AP Exclusive: Modest premium hikes as 'Obamacare' stabilizes (copy)

The HealthCare.gov website is photographed in Washington on Dec. 15, 2017.

More people have health insurance in McLennan County than ever before, due, in part, to the Affordable Care Act.

Despite multiple attempts by Congress and the Trump Administration to repeal the law, shortened enrollment periods and a series of program cuts, the Affordable Care Act continues to provide access to health care for thousands of new and repeat marketplace customers in McLennan County and millions of people across the country.

But recent funding cuts to key Affordable Care Act outreach efforts may keep some potential Texan insurance customers in the dark.

“The data is pretty clear, if you have (health insurance) coverage then you end up having better health care during your lifetime,” said Waco Family Health Clinic CEO Roland Goertz.

The years following the law’s passage in 2010 were marked by a significant decrease in the number of uninsured patients seeking health care at the Waco Family Health Clinic, Goertz said.

Open enrollment

In less than six weeks, between Nov. 1 and Dec. 15, Texans will once again have the opportunity to enroll in a health insurance plan for 2019 through the marketplace’s open enrollment period on HealthCare.gov.

Individuals who lost health insurance coverage this year, or had a major life change, like getting married or having a baby, may be able to get health insurance coverage after Dec. 15 through a special enrollment period.

Regardless of political views, and taking into account a possible influx in the number of people insured through an employer, the Children’s Health Insurance Program, or Medicaid; the passage of the Affordable Care Act has made “historic progress” in reducing the uninsured rate in Texas, said Center for Public Policy Priorities Senior Research Analyst Stacey Pogue.

“Every year before 2013 our uninsured rate, for a long time we’ve had the highest number of uninsured and the highest rate of uninsured, it always bounced around 20 and 25 percent rate, but never one year would it even go down more than one percent,” Pogue said. “But as soon as the marketplace opened, we had a 5.5 percentage point drop in our uninsured rate from 2013 to 2016 before and after the marketplace.”

Between 2006 and 2016, the number of uninsured people in McLennan County declined by 10 percent, according to census data. While local enrollment in the marketplace has decreased in recent years, about 5,300 residents continue to rely on marketplace plans to provide essential health coverage.

At present, an estimated 37,000 residents lack health insurance coverage in the county. By and large, Texas remains the state with the largest number of uninsured residents in the country, with about 23 million uninsured people living and working in Texas today. Meanwhile, Massachusetts ranks the best in the U.S.; fewer than three percent of Massachusettsans are uninsured.

The Affordable Care Act bans health insurance companies from excluding people with preexisting health conditions, like diabetes and cancer; and provides financial assistance, either through subsidies or tax credits, to qualifying low-income individuals.

In 2016, about 80 percent of McLennan County marketplace customers received a tax credit that lowered their monthly healthcare premium by $368 on average, according to census data. Another 60 percent of local customers received a discount in co-payments and deductibles.

Navigators

The health care law implemented a federally funded outreach effort, the Navigator program, to employ and train community health workers in 34 states, including Texas, to help people compare insurance plans, apply for financial assistance, appeal an insurance claim denial and enroll in Medicaid, CHIP or a marketplace insurance plan through the Affordable Care Act, free of charge to the customer.

“There’s a whole lot of complexity that goes into applying for coverage and picking a plan, that I think a lot of people take for granted,” she said. “Although everybody would say that their insurance is complicated and incomprehensible, most of us don’t have to go pick from 80 plans all on our own and do it every year.”

Without Navigators, low-income or homebound Texans, without easy access to a computer and an internet connection, may face additional barriers when applying for health insurance.

“Some of the hardest to reach populations have some really substantial barriers to getting and maintaining coverage,” she said. “The idea behind the Navigator program was in-person assistance, someone you could meet with face-to-face. Navigators were an entirely new concept that consumers need assistance and some need more than others. The system without them wasn’t providing that.”

Up until one week ago, McLennan County had a federally funded navigator devoted solely to the Waco area through the Community Council of Greater Dallas, a nonprofit organization which serves more than 50 counties from Texarkana to San Antonio, but, after the Trump administration’s latest round of cuts to the Obama-era program, the organization lost all funding for the program six weeks shy of the start of the open enrollment period.

“You can imagine how shocked we were that we didn’t receive anything,” Managing Director Yolanda Perez said. “It’s disappointing to us. … These cuts directly impact people who are seeking high quality and affordable healthcare.”

In the past two years, the Centers for Medicare & Medicaid Services slashed $53 million from the program’s budget, leaving Navigator with 80 percent less funding for programs across 34 states, according to a release from the Center on Budget and Policy Priorities.

To replace the dwindling Navigator program, the Center for Medicare and Medicaid Services has enlisted the help of private sector health insurance agents, according to a statement released about the budget cuts.

“Navigators are one of many ways individuals can get help shopping for, and enrolling in, health insurance coverage; CMS continues to expand options for individuals to enroll in coverage through partnerships with the private sector, including agents and brokers and health insurance issuers,” the release said.

But, unlike navigators and certified application counselors, private sector health insurance brokers are not obligated to offer unbiased health insurance advice and are often paid by health insurance companies to sell particular plans.

For the first time in five years of operation, in the absence of federal funding, the Dallas-based organization has committed to raising enough money on its own to employ certified application counselors, the next step down from a navigator, to get through the open enrollment period.

“We’ve already reached out for emergency funding,” Perez said. “Again, this is jarring news for us, but I will tell you we are undeterred. We issued email and letter writing campaigns. … We’re confident that we’re going to find a way.”

In light of the number of uninsured people in McLennan County and across the state, Goertz said it’s time for politicians to stop playing games with human lives.

“I think it’s sad that health care, a basic need for a person to be productive and live a long good life, has been made such a political football,” he said. “I just think that somewhere out there in some time and place we’ll understand that it’s not something you should play politics with.”

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