnosis, that was the only option for them and their older son. Under the Affordable Care Act, they found an Aetna plan through the marketplace for less than half of that each month.
“We were paying about $1,200 for all of us, and I was extremely happy,” Flood says.
It didn’t take long for that euphoria to fade. Even though more than a million Texans signed up for coverage last year, health insurers say they’re losing more money than they expected, raising premiums and dropping out of the marketplace altogether. That’s shaken people like Bob Flood two ways: first, price increases.
“We’re paying more than double what we were playing back then,” Flood says.
Fast-rising health care costs isn’t new, that’s been the trend for decades. Also, while the “benchmark plan” premium price has gone up, the increase in Texas – 18 percent — is lower than the national average of 22 percent. Dallas County will see an even lower rate increase: 7 percent. The increase in Dallas is lower than in Austin, San Antonio, Houston and El Paso.
Three insurance companies have left Texas this year
Still, people like the Floods are feeling the price pinch. And the shove of shrinking health networks.
Before the Floods selected an Aetna plan on healthcare.gov, Amy Flood called their longtime family doctors to make sure they’d accept the plan. Most said they would.
“Then, I went and suddenly two or three of them didn’t want to take [our insurance],” she says. “So even with insurance I ended up private paying out of pocket. I didn’t appreciate that but at that point there was little I could do about it.”
This year, three insurance companies stopped offering Texas plans on the marketplace: United Healthcare, Scott & White and the Floods' insurer, Aetna. Insurance startup Oscar also pulled out of North Texas. Now before you start picturing Obamacare tumbling down like a wobbly Jenga tower, Stacey Pogue of the Center for Public Policy Priorities in Austin says take a deep breath.
“We’re definitely in a period of instability,” she says, “But that does not spell the end of Obamacare.”
Many Texans are receiving federal subsidies to help pay
Pogue says news headlines have highlighted the negatives – skipping over more positive news like the fact that uninsured rate in Texas rate dipped below 20 percent for the first time in a decade. Or that a company called Ambetter decided to start offering plans in North Texas. And, she says the vast majority of folks – five of every six Texans – who buy plans in the marketplace are getting federal subsidies to help pay for premiums.
The federal government says nearly three out of four Texans with insurance can get a plan for $75 a month, thanks to a subsidy.
The penalty for not having health insurance in 2017 will be 2.5 percent of your income or a flat rate, which last year was $695 per adult. Pogue says that penalty, just like the subsidies available — is probably too low.
“We need both the stick and the carrot and a lot of folks think neither one is strong enough to get the broad participation in the marketplace that experts predicted up front.”
The Flood family isn’t getting subsidies, and has had to switch from Aetna to Blue Cross and Blue Shield of Texas. Still, they think the Affordable Care Act can work, as long as a mix of younger and healthier people sign up. Amy says it’s even caused her to rethink her politics.
“I don’t mind saying, I’m a lifelong Republican who this year’s voting Democrat simply for the healthcare reason,” she says.
Hillary Clinton has pledged to maintain and adjust Obamacare, Donald Trump wants to repeal and replace it.
Get help navigating Obamacare:
You can view and select plans on the health insurance exchange at HealthCare.gov.
For help by phone, you can call the toll-free number 1-800-318-2596. If you're hearing impaired, please use the TTY line: 1-855-889-4325. Telephone support is available 24/7.
For in-person assistance, you can locate “assisters” or “navigators” as well as health insurance agents near you by typing in your zip code here.
Dates and deadlines from Healthcare.gov:
- Nov. 1, 2016: Open Enrollment started — first day to enroll, re-enroll, or change a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as Jan. 1, 2017.
- Dec. 15, 2016: Last day to enroll in or change plans for coverage to start Jan. 1, 2017.
- Jan. 1, 2017: 2017 coverage starts for those who enroll or change plans by Dec. 15.
- Jan. 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period.
