Health care prices and access: What we’re working on

This is a preview of our Texas 2036 newsletter highlighting our work around health care prices and access. To receive this weekly highlight of our work, sign up here.

Affordable Care Act Enrollment 🩺

Setting the Scene: Two weeks ago, the Centers for Medicare & Medicaid Services released the most recent national snapshot of enrollment for the Affordable Care Act Marketplace through Jan. 7.

  • Also known as the exchange, this is where people can access federally subsidized health insurance plans.

By the Numbers: More than 2.32 million Texans are enrolled in ACA plans so far, with an estimated 2.45 million expected to sign up this period.

  • Enrollment has more than doubled since 2020, and jumped from 1.84 million last year.

What’s Going On: Additional research will be needed to pinpoint the primary drivers, but a number of plausible theories have emerged:

  1. Lower (net) prices, due in part to passage of Senate Bill 1296 in 2021
  2. Increased eligibility
  3. Increase in perceived need
  4. Changing workforce trends

Dive deeper.

Who Are the Uninsured 🩻

Cause for Concern: While enrollment in the ACA Marketplace increases, too many Texans are still uninsured.

  • About five million Texans are uninsured, making Texas the state with the nation’s highest uninsured rate at about 18% in 2021.

Finding Out Why: Most uninsured Texans qualify for a government health program or federal subsidies but they have not signed up.

  • Our multi-year study, “Who Are the Uninsured?,” aims to find out why. We recently wrapped year one with a series of surveys and focus groups.

What We Know: Initial findings show that lack of awareness, financial concerns and lack of certainty about eligibility are frequent barriers to health insurance enrollment.

  • There’s no one-size-fits-all description of the uninsured population. Thus, solving the uninsured problem will require multiple solutions that address the varying reasons why Texans may not have coverage.

Read more.

Health Care Prices and Affordability 💳

Under the Surface: The lack of health insurance isn’t the only issue.

  • Even Texans with coverage aren’t getting the care they need due to high prices—56% of insured Texans reported skipping or postponing care due to costs in a recent Episcopal Health Foundation survey.

In the Clear: Starting Jan. 1, 2021, federal law required hospitals to provide clear, accessible pricing information about their services.

  • Texas passed a similar law that went into effect in September 2021.

Tracking the Data: We began research to evaluate the actual prices paid by insurers and patients for various health care services around Texas. However, initial compliance was so low that we shifted focus to tracking compliance.

  • Our Hospital Price Transparency dashboard allows users to explore compliance in different regions, see how compliance has improved over time—the last update was October 2022—and view insurer-specific prices for some common medical procedures.

👉 As compliance has improved, we plan to return focus to evaluate actual prices paid and explore the extent of price variation around the state.

Texas Takeover: We are also exploring the impacts if the state were to adopt a state-based health insurance marketplace by taking over operation of the ACA Marketplace from the federal government. Benefits could include:

  1. Hundreds of millions of dollars in savings.
  2. A more user-friendly and seamless user experience.
  3. Greater flexibility to develop and implement a State Innovation Waiver.
  4. A streamlined enrollment process.

Learn more.

Filling the Gaps: Nurse Practitioners 🧑🏽‍⚕️

Did You Know: More than 15 million Texans are impacted by Health Professional Shortage Areas, where an insufficient number of physicians are available to care for the population.

  • Despite this high amount, many HPSAs need as few as one provider to address the shortage in their area.

A Problem to Solve: Texas requires nurse practitioners to have a delegation agreement with a physician in order to practice to the fullest extent of their license.

  • To expand access to health care, Texas should follow the lead of 26 other states and eliminate this burdensome and costly requirement.

👉 A Texas Nurse Practitioners survey found that 55% of nurse practitioners say that delegation requirements have kept them from creating or expanding their practice and seeing more patients.

Practical Solutions: Nurse practitioners have graduate level degrees, hundreds of hours of clinical training and practice primary care at a rate of 73%, according to the American Association of Nurse Practitioners.

  • Initial findings from our “Who Are the Uninsured?” study show that some populations may prefer the care of a nurse practitioner to a physician.

👉 national study also indicates that nurse practitioners are practicing in underserved areas more and more, making up for a shortfall of physicians. 

Keep reading. 

Spotted at the Capitol 📸

Legislative staff at the Capitol got a look at the early findings from our “Who Are the Uninsured?” study on Friday, Jan. 20.

Thanks to research partner Cicero for joining Texas 2036 Senior Policy Advisor Charles Miller (second from the right) and Policy Advisor Emily Brizzolara-Dove (far right) for the presentation.