Many Texans were struggling to pay for basic health services on the eve of the launch of the Affordable Care Act's Health Insurance Marketplace, according to a report released by Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation. The report also found that even those with health insurance reported dissatisfaction with the cost and availability of services. Most Texans expect more of the same in 2014.
The Health Reform Monitoring Survey (HRMS)-Texas report is based on the HRMS, a national project that provides timely information on implementation issues under the Affordable Care Act (ACA) and changes in health insurance coverage and related health outcomes. The Baker Institute and the newly formed Episcopal Health Foundation are partnering to fund and report on key factors about Texans obtained from an expanded representative sample of 1,595 Texas residents.
"The Affordable Care Act is the most ambitious and most expensive federal health care program since the creation of Medicare in 1965," said Vivian Ho, the chair in health economics at Rice's Baker Institute, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. "Given its cost, it is imperative that we track its effects on both uninsured and insured Texans. Our initial results indicate that a significant portion of Texans need help with finding more affordable health care and insurance coverage. Going forward, the HRMS-Texas will allow us to see whether or not the ACA truly succeeds in making Texans better off."
Ho co-authored the study with Elena Marks, the president and CEO of the Episcopal Health Foundation and a health policy scholar at the Baker Institute, and Patricia Bray, director of the Episcopal Health Foundation's research program and an adjunct faculty member at the University of Texas School of Public Health's Fleming Center for Healthcare Management.
The HRMS-Texas report is the first in a series on the implementation of the Affordable Care Act in the state and examines the experiences of insured and uninsured Texans in obtaining and paying for health care services immediately before the opening of the Health Insurance Marketplace in October 2013.
The HRMS-Texas data show that prior to the opening of the Health Insurance Marketplace, Texans needed more affordable care. When insured and uninsured Texans were asked about their ability to pay for health services in the preceding year, both groups reported gaps in affordability, with 23.1 percent of insured people reporting trouble paying medical bills and 34.7 percent of uninsured reporting trouble.
Although Texas has the highest rate of uninsured residents in the United States (according to the 2012 U.S. census, 27 percent of nonelderly Texans were uninsured), three-quarters of those surveyed had health insurance in September 2013. Following national trends, the majority of respondents (56.2 percent) were covered by employer-sponsored insurance, including public and private employers and the military and the Veterans Affairs. Almost 9 percent were covered by public insurance (primarily Medicaid or Medicare), and 10.3 percent had purchased health plans through the individual insurance market.
Texans were generally satisfied with the quality of their health plans but were not satisfied with the cost, the survey found. Texans who purchased individual insurance plans reported the greatest dissatisfaction with their health plans, especially regarding the cost of premiums and copays. They also reported the most dissatisfaction of any group with the quality of available care and their protection against high medical bills. A goal of the Health Insurance Marketplace is to provide these people with access to the same quality plans as those offered by employers at more affordable prices than were available in the pre-ACA insurance market.
"The survey results indicate that even among middle-class Texans with health insurance coverage, many are finding physician care and prescription drugs to be unaffordable," Marks said. "People are generally happy with the range of health care providers they can choose from and the quality of care they receive. They are much less satisfied with the size of their insurance premiums and copays, and they worry about the financial consequences of large medical bills."
This survey also asked Texas respondents about their expectations of the impact of the ACA on their own health care and health insurance going forward. Insured respondents were asked whether they expected changes in their own insurance in 2014. Almost half of insured Texans expected change in 2014. "The expectation of change reported by Texans is consistent with the uncertainty and anxiety many Americans feel as we embark on a new health insurance system," the report's authors concluded.