Harris County’s public health care agency, responding to a budget crisis, will eliminate more than 19,000 people next year from eligibility for free or nearly free services, hoping most of these patients will obtain coverage through the Affordable Care Act.
The board of the agency, Harris Health, voted Thursday to reduce its income threshold for subsidized care from 200 percent of the federal poverty level to 150 percent, saving the system a projected $21.3 million in fiscal year 2017.
Of those losing coverage, more than 15,000 would be eligible to purchase insurance plans through Healthcare.gov, the health insurance exchange created by the federal law widely known as Obamacare. Most would qualify for large subsidies that would lower the cost of their premiums, deductibles and co-payments.
“We know the seriousness of what is about to take place, but something is going to have to take place for us to survive” in the face of a $53 million budget deficit, board chairman Elvin Franklin said before the vote. “We have to make some hard decisions from time to time, and sometimes those decisions are not going to reflect what everybody wants.”
Under the revised guidelines, an individual making more than $17,655 annually or a family of four with income exceeding $36,375 would no longer be eligible for subsidized care. The change would affect an estimated 19,527 patients, about 6 percent of the 325,000 clients the agency serves.
Harris Health and local advocacy groups will have a major challenge in helping people, like Walker, understand their options and how health insurance works.
Plans sold through the exchange are arranged into four tiers – platinum, gold, silver and bronze. Platinum and gold plans generally have higher premiums but lower deductibles and copayments. Bronze plans have the lowest premiums but high deductibles and copayments.
Federal subsidies, provided through tax credits, and cost sharing help are only available through silver plans. Often, paying a higher monthly premium for a silver plan will be less expensive in the long run for an individual patient.
“We’re talking to people who have never had health insurance before,” said Tiffany Hogue, policy director for the Texas Organizing Project, an advocacy group for the poor that has been conducting enrollment outreach. “Unless they’re sick, this is not their top priority or concern. And it’s complicated to show them the value of why they need it now.”
The education effort may get a significant boost from the federal government. Health and Human Services Secretary Sylvia Burwell announced Tuesday that Houston was among the five areas the agency will target with expanded enrollment outreach because they have high levels of uninsured people.
“We’ve found that costs are still a big concern – about half of the people who are uninsured have less than $100 in savings,” Burwell said. “And people are worried about fitting premiums into their budgets. Almost 60 percent of people who are uninsured are either confused about how the tax credits work or don’t know that they are available.”
While their monthly costs may increase, patients who enroll in the exchanges will have other benefits of health insurance. For example, they can seek care from doctors and hospitals outside the Harris Health System. And their plans can provide coverage when they travel out of the area.
This has been under discussion for several weeks now, as Harris Health has tried to deal with its deficit. They could apply some of the savings they’ll get from 15,000 people signing up for Obamacare to help the 4,000 or so that don’t qualify for subsidies, and still come out way ahead. It’s going to be hard on a lot of people, and some will unfortunately fall through the cracks, but it doesn’t make sense for Harris Health to not do this. Let’s put the blame for any problems that arise – indeed, for the shortfalls that are forcing this in the first place – where it belongs: on the state, particularly Greg Abbott and Dan Patrick and the Legislature, for refusing to expand Medicaid. That would have provided coverage to a large number of the people that will still be serviced by Harris Health. Medicaid expansion would also provide coverage to many people who suffer from mental illness, including a significant portion of the homeless and the people who make frequent trips to the local jails. Our state leadership isn’t interested in any of that. They want to push those costs down to the local level, where they don’t have to take responsibility for it, and they want to arbitrarily cut costs despite the huge negative effects that has. That is the root cause of these problems, and it will remain so until we have different leadership. I hope I live long enough to see it. KUHF and the Chron editorial board have more.