Supreme Court Ponders as Health Care Reform Benefits Many Texans

Health Care

Supreme Court

Supreme Court Ponders as Health Care Reform Benefits Many Texans. Photo: stock.xchng, davidlat.

On March 23, 2012, the Affordable Care Act turned two years old, just a few days before the U.S. Supreme Court heard arguments on the constitutionality of the health care reform law and related issues. Many parts of the Affordable Care Act are in effect now, although some sections will not be active until 2014. The Supreme Court is not expected to announce its decision until June, so how it will affect health care reform is still unknown.

Meanwhile, millions of people across Texas and the nation are already benefiting from the Affordable Care Act, the Center for Public Policy Priorities recently stated. “If the law stays intact, Americans will gain many additional benefits and consumer protections in 2014,” the Center for Public Policy Priorities added. The center said Texas has more to gain than any other state because of how many people will be covered and additional federal funds. Nearly 6 million Texans, one out of every four, is uninsured, the highest rate in the nation.

A few ways Texans benefit from federal health care reform, including people with disabilities, are:

  • Children cannot be denied coverage due to a pre-existing condition.
  • Texans in Medicare who hit the “donut hole,” a gap in coverage, saved $135 million on prescription drugs in 2011, with an average savings of $639 per person.
  • 2.2 million Texans in Medicare received a check-up or preventive care with no co-pay in 2011.
  • 7.5 million Texans no longer have a lifetime limit on their health insurance.
  • 4,029 Texans enrolled in the federal Pre-existing Condition Insurance Plan as of December 2011.
  • Health plans must spend at least 80 cents of each premium dollar on care. Because of this, some insurance companies are asking for small rate increases than in the past or even lowering rates. The Texas Department of Insurance estimates $160 million in rebates will be paid to individual policy holders by August 1, 2012. Rebates also will be due for employer-sponsored plans.

More changes to insurance phase in over the next few years. The biggest changes will be in 2014, when Americans can no longer be denied coverage based on their health status or charged more because of their gender or pre-existing conditions. Also in 2014, adults living in or near poverty become eligible for Texas Medicaid and new competitive insurance marketplaces, called exchanges, will offer private insurance on a sliding scale to families with moderate incomes, see timeline on key health reforms and other information.

On a related matter, Texas lawmakers are concerned about how the state will fund the expected increase in Medicaid patients. The Health and Human Services Commission predicts that by the end of 2014, Medicaid will expand from 3.5 million beneficiaries to 4.7 million. While the cost is unknown, Texas Comptroller Susan Combs said Medicaid spending is now about 20 percent of the state’s general revenue, and the mandates could increase costs to about 37 percent by 2023. She said that “It will cost our state at least $18 billion dollars to cover increased Medicaid costs in the first 10 years.” At the same time, advocates point to cost savings that are expected to occur when most Texans have access to health care and are able to access health services earlier.

Visit the Texas Comptroller’s website for more information on the impact to the state’s Medicaid program.