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The Affordable Care Act in Texas

The Affordable Care Act in Texas. Elena M. Marks, JD, MPH Health 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

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The Affordable Care Act in Texas

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  1. The Affordable Care Act in Texas Elena M. Marks, JD, MPH Health Policy Scholar

  2. 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

  3. Predicted Coverage Changes Feb. 2013, CBO estimates that 30 million will gain insurance by 2023. 90% of Americans will be insured.

  4. 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

  5. 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 peradult 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 $2,085per family in 2016

  6. 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

  7. Essential Health Benefits

  8. Plan Levels of Coverage

  9. 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

  10. Premium Subsidies

  11. Federal Poverty Guidelines, 2013

  12. Sample Premiums and Subsidies

  13. Texans’ Insurance Coverage, 2010 Source: KFF

  14. 24% Uninsured Texans, 2010 Source: HHSC presentation, 7/12/12

  15. Current Texas Medicaid eligibility

  16. Medicaid Expansion 16

  17. Texas Medicaid growth tracks population growth 19% 40% 26% 79%

  18. 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

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