Proposed federal health plan brings uncertainty in Texas

Doug Curran gets to take care of people “from the cradle to the grave,” and he says it’s the best job ever.

As a family doctor in Athens, Texas, for the past 35 years, Curran says his patients are his friends, and that means hearing all of their happy and frustrating run-ins with health insurance since the Affordable Care Act went into effect. He has patients who were thrilled to have insurance for the first time ever and patients who bemoan the rising copays and monthly costs.

It hasn’t been all smiles for Curran, either, who says there are a lot more hassles in his job, including having to seek prior approval before prescribing certain drugs and having a smaller pool of doctors and specialists in the area to refer patients to.

While Texas state leaders and legislators have been calling for the repeal of Obamacare since day one, the state has benefited from it. Texas’ uninsured rate went from 22.1 percent in 2013 to 17.1 percent in 2015, according to the latest U.S. Census data. But after Republicans in Congress unveiled their long-awaited plan to repeal the law on Monday, Curran said he was concerned that Texas patients and doctors would not want to understand how the changes will affect them.

“I worry about patients and physicians throwing their hands up and saying, ‘Golly, this thing is driving me crazy, I don’t want to deal with this anymore,’” he said. “I think it’s important we figure this out and try to do the right thing for our patients.”

Effects of proposed plan unclear

Under Republicans’ proposed American Health Care Act, changes would include eliminating the individual mandate; doing away with so-called essential health benefits that insurance plans have to provide, such as preventive care screenings, emergency room visits and lab tests; undoing the requirement for employers with 50 or or more employees to provide insurance; adding age-based subsidies to help pay for health insurance premiums; and incentivizing continued coverage by charging people a late enrollment fee if they go without coverage for more than two months.

The plan does keep some Affordable Care Act provisions, including people under 26 being able to stay on their parents’ health insurance plan and pre-existing conditions still being covered.

Currently, the Affordable Care Act requires everyone to have health insurance, either through federal or state health exchange websites or through an employer, with some people qualifying for tax credits to help cover the cost. Those who forgo insurance face tax penalties.

Right now, the potential impacts of the proposed new health plan in Texas are unclear.

Joe Ibarra, Texas deputy state director for Enroll America, said the organization’s partners were already fielding calls from consumers asking if they still had to pay their health insurance bills. He said people should continue paying their bills and going to the doctor.

“We think it’s very important for the community to know [that] while some in Congress have proposed a health care replacement plan, nothing has changed,” Ibarra said. “Consumers should still feel confident in their 2017 plan, and they may qualify for coverage under special enrollment deadlines.”

He also said it’s important for people to know that subsidies they may be getting to help them pay for health insurance have not changed yet.

In 2016, 84 percent of Texans who bought a health insurance plan received tax credits. The average subsidy was $257 per month, according to a U.S. Health and Human Services Department report. That helped lower Texans' premiums to an average of $87 per month after subsidies. But some residents make too much money to qualify for subsidy help.

Anne Dunkelberg, associate director for the left-leaning Center for Public Policy Priorities, said that under the American Health Care Act, subsidies will likely not be as helpful for consumers. She pointed out that age-based subsidies don’t take into account how plan prices differ based on where someone lives. That could leave some individuals or families unable to afford coverage.

“We’re looking at a system that really is harder on those who are older, lower income and potentially those that are sicker just because you’re the one who can’t go without the coverage,” Dunkelberg said. “They’re not charging more based on actual status, just based on age.”

Policy analysts are most dismayed that Congress is plowing ahead even though the Congressional Budget Office has not released a full analysis of the bill. The nonpartisan office is responsible for estimating how the cost of legislation would impact the budget. Without that analysis, it’s unclear how many people could lose coverage under the new plan.

“CBO scores were integral to structure of Affordable Care Act,” tweeted Norm Ornstein, a congressional expert at the American Enterprise Institute, a conservative think tank. “The House GOP plan is the most irresponsible policy-making path I have seen.”

