Texas health insurance marketplace: history and
news of the state’s exchange

BCBS of Texas and Bright Health offering plans for 2018; cost of CSR added to silver premiums,making other
metal levels particularly affordable

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Louise Norris
Individual health insurance and health reform authority; broker
March 22, 2018

More Texas coverage

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    • Insurance for those over 64

Highlights and updates

  • 2018 enrollment down 4.6% from 2017
  • One insurer in 2017, but Bright Health joined in 2018
  • Average rate increase 15.6%, including added premiums to cover CSR cost
  • Cost of CSR added to silver exchange, other metal levels particularly cheap for some
  • 2018 rates and new insurer indicate death spiral no longer a danger

Texas exchange overview

The uninsured rate in Texas is higher than any other state at 16.6%. That number is more than double the national average. The state has the third highest exchange enrollment in the country, coming in behind California and Florida. For 2018, over a million people are enrolled through the Texas Exchange. However, the state opted to not expand Medicaid leaving nearly 638,000 residents in the coverage gap.

In 2017, the state approved the bill S.B.2087 which allows Texas to create a temporary high-risk pool when federal funds become available. The bill prevents the state from using the pool to expand Medicaid and the pool can be used to offset costs for private insurers as well as insure people with pre-existing conditions.


Health Rankings

The Commonwealth Fund’s Scorecard on State Health System Performance ranked Texas 44th. The state ranked poorly in Access and Affordably. The only category they ranked highly in was Healthy Lives including: the prevalence of smoking, the prevalence of suicide, alcohol, and drug related deaths. America’s Health Rankings gave the state 34th place. The state also ranked 2nd when it comes to number of children below the age of 18 who are uninsured.

Rates and Carriers

There were a total of eight insurers for the 2018 year that will all be returning for 2019. Celtic/Ambetter will return with a 4.7% rate increase, Blue Cross Blue Shield a 6.5% decrease, Christus with a 9.6% increase, Molina, with a 7% increase, Oscar with a 17% increase, Sendero with a 33.8% increase, Community Health and lastly, SHA/FirstCare with a 19.9% increase.

Texas and Medicaid

Researchers at New York University estimated that if Texas still has not expanded Medicaid by 2022 Texas will be forfeiting $9.6 billion in federal funds. In just five years, Medicaid in Texas grew by 7%. Texas has strict eligibility guidelines for non-disabled adults without dependent children are ineligible regardless of income and parents with dependent children are only eligible if their household income doesn’t exceed 15% of Poverty which is less than $3,000 annually for a family of three.

Medicare in Texas

In Texas, 13% of the state population is enrolled in Medicare whereas the national average is 17%. 84% of Medicare enrollees qualify based on age and 16% qualify based on a disability. Annually, the state spends about $10,549 per enrollee. As of 2015, 31% of Texas Medicare enrollees opted for a Medicare Advantage Plan. 44% of Medicare enrollees selected a Medicare Part D plan for prescription drugs.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.