Texas Health Care

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Anne Dunkelburg, associate director of the Center for Public Policy Priorities, presented on Texas Health Care at the 2013 Texas Latino Policy Summit.

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Texas Health Care

  1. 1. Texas Health Care: Current Action & Policy Issues Click to edit Master title style Latino Policy Summit Click to edit Master subtitle style Anne Dunkelberg, Associate Director – dunkelberg@cppp.org Center for Public Policy Priorities Saturday, October 19, 2013 CPPP.org 1
  2. 2. Most Uninsured Texans are WorkingAge Adults, 2011 81,000 3% of Texas Seniors uninsured 65+ <2/3 are below 200% FPL 63% are below 200% FPL 6.1 million uninsured Texans (23.8% of all ages) 0-18 1.2 million Rate: 16.3% of 0-18 are uninsured 19-64 Compare to Massachusetts: 219,000, just 3.4% of all ages 4.8 million Rate: 30.9% of 19-64 are Uninsured Source: U.S. Census, March 2012 CPS 2
  3. 3. Texas Uninsured by Income 2011… 89% of the 6.1 million uninsured have incomes <400% FPL >400% FPL >$89,400 656K 300-400% FPL $67,050-$89,400 501K 250-300% FPL $55,875-$67,050 <100% FPL <$22,350/yr for family of four 1.912 Million 6.1 million includes 1.7 million non-US citizens; ~2/3 of these (about 1.1 million) likely undocumented 421K 626K 614K 200-250% FPL $44,700-$55,875 921K 100-125% FPL $22,350-$27,938 525K 150-200% FPL $33,525-$44,700 125-150% FPL $27,938-$33,525 Annual income limits given for a family of four, 2011 federal poverty level CPS U.S. Census, 2012 3
  4. 4. Figure 4 Hispanics have particularly high uninsured rates. Insurance Coverage of Hispanics in the United States and Texas, 2011: Employer/Other Private Medicaid /Other Public 32% 30% 38% 25% 39% 37% United States Texas Data may not total 100% due to rounding. SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS.
  5. 5. Figure 5 Hispanics in Texas have particularly high stakes in the Medicaid expansion decision. Nonelderly Uninsured <138% FPL by Race/Ethnicity United States Texas Black 17% Hispanic Hispanic 63% 35% Black 11% White 40% Asian/ Pacific Other Islander 2% 5% Total = 25.4 Million NOTE: Totals may not sum to 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2011 American Community Survey White 21% Asian/ Other Pacific 1% Islander 3% Total = 3.1 Million
  6. 6. ACA Coverage and Coverage Gap >$94,200 for a family of four; >400% of FPL Job-based coverage, or Full-cost coverage in the exchange Family Income $70,650-$94,200; 300-400% of FPL Job-based coverage, or Subsidized exchange coverage: premiums capped at 9.5% of income $47,100-$70,650; 200-300% of FPL Job-based coverage, or Subsidized exchange coverage: premiums capped at 6.3 – 9.5% of income $31,322-$47,100; 133-200% of FPL CHIP <$31,322 for a family of four; < 133% FPL • Job-based coverage, or • Subsidized exchange coverage: premiums capped at 2% - 6.3% of income Medicaid Coverage Gap below poverty line ($23,550 for family of four) Children Adults (not eligible for Medicare or Medicaid today) Family income based on 2013 federal poverty income levels for a family of four
  7. 7. The Texas Coverage Gap • About 1 million U.S. citizen adults < 100% FPL are uninsured in Texas and will have no coverage options. • The average “coverage gap” Texan works in frontline entry-level positions such as: – Retail trade – Accommodation and food services – Healthcare and social assistance, and – Construction 6.1 million uninsured Michael E. Cline, Ph.D., and Steve H. Murdock, Ph.D. , Rice University, Estimates of the Impact of the Affordable Care Act on Counties in Texas, April 2012.
  8. 8. Texas Medicaid/CHIP: Who is Helped Today CHIP, 591,756 January 2013, HHSC data Disabled, 422,467 Elderly, 326,501 Poor Parents, 144,040 Medicaid Children, 2,547,199 Total enrolled 1/1/2013: 3.6 million Medicaid; TANF Parent, 83,772 Maternity 86,975 592,000 CHIP 1 in 7 Texans, but 42% of Texas kids 8 8
  9. 9. Status of State Action on the Medicaid Expansion Decision, as of September 30, 2013 Source: KFF.org 9