Health insurers in Texas have already taken flak for rising premium prices, and that could continue under the proposed federal plan.

Kay Ghahremani, president and CEO of Texas Association of Community Health Plans, said doing away with the individual mandate would be troublesome for insurers, which she said need a predictable number of people signing up for coverage so they can keep premium costs steady and cover the costs of providing services.

“They can’t experience losses year after year; they won’t be able to stay in business,” Ghahremani said. “Just from my initial read of what’s being proposed, I don’t see anything to lessen that volatility, and in fact, I think it increases volatility for insurers.”

Texans in Washington gear up for fight

In Washington, several members of Texas’ congressional delegation are in the melee as the legislative and public relations push begins for the new health law.

U.S. Rep. Kevin Brady, R-The Woodlands, said during a news conference Tuesday that “House Republicans are choosing to act now” with the bill. He is slated to lead a hearing on the legislation Wednesday in his role as House Ways and Means chairman.

“As Republicans, we have a choice. We can act now, or we can keep fiddling around and squander this opportunity to repeal Obamacare and begin a new chapter of freedom for the American people,” Brady said.

Despite Republican control of Congress and the White House, it’s not guaranteed the proposed law will pass. It is highly unlikely the bill will earn any Democratic votes on the House side, and Republicans are facing an onslaught of criticism on their repeal efforts from liberals and conservatives alike.

There are also no guarantees that Republicans will vote for the bill, either. That could complicate U.S. Sen. John Cornyn’s job as Senate majority whip.

“We have an opportunity to do better for the people we represent, who are counting on us to deliver, to repeal Obamacare and replace it with options that work, and I believe the plan released [Monday] night is a major step in the right direction,” Cornyn said on the Senate floor.

U.S. Sen. Ted Cruz avoided taking a hard position on the legislation, saying in a statement he was "still studying the details of the bill."

"I am working closely with members of the House, members of the Senate and the Administration to pass a repeal bill that honors our commitment to repeal Obamacare, that lowers costs, that expands access and choices and patient control over your own healthcare," Cruz said.

U.S. Rep. Gene Green, a Houston Democrat and senior member of the House Energy and Commerce Committee, which will hold its own hearing over the bill Wednesday, called for a “30-day public comment period” and said he was “deeply disappointed” with his GOP colleagues.

Meanwhile, U.S. Rep. Louie Gohmert, R-Tyler, could be one of U.S. House Speaker Paul Ryan's hardest sells on the American Health Care Act. In an appearance on Fox News’ “Hannity” Monday evening, Gohmert indicated he hoped for changes to the bill during the amendment process.

Other members of the Texas GOP delegation were largely quiet on the bill.

But conservative groups, including Heritage Action for America, Club for Growth and the Texas Public Policy Foundation, slammed Republicans for offering up a plan that resembles the Affordable Care Act instead of the bold repeal they originally sought.

U.S. Rep. Michael Burgess, R-Lewisville, an obstetrician, is at the center of much of the legislation as the chairman of the House Energy and Commerce Subcommittee on Health.

“It is not the end of the process; it is the beginning of this process,” he said of the bill.

For now, Curran said it’s important that doctors and patients stay engaged and watch how the new health law shapes up — and for health providers to not be afraid of looming changes.

“Hopefully that product will be something that helps people get insurance and the health care they need so that they’re able to enjoy life and do the things they want to do because they’re healthy,” Curran said.

Read related Tribune coverage:

• As Republicans prepare to dismantle Obamacare, mental health advocates are worried that benefits for counseling and substance abuse treatment will be lost in the shuffle. 
• Texans signing up this year for health insurance under the federal Affordable Care Act may see higher costs but should also qualify for larger subsidies. 
• The roughly 1.3 million Texans who bought health insurance under the Affordable Care Act will likely have fewer, more expensive coverage options in 2017, as health plans continue to announce they will no longer sell their products in Texas.

Disclosure: The Center for Public Policy Priorities and Texas Public Policy Foundation have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.