health care reform

The Patient Protection and Affordable Care Act is a long, complicated document that will cause real changes in the way that you and your family access and pay for health insurance. Texas Impact is committed to helping you understand the bill and making sure that you get the benefits available to you. In the coming weeks, we will pick apart the bill—starting with the provisions that go into effect in 2010—so you can see who will be affected.

The Temporary High-Risk Pool

One goal of healthcare reform is to expand access to affordable insurance to those who cannot afford it. To that end, the Patient Protection and Affordable Care Act establishes broad coverage provisions that take effect in January 2014. Until then, however, the Act sets up a temporary high-risk pool for people who have pre-existing medical conditions and are without insurance.

Beginning on June 21, 2010, all individuals who have a pre-existing condition and how have not had health insurance for six months are eligible to enroll in the Temporary High-Risk Pool. This pool is meant to serve as a final safety net for those without insurance. To discourage people from switching from private insurance into this plan, the Act mandates that individuals must be without insurance for six months before enrolling.

The Temporary High-Risk Pool provides benefits that many plans, including Texas' own high-risk pool, do not offer. Kathleen Sebelius, Secretary of Health and Human Services, will determine the minimum benefits in the package, but right now we know that this plan must cover at least 65% of healthcare costs, that out-of-pocket spending is limited to $5,950 for individuals and $11,900 for families, and that premiums must be set as if for a 'standard' population, rather than a 'high-risk' population. Hopefully, the provisions will help keep this plan affordable for Texans. The federal pool, though, does allow for premium variation by age, geographic area, family composition and tobacco use.

States had various options as to how they would choose to administer this program. HHS Commissioner Tom Suehs told Secretary Sebelius on April 30, 2010 that he would allow the federal government to operate the pool in Texas. More information about how the federal government will operate the program will be forthcoming.

Updates on the Temporary High Risk Pool (PCIP)

To see the Kaiser Foundation's analysis of this provision, click here.

To see Secretary Sebelius' letter to states about developing a high-risk pool, click here.

For more information about how the Affordable Care Act will affect Texas, click here.

Health Reform Step-by-Step: Free Preventive Care

Health Reform Step-by-Step: Extension of Young Adult Coverage

Health Reform Step-by-Step: The Doughnut Hole

Health Reform Step-by-Step: Small Business Tax Credits

At a joint committee hearing on March 31, the Senate Committee on State Affairs and the Senate Health and Human Services Committee discussed how the recently passed federal healthcare reform bill will impact Texas's public and private insurance system, its healthcare industry, CHIP and Medicaid, and the state budget.

Health and Human Services Commissioner Tom Suehs and Texas Department of Insurance Commissioner Mike Geeslin both testified that the bill causes wide-reaching changes; however, they could not speak to exactly what those changes would entail. Commissoner Sueh's said that HHSC must work to figure out answers as they begin to implement the bill.

One of the biggest questions is the bill's impact on Texas' budget. Commissoner Suehs estimated that between 2014 and 2023, it will cost about $27 billion. The Congressional Budget Office (CBO), however, estimates that bill will only cost Texas $1.4 billion. There are some reasons for this discrepancy, though they cannot account for all of it:

• The CBO report estimates the cost from 2010- 2019; Suehs' estimate is for 2014- 2023.
• The CBO report does not take administrative costs into account.
• Commissioner Suehs does not include potential savings from the bill in his estimate.

Watch three clips of legislators and Commissioner Suehs discussing the financial implications of health care reform for the State of Texas.

Suehs testified that there may be potential savings in certain pilot programs that the bill allows for. These programs include compensation based on health outcomes, increased mental health care, and long-term home care for the chronically ill.

Watch Commissioner Geeslin give his take on the outlook for Texas and TDI as health care reform is implemented.

Watch Commissioner Suehs describe the innovative pilot programs that Texas can now implement because of the bill.

We do know, though, that this legislation will help approximately 90% of the 6.1 million uninsured Texans get coverage. About 2.1 million Texans will get coverage through Medicaid expansions, which will put a drain on the already overstressed eligibility system in Texas. Commissioner Suehs testified that he and his staff full intent to have the eligibility system in working order before the exchange is implemented.

Watch Commissioner Suehs talk about how many of the 6.1 million Texans who are currently uninsured will get coverage through the Patient Protection and Affordabie Care Act.

Watch Commissioner Suehs discuss how HHSC will manage the increased caseload because of expansion to Medicaid.

You can see HHSC's and TDI's presentation to the joint committee by clicking here and here.

For more information about healthcare, you can read a summary of the Patient Protection and Affordable Care Act and the reconciliation bill.