More than 21 million people across the country, including close to 3.5 million Texans, signed up for health care plans through the Affordable Care Act (ACA) Marketplace for 2024.
Charles Miller, a senior policy advisor with Texas 2036, said it’s a record high for Texas.
“It’s been some explosive growth,” he said.
About 2.4 million Texans signed up for a plan through the Marketplace during open enrollment in 2023, according to the Centers for Medicare and Medicaid Services, and a little over 1.8 million in 2022. According to health policy organization KFF, Texas, Florida and Georgia “account for half of the national growth in Marketplace enrollment this year.”
Miller said changes that made Marketplace plans more streamlined and affordable are part of the reason for the growth. The Inflation Reduction Act and the American Rescue Plan improved subsidies and lowered costs, and are in place through the end of 2025.
The federal government also gave out about $100 million to expand insurance Marketplace navigators in community organizations. Navigators help people apply for health insurance on Healthcare.gov and answer questions about the process.
Miller said it’s too soon to tell how this increase in coverage will impact the state’s uninsured rate – the highest in the country. According to the latest census data, 16.6% of Texans are uninsured, more than double the national rate.
Health insurance, Miller said, gives people options to deal with medical issues before they become chronic or life-threatening.
“If you have health insurance, you are going to have some financial peace of mind and financial stability,” he said. “You are going to be able to make those decisions to seek care with finances being a little bit less of an issue.”
Senior policy analyst Karla Martinez with Every Texan said while the growth is a good sign, there are still people who can’t afford a Marketplace plan and don’t qualify for other kinds of insurance, like Medicaid.
“Texas only has so many doors open for people,” Martinez said. “A lot of people don’t have a door at all for health insurance.”
She said the Medicaid unwinding process – during which the state is determining people’s eligibility after pandemic-era protections ensuring coverage ended – has left 1.8 million Texans without health insurance. According to KFF, more than 60% of people who lost coverage were kids.
“It’s really hard to grasp both of those concepts, right,” said Martinez. “Healthcare.gov is working really well, and at the same time a lot of people are losing their Medicaid.”
One way the state could improve health care access for low-income families, Martinez said, is by expanding Medicaid. Texas is one of only 10 states in the country that has yet to do so.
But in the meantime, she encourages people who might have lost Medicaid coverage to check their eligibility for an ACA Marketplace plan. They could qualify for a special enrollment period, even if the open enrollment period ended a few weeks ago.
“It’s not too late to check out what your options are and see if the door is open for you,” Martinez said.
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