Henry Ford once said, “Coming together is a beginning, staying together is progress, and working together is success.” Regarding the reduction of our uninsured and underinsured population, it’s time for Texas to strive for success.
The latest Gallup-Sharecare Well-Being Index showed the uninsured rate in 2017 rose by significant margins in 17 states, with Texas having the highest rate for the 10th straight year at 22.1 percent. The increases signal a frustrating reversal in the trend previously fostered by health insurance markets.
Admittedly, the uninsured rate is still below the high-water mark of 27 percent in 2013, but the numbers are clearly moving in the wrong direction. The recent survey revealed that the biggest reversals were happening in the South and in the 19 states that did not expand Medicaid. Texas, of course, falls into both categories.
If you recall the story from February, a Weatherford school teacher was suffering from the flu. She planned to pick up the flu medication prescribed by her doctor, but she considered the $116 co-pay too expensive, as she needed to buy food for her children. Her symptoms soon escalated, and she was admitted to the hospital where she died.
How many potential cases like this are in Texas? One would hope very few, but when you walk down a street, every fifth person you meet is uninsured. This does not take into account the underinsured who struggle with coverage and access to care, such as the Weatherford teacher.
Why has the uninsured rate started to climb? The open enrollment period for 2018 suffered from reduced public marketing, the enrollment period decreased by 50 percent, and navigator budgets slashed by 86 percent. Such drastic slashing in funding almost guarantees reductions in insured residents.
The short-term insurance plans, if allowed to exclude beneficiaries with pre-existing conditions, will surely negatively impact insurance premiums and potentially leave the most vulnerable people in our society with no coverage.
In addition, many insurers have withdrawn from the marketplace, resulting in fewer choices. The elimination of the individual mandate penalty as part of the December 2017 tax reform plan will surely reduce even more participants, which could trigger premium increases.
Many argue the majority of people on the exchanges receive subsidies protecting them from premium increases, but middle-class people who do not qualify will feel the brunt. Additionally, the recent federal actions weakening coverage requirements could prohibit individuals from purchasing short-term and association plans.
An issue brief published in May from the Kaiser Family Foundation found that annual financial data from 2017 suggested the individual market was stabilizing and insurers were making profits with no sign of market collapse. This would suggest insurers were finding better footing in the new marketplace and that premium increases would get more reasonable. Instead, recent ACA measures and proposals will likely lead to much greater premium hikes than necessary.
It does not require a crystal ball to predict that the uninsured and underinsured rates will continue to rise, creating higher premiums for everyone in Texas.
In January, the 86th Texas Legislature will convene in Austin. Hopefully, they will address expanding health coverage in Texas, prohibit short-term coverage from discriminating based on health status, and limit the maximum time an individual may be enrolled to less than 364 days.
To paraphrase Mr. Ford, all stakeholders need to come together, stay together and work together for a successful solution to our healthcare insurance issues in Texas. Texans deserve medical coverage and access, and shouldn’t have to choose between feeding their family or paying for medical treatment.
Steve Love is the president and CEO of the Dallas-Fort Worth Hospital Council.