Texas Health Insurance

Last Updated on September 21, 2020 by Andrew Lee

There is no doubt that Texas greatly benefitted from the Affordable Care Act. Thanks to the law’s implementation, the state saw a considerable decrease in the number of its residents who went without insurance. However, there are still many challenges that the Lone Star State should take care of, such as its health ratings, and the fact that the current administration promised to repeal Obamacare.

This guide covers some of the most critical changes to the state’s health insurance sector.

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How the state stands in terms of health

Texas didn’t fare well in the 2015 Commonwealth Fund’s Scorecard on State Health System Performance, ranking only 40th of 51. It did perform above average under the study’s “Healthy Lives” indicator, scoring a quintile of 2. It received a score of 3 for both “Avoidable Hospital Use & Costs,” and “Equity,” and 4 for “Access” and “Prevention & Treatment.”

Here are some of the significant findings under its “Healthy Lives” scorecard:

  • Mortality amenable to healthcare: 93 out of 100,000 people
  • Breast cancer fatalities: 20.2 out of 100,000 women
  • Colorectal cancer fatalities: 14.7 out of 100,000 people
  • Percentage of adult smokers: 14%
  • Adult obesity: 32%
  • Obesity in children aged 10-17: 37%

Under its “Access” scorecard, the study found the following:

  • 26% of adults (19 to 64 years old) don’t have insurance, compared with the national average of 15%
  • 12% of children (infants to 18 years old) are uninsured, as opposed to the countrywide average of 6%
  • 18% of the adult population chose not to obtain insurance due to the high costs associated with it
  • 17% of adults had expensive out-of-pocket medical bills

Uninsured rating reduction of 6.6%

There are numerous factors insurance providers use to calculate rates, and the number of people without insurance in a given location is one of them. Fortunately, since TX managed to bring this down over the years, it somehow prevented an extremely high rate of increases this 2017.

Back in 2010, the state had the highest percentage of uninsured rating in the country, at 23.7%, the U.S. Department of Health & Human Services reports. Within five years, it managed to pull this down to 17.1%. The 6.6% decrease meant that 1,781,000 more people, from its then estimated population of 27,469,114 (2015, latest data), gained insurance.

Premium average projections for 2017

Rate increases for plans offered in the state exchange average at 29.35%. This is more than 4% higher than that of the national average of 25%. However, this is still better than what many other states have to face this year.

This said, you should enter the health insurance market knowledgeable of the following premium averages for 2017, as the United States Department of Health & Human Services projected:

  • Average lowest-cost, monthly premium within metal level: $362
  • Average net premium for lowest cost plan within metal tier: $89
  • Second-lowest silver before advance premium tax credit (for a 27-year old with a $25,000 household income): $261
  • Second-lowest silver after advance premium tax credit (for a 27-year old with a $25,000 household income): $142
  • Second-lowest silver before advance premium tax credit (for a family of four with a $60,000 household income): $945
  • Second-lowest silver before advance premium tax credit (for a family of four with a $60,000 household income): $945
  • Second-lowest silver after advance premium tax credit (for a 27-year old with a $25,000 household income): $405

Improved health ratings mean more than just better premiums

Yes, improving health ratings will mean better premiums for the residents of Texas. However, the benefits go beyond this. If the state improved its health ratings considerably to the point that it becomes as well-performing as the number one state, about 3.4 million more adults will become insured. It can also reduce its emergency department visits by more than 93,000 cases among its residents who have Medicare.