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Confusion Lingers in Texas as Insurance Exchange Enrollment Nears

Veronica Zaragovia for KUT News

The federal government is spending millions to promote new health insurance plans being sold through online marketplaces as part of the Affordable Care Act.

They’re trying to get the word out that people can start buying insurance through the marketplace on Oct. 1. But with just a couple weeks to go, many people say they have more questions than answers. 

Erica Gammill is an organizer with nonprofit Enroll America, an effort to teach people about the health insurance marketplace. It's basically a website where consumers can shop for and compare insurance plans – kind of like the travel site Orbitz.

At the Austin Convention Center at a back-to-school event, parents were approaching her and learning – many for the first time -- about the marketplace.

"This is the goal of our organization, to be the educational voice for this new law and to provide as much information for as many consumers as possible," said Gammill, adding she wasn't surprised by how many people didn't know about it.

Shawn McDaniel from Austin is one of the potential consumers.

"I really don’t know what’s going on right now about the insurance. I heard about it but I heard from other people," he said.

McDaniel isn’t alone. About 5 million adults in Texas lack insurance. The state has the highest uninsured rate in the U.S. And just as McDaniel is unsure about what will change come Oct. 1, so are many doctors.

"In fact, I’m not sure Secretary [Kathleen] Sebelius knows what’s going to happen Oct. 1. But something’s going to happen and it’ll be most likely unprecedented," Dr. Stephen Brotherton said.

Brotherton is the president of the Texas Medical Association. Nothing actually changes on Oct. 1. People who want to can start shopping for insurance using the marketplace on that day. But no one is required to have insurance – under the so-called individual mandate – until Jan. 1. And no one is required to give up their existing health insurance. Brotherton says confusion is greater in Texas because it’s one of six states that won’t enforce reforms under the federal law.

"In this state the feds are taking the plan out but yet the state insurance commission [the Texas Department of Insurance] is also asserting they have some authority," Brotherton said. "They don’t want to be involved in trooping it out but they should have a role in determining if the plans are valid.

"Everybody has to offer the same benefits and all of it will be displayed so the consumer compares apple to apples for every individual plan they might be considering," said Dallas-based Marjorie Petty, regional director for the U.S. Health and Human Services. She says all of the companies offering insurance on the exchange have been approved to do business in Texas.

But Brotherton questions how many doctors will actually take these plans.

"Coverage and access are not the same thing," he said. "You can have a policy, but if it’s below your doctor’s break even point to keep his office open he’s not going to accept that."

Most of the uninsured in Texas are Latinos. Juan Flores is with La Fe Policy Research and Education Center in San Antonio. He says despite the tax subsidies for qualifying families, not all will be able to afford these health plans. And, he adds, state officials’ refusal to expand Medicaid eligibility means many of Texas’ poorest families will continue without insurance.

"So we need to politically go back and put pressure on those public officials to change their mind. They can change it tomorrow," Flores said. "All  [Governor Rick Perry] has to do is send in a letter and say we want the Medicaid expansion."

Latinos have not done a good job flexing their political muscle in the past, Flores added, but he hopes that will change if the uninsured get mobilized.

"As they become more aware of the kinds of obstacles that are preventing their mobility and the wellbeing of their families, and the people who are doing and preventing that, certainly I hope that gives them the urgency to come out and vote," he said.

In the short term, less than a month remains before the marketplace opens. People will be able to find the Texas exchange through In the meantime, there’s an 800 number on the site for people with specific questions. It connects to a call center in Brownsville – with help available in 150 languages. 

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