For Carol Elliott, a Port Aransas resident in her early 60s, the Affordable Care Act is not a failure.
“The Affordable Care Act saved my life,” the musician says.
Elliott lived in Nashville for a long time, but has spent the last 15 years living in the island town in the Gulf of Mexico off the Texas shore.
She says money has always been tight, and she’s had to cut corners through the years. That’s often meant she’s been priced out of health insurance.
But when the Affordable Care Act, also known as Obamacare, was passed in 2009, things started looking up. That was especially true when an online marketplace allowing people to buy insurance directly from companies with the help of government subsidies was created under the law.
As soon as the exchange was up and running in Texas, Elliott says, she signed up.
“And a week later – maybe it was a couple weeks – I was diagnosed with breast cancer,” she says.
Doctors caught her cancer early, and Elliott was able to avoid chemotherapy. Her treatment plan included a lumpectomy, radiation and CAT scans, which were all covered by her new insurance plan.
“I was able to get all the treatment I needed,” she says. “My out-of-pocket expenses for everything that I just outlined were really minimal.”
Elliott, who is now cancer-free, says she has noticed some changes in her insurance plan lately.
“After the first year, the cost has gone up some,” she says.
In their fight to repeal Obamacare, Republicans have repeatedly pointed to a steady increase in premiums. But the prescriptions and causes for these premium hikes are different depending on whom you talk to. The Senate is expected to try again next week to vote to repeal Obamacare, which has been a GOP goal for years. President Trump says if Republican efforts to kill the law fall short, his plan is to just let it implode.
“We will let Obamacare fail and then the Democrats are going to come to us and say, ‘How do we fix it?’” he told reporters Tuesday.
Proponents of the Affordable Care Act argue the existing law needs to be enforced and shored up. Yes, premiums are going up, Elliott says, but she points out that she is still able to afford her health plan.
“The vast majority of enrollees are shielded from those premium increases,” says Stacey Pogue, a senior policy analyst with the left-leaning Center for Public Policy Priorities. “They're not paying it out of their pockets because we have subsidies that offset the increase for those enrollees. But the underlying premium is going up – and that is important.”
Pogue says in the first few years, the average premium went up about 3 to 5 percent in Texas, which is pretty modest. This past year, though, increases were around 18 percent. While that’s high, Pogue says, it’s actually lower than the national average. And again, she says, Obamacare was designed to protect consumers from shouldering the burden of premium increases.
Those increases are why Republicans, including Sen. John Cornyn, say the law is failing. In fact, he says he thinks it will get worse under the law's own weight.
“We are projected to see double-digit increases in premiums and insurance companies pulling out of the marketplace unless something is done,” he told reporters during a conference call.
Inaction On Obamacare
Cornyn believes the Affordable Care Act should be repealed. He was part of a small group of senators who crafted the Senate’s replacement for the law.
A nonpartisan scoring of the Senate plan from the Congressional Budget Office (CBO) found it would make premiums skyrocket, however. In fact, the CBO report said millions of people would be forced to give up their health insurance.
Pogue argues inaction could also make things worse.
“One of the biggest things is whether the Trump administration is going to continue paying cost-sharing reductions,” she says. “These are subsidies that lower the amount of deductibles that low-income people in the marketplace have to pay.”
Under the Affordable Care Act, insurers are required to lower out-of-pocket expenses for low-income people in the exchanges. That’s the “affordable” part of the Affordable Care Act.
Pogue says the question now is whether the federal government will continue its commitment to reimbursing insurance companies for that.
“If the Trump administration stops that practice, insurers would have to increase their premiums to offset those losses,” she says. “And in Texas that means premiums would go up overnight – for no other reason – by 19 percent.”
And that’s not the only way the new administration could affect premiums, even if the law isn't repealed.
Trump has also called for the feds to stop enforcing the individual mandate, which requires everyone to have health insurance. That means fewer healthier people will be in the marketplace to help offset the cost of sicker people, which could mean higher premiums.
The administration could also roll back tax credits to help people pay for their premiums. Smaller tax credits could end up making insurance plans too expensive for some.
And that brings us to another way in which the GOP says Obamacare is failing: There aren’t enough insurers in the exchanges.
“This year Americans in 70 percent of counties nationwide have less than two insurers to choose from,” Cornyn said.
The senator is talking about two insurance companies, not insurance plans. However, this still points to a big problem over competition and choice.
In fact, there are some counties that might have zero insurers in their marketplace next year.
Pogue calls them “bald spots.” She says bald spots are a huge problem, but they are not a problem in Texas.
“None of those are in Texas,” she says. “Right now it appears that every county in Texas will have one or more insurers offering coverage.”
The picture is better when you look at Central Texas.
"Our market is actually growing,” says Elizabeth Colvin, the director of Insure Central Texas at Foundation Communities in Austin.
Colvin says the problems with the exchanges in more rural parts of the country don’t exist here.
“We have a very robust market in Central Texas,” she says. “We had 30 plans to choose from this past season with three different insurance companies. And for this upcoming season we expect to have four different insurance companies. A new insurer is coming to Central Texas.”
Of course, insurance companies are watching to see what happens in Washington before they formally commit to selling plans in any exchanges next year, but Colvin says so far things look good for Central Texas.
Pogue says the exchanges in Texas aren’t perfect, but they are in a good position for the coming year.
“You know, it's more than 60 percent of the population has three or more choices in the marketplace,” she says. “And it’s just 10 percent of people who only have one choice.”
Pogue says the marketplace has done well here mostly because Texas is a place where insurers want to sell insurance.
“Texas has always had a big enough population and plenty of low-income people who don’t have insurance,” she says.
Pogue says Obamacare may be struggling in some big ways in other parts of the country, but the federal exchange in Texas has largely been a success.
“It’s working just like it’s supposed to,” she says.
Pogue says continued success depends entirely on what Congress and the Trump administration decide to do in the coming weeks.