3.3 million Texans enroll in ACA marketplace

This is a preview of our Texas 2036 newsletter with a snapshot of Texas ACA enrollment numbers. To receive this weekly look at our work, sign up here.

A boost to the health of Texas… ACA enrollment in the Lone Star State passes new milestone 🩺

3.3 million Texans, or more than one in 10 Texans, have signed up for coverage through the ACA’s Health Insurance Marketplace since the start of the open enrollment period for 2024.

And that number is sure to increase. That 3.3 million figure is current as of Dec. 23. With enrollment continuing until next week, the question now is how much higher will Texas’ figure be?

Texans still have time to sign up for a plan

The Open Enrollment Period runs until Jan. 16. Those who enroll by midnight on Jan. 16 can get coverage that starts Feb. 1, 2024.

Who are the uninsured?

In our Who Are the Uninsured? report from December, Texas 2036 elaborated a list of profiles that best describe why various subsets of the uninsured don’t obtain health coverage.

Those profiles, listed below, break down into two major categories of barriers:

External: corresponds to things like cost, difficulty navigating systems, and concerns about legal risks.

• Scrappy Value Hunters: Pragmatists who continually search for cheaper ways to access care.
• Simply Can’t Afford It: Those who want insurance but believe they are unable to pay for it.
• Hard Knock Life: Affected by major medical and/or non-medical tragedies. This group recognizes the importance of insurance but cannot prioritize it over basic survival needs.

• Mothers and Caregivers: Prioritize the insurance and care needs of their dependents over their own.
• Undocumented and Wary: Interested in insurance but distrusting of existing systems. This group lacks confidence in their ability and eligibility to enroll in insurance.

Internal: conveys a lack of urgent concern about their health or possibly unrealistic expectations about price of care as adults.

• Indestructibles: Young, healthy people who are unlikely to have experienced a major health crisis and older, unhealthier people who don’t perceive their health issues as immediate concern. They see insurance as a future necessity but not an immediate one.
• Anxious Avoiders: This group lives by the mantra “out of sight, out of mind.” They avoid care because they fear the issues that may be discovered if they were to visit a doctor.
• Assumed Care: Enrolled in Medicaid as children and expect the same level and price of care as adults.

A golden opportunity for Texas’ uninsured

We estimate that roughly 1.5 million of the 5 million uninsured Texans likely qualify for a no-cost plan via the ACA marketplace.

Texas lawmakers could better optimize the state’s enrollment figures by taking action to build and operate a state exchange on which ACA marketplace plans would be sold.

Here are a few of the benefits to Texas of running its own exchange:

• Streamlining the enrollment process to make it less cumbersome for the uninsured.
• Improving outreach and education to the uninsured.
• Rebranding the exchange as a Texas product.

Here’s one more thing… Texas opting to run its own exchange is the fiscally conservative choice.

We estimate Texas could save hundreds of millions of dollars in premium fees that it currently pays to the federal government to operate the ACA exchange for the state.

Texas would assume the costs of building and operating a state exchange, but we estimate that it would cost far less than what the state pays in premium fees. Those savings could be used to implement policies to further reduce the uninsured rate.