Cynthia Donnell started the process of enrolling in the federal health insurance marketplace in November, but she faced delays when the marketplace’s launch was riddled with technical complications.
Now, with the March 31 open enrollment deadline looming, she decided to finish the process, recently attending one of many late enrollment events hosted by health care reform advocates.
“I can go rest easy tonight and get some good night sleep knowing that I have insurance and can go to my own private doctor and get the care that I need,” said Donnell, 57, a part-time employee at Enterprise who completed her enrollment during a session at the David Chapel Baptist Church in Austin. She qualified for a monthly subsidy of $431 to help pay for her insurance, which she hasn’t had since she was on Medicaid during her two pregnancies.
As enrollment numbers continue to lag behind expected totals, Donnell is among the uninsured Texans whom federal health reform advocates are working to enroll in the marketplace ahead of the upcoming deadline for the first open enrollment period. Given Texas’ figures — more than 6 million individuals, or roughly one in four Texans, are uninsured — advocates see the state as key to President Obama’s signature law and prime territory for a final blitz.
But opponents of the law say that the Obama administration will not meet its expectation of enrolling 6 million Americans because health insurance plans available through the marketplace are too costly.
“A lot of these people are going on [healthcare.gov] and seeing exactly how much the plans are going to cost them per month out of pocket,” said John Davidson, a health policy analyst at the Texas Public Policy Foundation, a conservative think tank. “And they are making the decision that it’s not worth it or that they can’t afford it.”
The Affordable Care Act requires most individuals to purchase health insurance by 2014, specifically by March 31, which will mark the final day of canvassing and enrollment outreach by nonprofits, local governments and community organizations.
At the start of March, 295,000 Texans had selected a coverage plan in the federal marketplace, but the number of total enrollees represents a small fraction of the uninsured in Texas.
National advocates for health reform have homed in on Texas’ enrollment in recent weeks, including U.S. Secretary of Health and Human Services Kathleen Sebelius, who was in Texas last week to promote enrollment efforts, including a final push to mobilize young adults to sign up for insurance through the marketplace.
Enroll America, a nonprofit group promoting the federal health reform law, launched a six-city bus tour through Texas last week to help people enroll in the exchange. Anne Filipic, president of the group, said it has focused on Texas because of the amount of people “who stand to benefit” from the federal health reform.
The organization has also set up a series of enrollment events throughout the state, including the one Donnell attended, as part of the final week of enrollment and is following up with individuals who started their process at one of the events to help them complete their enrollments.
Locally, state Democratic legislators have hosted their own enrollment efforts or have worked with entities like the Texas Organizing Project, a group that advocates for low-income Texans, to host regular enrollment events in Dallas, Bexar and Harris counties.
Federally qualified health centers in Texas also received more than $15 million federal grants to help individuals enroll in the marketplace. Lone Star Circle of Care clinics was among the top recipients in the state, receiving a combined $600,000 in grants to provide enrollment assistance.
Lone Star spokeswoman Rebekah Haynes said its 35 certified application counselors have seen an uptick in demand for enrollment assistance in the last few weeks, and they are working with hundreds of individuals to verify whether they qualify to purchase health insurance through the marketplace.
Texas could have delivered half of the enrollees the Obama administration is banking on. The Kaiser Family Foundation estimates that 3,143,000 Texans are potential marketplace enrollees, but only 9.4 percent of that population has enrolled. (Potential enrollees include uninsured Texans who are U.S. citizens and have incomes above the amount needed to qualify for Medicaid.)
Davidson, of the Texas Public Policy Foundation, attributed the low enrollment numbers to costly premiums throughout the marketplace and said that the state would not see a substantial change in the number of uninsured regardless of a last-minute surge in enrollment.
“What we’ve seen in almost six months now of open enrollments is exactly what skeptics of the Affordable Care Act said we would see,” Davidson said, adding that reluctance to purchase insurance through the marketplace stems from expensive health insurance plans and disincentives to accept federal subsidies to pay for coverage because individuals can be required to pay portions of them back if their income increases.
The amount of newly insured individuals under the ACA has been unclear so far because federal data does not indicate how many previously uninsured individuals have enrolled in health plans on the federal marketplace and is instead a total of all enrollments in the state.
Those who remain uninsured can expect a tax penalty when they file their 2015 income tax. Uninsured individuals who don’t qualify for an ACA exemption could face a fine of either $95 or up to 1 percent of the portion of the person’s adjusted gross income after the first $10,150. And penalties are slated to increase in following years.
Tiffany Hogue, health care campaign coordinator for the Texas Organizing Project, said the state’s low enrollment figures could be blamed in large part on the hostility the ACA has faced in Texas. “We don’t have a hospitable climate here,” Hogue said, faulting misinformation, additional regulations on navigators issued by the Texas Department of Insurance and the state’s decision to not expand Medicaid eligibility to cover low-income adults.
When Texas declined to expand Medicaid, which would have in part been federally funded, a “coverage gap” was created that consists of individuals who make too much money to qualify for Medicaid but not enough to qualify for tax credits to help pay for coverage on the federal marketplace — about $15,856 for an individual or $32,499 for a family of four.
More than 1 million Texans fall into that group, according to the Kaiser Family Foundation.
Texas’ Republican leadership has stood by the state’s decision to not expand the Medicaid system, saying that an expansion would have hurt the state financially and that the system instead needed to be fixed.
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.