What Texas Would Look Like Without Obamacare
The state leading the latest effort to overturn the health law used to have weaker coverage and more uninsured residents.
https://www.nytimes.com/2020/06/26/upshot/texas-obamacare-coronavirus.html
By Sarah Kliff
June 26, 2020
Updated 3:13 p.m. ET
Texas, in the midst of a surge of coronavirus cases, asked the Supreme Court on Thursday to overturn the Affordable Care Act.
If successful, the court challenge could wipe out the health law’s protections for pre-existing conditions. And as many as 23 million Americans could lose coverage.
Texas has long been at the center of this fight. It leads an 18-state coalition in challenging Obamacare’s constitutionality. A federal court there ruled in favor of Texas in 2018, a decision that surprised many legal experts. The lawsuit bears the state’s name, too: Texas v. United States.
Texas had the highest uninsured rate in the country before the Affordable Care Act, and still does today. This is largely because Texas does not participate in the health law’s expansion of Medicaid.
Those changes would come at a moment when Obamacare has heightened importance. Many of the millions who have lost jobs, and the insurance that comes with it, are expected to transition to buying their own coverage in the individual market. A report from the Urban Institute estimates that 1.6 million to 3 million Texans will lose employer-sponsored coverage as a result of the economic downturn.
In 2010, the year the Affordable Care Act passed, Texas had an uninsured rate of 23.7 percent. That worked out to nearly six million Texans without insurance.
At the time, there was widespread variation in how states ran individual insurance markets. About 16 million people, including one million Texans, got coverage through those markets, and Texas had one of the less-regulated ones.
Texas, for example, allowed insurers to charge women higher premiums than men (a practice that was outlawed or restricted in 12 other states, mostly Northeastern ones). Individual market insurers could deny coverage to those with pre-existing conditions. The average individual market plan around that time came with a $222 monthly premium. The plan was not required to cover expensive benefits such as childbirth or prescription drugs.
Most Texans gaining coverage have done so through the health law’s insurance marketplaces. The premiums in Texas have tended to be lower than those elsewhere in the country, but there have been some big increases in recent years. The monthly price of a midlevel individual market plan has increased to $462 this year, up from $359 in 2017.
Texas’ decision not to participate in the health law’s Medicaid expansion significantly limits the health law’s reach there. The Kaiser Family Foundation estimates that 1.5 million low-income Texans would be eligible for coverage if Texas participated.
Of course, Texas and other states could come up with a plan to replace the Affordable Care Act. So far, that hasn’t happened: As The Texas Tribune reported, the State Legislature did not prepare a replacement plan before adjourning at the end of 2019.
The body, which meets every other year, will not convene again until 2021.
Lots more at the link. A lot more.
