Health Reform Facts: Texas

DEMOGRAPHY

Percent of Population in Texas per Race / Ethnic Group 2

The Patient Protection and
Affordable Care Act (ACA) was
enacted on March 23, 2010.
Successful implementation 4.4
requires cooperation between key
stakeholders, federal and state
agencies, and reform advocacy
White (Non Hispanic)
organizations. Because the fifty 36.5
states vary greatly, each state’s 47.4 Black
implementation process will be Hispanic
unique. Other*

In 2009, Texas had the second

largest population in the United 11.9
States, estimated to be
24,782,302. 1 Texas is also very
diverse, which makes this state
unique in many ways, including
* Others include American Indian & Alaska Native, Asian, and Native Hawaiian and other
health care needs and presents a Pacific Islanders.
special challenge to those trying to
implement health reform in the
state.
TEXAS AND THE UNINSURED: HOW WILL THE AFFORDABLE CARE ACT HELP?

While 81% of all Texans have health insurance, over 6.5 million individuals remain uninsured,3 including
11% of Arizona’s children 4 and 28% of the state’s working population.5

ACA is designed to address these concerns by providing affordable access to health insurance coverage
to those individuals who would otherwise be unable to obtain coverage, and to extend current benefits
and services provided by Medicaid (a federal and state funded public insurance program that provides
health insurance coverage for low-income and disabled individuals and families).

NEW BENEFITS OF ACA AND THEIR EFFECTS IN TEXAS

ACA establishes new requirements for private health insurers in order to make health
Insurance care plans more accessible to the public. These requirements include the following:
Coverage  Effective Immediately: Plans must cover certain preventive health services, such as
vaccines and screenings, without a co-pay.

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National Coalition on Health Care July 2010
  Effective September 2010:
o Insurers will not be allowed to drop any insured person because he/she gets
sick or develops a chronic health condition. In addition, ACA allows individuals
to renew health insurance coverage regardless of their health status.
o Individuals up to the age of 26 can choose to be covered under their parents’
insurance plan.
 Effective January 2014:
o Under the “guaranteed issue” provision, an insurer must accept every
employer and individual in the state that applies for coverage.
o Insurers cannot exclude people from coverage if they have a pre-existing
condition (e.g., asthma, diabetes, or any other long-term condition) or past
illness.
o All insurers will be required to offer a coverage package that offers essential
benefits.
Effective Immediately: ACA makes tax credits available to qualifying small businesses to
Small
help them afford coverage for their employees. These tax credits could total up to 50% of
Business
a business’ health insurance premiums. In 2008, Texas had over 323,900 small
Assistance
employers,6 which represented over 72% of the state’s employers.7
Effective January 2014: ACA provides a tax credit to qualified individuals so that they may
Tax Credits purchase health insurance through the exchanges. Qualification for the tax credit will be
for based on the individual’s household income and his/her number of dependents. A
Individuals person who earns between 133% and 400% of the federal poverty level 8 may be eligible
for individual tax credits.
Effective January 2014: ACA requires that states create an insurance market “exchange”
Health – a marketplace where people will be able to compare and shop for health insurance.
Insurance This will make access to health plans easier and more efficient. U.S. citizens, legal
Exchanges immigrants, and small businesses will be able to purchase insurance through these
exchanges.
Effective July 2010: High-risk pools are designed to provide health insurance coverage to
people who were previously uninsurable due to a pre-existing condition. Texas has its
High-Risk
own program called Texas Health Insurance Pool. In 2008, this program covered 26,908
Insurance
individuals in the State of Texas.9 Gov. Perry indicated to Health and Human Services
Pools
(HHS) Secretary Kathleen Sebelius his interest to establish a new federally funded high-
risk pool.10
Effective January 2014: ACA contains provisions that would create new eligibility
Expansion requirements for Medicaid. For example, adults under the age of 65 earning less than
of 133% of the federal poverty level, may be eligible to apply regardless of whether they
Medicaid have children. It is estimated that approximately 1,798,314 Texans may be able eligible
to join Medicaid. 11

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National Coalition on Health Care July 2010
 IMPLEMENTATION CHALLENGES IN TEXAS

Successful implementation of ACA will require a joint effort among local, state, and federal agencies, as
well as many non-governmental organizations. The State of Texas will face several challenges:
 Budget 12 – The limited budget in Texas will be a real challenge for implementation, specifically
when expansions for services are expected. In May 2010, the Texas Health and Human Services
Commission reduced its budget by 23%. This reduction severally affects Medicaid and other health
care delivery services in Texas.
 Health Care Workforce – With the potential increase of Texas's insured population, it is important
that primary care physicians and other necessary health care professionals are engaged in health
care reform. ACA provides grants and loan forgiveness to health care professionals; this will help
Texas ensure that it has an appropriate supply of doctors, nurses, social workers, and other
professionals to cover the increased demand.
 Diverse Population – Texas's diverse population presents a special challenge to those implementing
ACA in the state. A key concern for Texas residents regarding their current health care system is
access to care. Providers must be sensitive to the state’s language, economic, and cultural diversity.
This means that access to care and the ability to understand one’s treatment should not be
threatened by one’s ethnicity, language, culture, or economic status.

1
U.S. CENSUS BUREAU. STATE AND COUNTY QUICKFACTS (2010), available at http://quickfacts.census.gov/qfd/states/48000.html (last accessed
June 2010). These figures are from 2009.
2
Ibid. These figures are from 2008.
3
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=125&cat=3 (last accessed June 2010).
4
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=127&cat=3 (last accessed June 2010).
5
COVER THE UNINSURED, ROBERT WOOD JOHNSON FOUNDATION, U.S. UNINSURED WORKERS, available at
http://covertheuninsured.org/uninsured_workers#map (last accessed June 2010). These figures are from 2006-2007.
6
Small businesses include employers with fewer than 50 employees.
7
U.S. DEP’T OF HEALTH & HUMAN SVCS. MEDICAL EXPENDITURE PANEL SURVEY (2008), available at
http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/state/series_2/2008/tiia1.pdf. These figures are from 2008.
8
The federal poverty level for the 48 contiguous states is $10,830 for a single individual. ASSISTANT SEC'Y FOR PLANNING AND EVALUATION, U.S.
DEP’T OF HEALTH & HUMAN SVCS. THE 2009 HHS POVERTY GUIDELINES (2010), available at http://aspe.hhs.gov/poverty/09poverty.shtml (last
accessed June 2010).
9
National Conference of State Legislatures, Coverage of High-Risk Uninsurables: State and Federal High-Risk Pools (May 27, 2010) available at
http://www.ncsl.org/?tabid=14329#2010_Pools (last accessed June 2010).
10
Ibid.
11
JOHN HOLAHAN & IRENE HEADEN, KAISER COMMISSION ON MEDICAID AND THE UNINSURED, MEDICAID COVERAGE AND SPENDING IN HEALTH REFORM: NATIONAL
AND STATE‐BY‐STATE RESULTS FOR ADULTS AT OR BELOW 133% FPL 41 (2010), available at http://www.kff.org/healthreform/upload/Medicaid-
Coverage-and-Spending-in-Health-Reform-National-and-State-By-State-Results-for-Adults-at-or-Below-133-FPL.pdf (last accessed June
2010).
12
TEXAS HEALTH AND HUMAN SERVICES COMMISSION, Summary FY2010-11 HHS General Revenue Reduction Options, (May 18, 2010), available at
http://www.hhsc.state.tx.us/about_hhsc/2011-budget/reduction-options.shtml#approved (last accessed June 2010).

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National Coalition on Health Care July 2010