  10. 10. Large Urban Counties & Medicaid Expansion 2014-2017: Share of $6 billion new statewide annual federal health care spending El Paso Dallas Harris Lubbock Travis $222 million $580.1 million $935.3 million $77.7 million $224.1 million Uninsured NOW 208,379 601,492 1,025,922 66,405 233,067 Estimated # Gaining Medicaid 51,462 131,042 223,165 19,693 55,676 Yearly Avg. NEW Fed $ Sources: Texas HHSC projections of ACA Medicaid expansion costs; THHSC historical Medicaid spending by county, 2010. Cline & Murdock estimates of ACA insurance gains by county. 10
  11. 11. Largest South Texas Metro Counties & Medicaid Expansion: 2014-2017 Share of $6 billion new statewide annual federal health care spending Bexar Cameron Hidalgo Nueces Webb NEW Fed $ $ 503.5 million $ 198.4 million $ 404.7 million $ 127.1 million $92.0 million Estimated # Gaining Medicaid 179,654 27,987 50,509 22,403 16,031 One-year Avg. Sources: Texas HHSC projections of ACA Medicaid expansion costs; THHSC historical Medicaid spending by county, 2010. Cline & Murdock estimates of ACA insurance gains by county. 11
  12. 12. Who Is Eligible? 12
  13. 13. Subsidies in the Marketplace • Advanced Premium Tax Credits – Individuals and families b/w 100 and 400% of poverty (FPL) – Sliding scale relative to income – Must be used to purchase inside the Marketplace – Can be paid directly to insurer, so you only owe the balance as a monthly premium • Cost-Sharing Reductions – Individuals and families b/w 100 and 250% FPL – Lower deductibles and copays – Must select a silver-level plan to qualify Family Size Annual income range – premium credits 1 $11,490-$45,960 2 $15,510-$62,040 3 $19,530-$78,120 4 $23,550-$94,200 Family Size Annual income range – cost sharing reductions 1 $11,490-$28,725 2 $15,510-$38,775 3 $19,530-$48,825 4 $23,550-$58,875 13
  14. 14. Coverage Level Options in the Marketplace Essential Health Benefits ambulatory services; 2. emergency services; 3. hospitalization; 4. maternity and newborn care; 5. mental health and substance use disorder services; 6. prescription drugs; 7. rehabilitative and habilitative services and devices; 8. laboratory services; 9. preventive and wellness services and chronic disease management 10. pediatric services dental and vision care 1. % paid by enrollee % covered by plan Platinum Gold 90% 80% Silver 70% Bronze 60% 0% 20% 40% 60% 10% 20% 30% 40% 80% 100% Catastrophic plan for people under 30; or if no other coverage is affordable 14
  15. 15. In-person Assistance to Enroll in Marketplace In-person assistance: • Agents/Brokers • Navigators • Certified Application Counselors (CAC) 15
  16. 16. Get Involved, Stay informed! Unless our leaders take action , on January 1, 2014: • an uninsured parent with two children living on $18,000 will have NO help from ACA for health coverage, but • another uninsured parent with 2 children earning $20,000 a year will qualify for full coverage on a sliding scale for $33 a month or less. A Diverse network of Texans and Texas organizations will keep working to find health care for the Texans in the “Gap Group,” to tell their stories, and to seek inclusion of Texas’ working poor in the ACA’s health reform. www.cppp.org You can link to all the websites below from our CPPP website: www.covertexasnow.org; www.TexasLeftMeOut.org www.texaswellandhealthy.org 16
  17. 17. FAMILY BUDGETS Use of This Presentation The Center for Public Policy Priorities encourages you to reproduce and distribute these slides, which were developed for use in making public presentations. If you reproduce these slides, please give appropriate credit to CPPP. The data presented here may become outdated. For the most recent information or to sign up for our email updates, visit our website. © CPPP Center for Public Policy Priorities 7020 Easy Wind Drive, Suite 200 Austin, TX 78752 P 512.320.0222 F 512.320.0227 CPPP.org
  18. 18. Figure 18 The Texas Medicaid expansion decision has important impacts for the overall uninsured and Hispanics nationally. Distribution of Total Uninsured <138% FPL Distribution of Uninsured Hispanics ≤138% FPL CA 15% CA 26% TX 12% FL 9% Other States 49% GA 5% NY IL4% NC 4% 4% Total : 25.4 Million NOTE: Totals may not sum to 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2011 American Community Survey TX 22% Other States 43% FL 9% Total: 8.9 Million

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