How an ACA Repeal Would Harm Texans

//How an ACA Repeal Would Harm Texans

With the Affordable Care Act (ACA) Open Enrollment deadline just one week away, it’s important to outline how important the landmark health law has been for Texans. Over 1.1 million Texans have selected plans in the health insurance Marketplace so far, with 27 percent of them being new to the Marketplace this year. 

In our new fact sheet, we outline how dangerous a repeal of the ACA by Congress would be for Texas, especially without immediate replacement. Remember that in the first U.S. Senate debate and vote to set Congress on a repeal pathway, numerous Senators cautioned—including a number of Republican officials—that an ACA repeal without replacement is not an option. Agreeing on a replacement plan, they argued, will likely take time.

CPPP held a briefing at the Texas Capitol on January 24 to go over these threats to Texas. Watch a recording of the presentation here, and view the slides here.

Here are some of the challenges Texas could face if Congress repealed the ACA without giving Texans any other options:

  1. Loss of Coverage, Collapse of Individual Marketplace. Over 900,000 Texans get sliding-scale discounts that cut their health insurance premiums by an average of 75 percent, and without those discounts most will drop coverage.  Coverage for another 900,000 insured unsubsidized Texans would also be in jeopardy.  Insurance experts predict collapse of the individual (direct-purchase) Health Insurance Marketplace is likely with either a full repeal or “repeal and delay.”  The American Academy of Actuaries has warned Congress that repealing major provisions of the ACA (even a repeal with a delay), or eliminating subsidies, could result in significant market disruption leading to millions of Americans losing health insurance.  Economists from the conservative American Enterprise Institute have raised the same concerns.
  2. Yearly or lifetime caps. If you have a serious injury or illness, you could hit a yearly or lifetime dollar cap, and have no more insurance coverage. Before the ACA, Texans with serious conditions like hemophilia, Crohn’s disease, cancers, or who needed organ transplant had coverage that stopped paying their bills at some point, leaving them scrambling for care, compromising their health and often causing financial ruin.  About 5 million insured Texans had a lifetime limit on their insurance policy before the ACA.
  3. Mental health coverage. Coverage of mental health needs or substance use disorder treatments could be dramatically reduced. Equal treatment for mental health and substance use disorder conditions—known as “mental health parity protections”—would be dramatically reduced with ACA repeal.  The ACA extended mental health parity to cover more insured Texans, and repeal would mean millions of Texans would lose protection of equal access to mental health benefits in insurance.
  4. Women could be unable to buy insurance that covers maternity, and could once again be charged more than men. Before the ACA ended gender discrimination in health coverage pricing, women in Texas were charged as much as 56 percent more than men for the same coverage (even with maternity benefits excluded).  Before the ACA, women literally could not purchase coverage on the individual market that covered pregnancy—and not just after a women got pregnant.  Insurers in Texas simply did not sell non-group policies that included maternity care.

Read more in our full policy brief here.

Anne Dunkelberg joined the Center in 1994. She is one of the state's leading experts in policy and budget issues relating to health care access. In 2007, she was named Consumer Advocate of the Year by Families USA in Washington, D.C. Before coming to the Center, she served as Program Director for Acute Care in the Texas Medicaid Director's Office and spent six years with the Texas Research League, where she authored numerous reports on Texas health and human services issues and tracked state health and human services budget issues. She earned dual degrees from The University of Texas at Austin—a Bachelor of Arts (Plan II), magna cum laude, in 1979 and a Master of Public Affairs from the LBJ School of Public Affairs in 1988.

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