My experience applying to ACA in Texas

by Crane-Station

Open enrollment for obtaining affordable health insurance to take effect in 2015 begins today. Even though I have an undergraduate degree in Biology and an associates degree in a medical field, as well as a reasonable grasp of reading and writing, my attempts to navigate previous versions of ACA enrollment websites proved futile. Knowing that the government website was problematic in the beginning, and being directed to return on November 15, I was eager to get an early start this morning, to review my options, and sign up for affordable health care at the earliest opportunity.

It is not meant to be. If you can conjure in your mind the most egregious exploitation of the poor in exchange for no medical benefit whatsoever, it might just be the Affordable Health Care Act, which is not affordable nor is it health care, at least in Texas. Because I am too poor to qualify for tax credits, and since Texas has declined to expand Medicaid, my entire health insurance coverage can be summed as follows: using an exemption code printed in the Eligibility Notice, I won’t have to pay a fine to the government, in April, at tax time. My eligibility notice states:

You recently submitted an application to the Health Insurance Marketplace. We reviewed your application to see if you can get health coverage through the Marketplace and help paying for coverage and health services.


Based on the information you provided, the new federal health care law provides that you could be eligible for free or low cost health care through Medicaid. However, the state of TX has chosen not to offer you this new health care coverage at this time.

You are not required to pay a penalty for not having health insurance because of your income and because the state of TX declined to expand Medicaid to cover individuals in your situation.

Your household’s yearly income is too low for a tax credit. Generally, individuals and families whose household income for the year is between 100 percent and 400 percent of the federal poverty line for their family size may be eligible for the tax credit.

• You don’t qualify for Medicaid or the Children’s Health Insurance Program (CHIP) in your state.

Since our yearly income is too low for a tax credit, I was anxious to locate an affordable plan, for purchase. I reasoned that there might be coverage available that would be affordable, in case of a catastrophic event, in the least. My husband and I could figure the cost for purchasing the plan into a new monthly budget that we are working on, given our recent move to Texas. After completing my application, the site directed me to an available 33 plans for purchase. Not one plan is affordable. In fact, some of the plans exceed or nearly exceed our monthly income. The lowest-cost plan available calls for nearly half of our monthly income, just for the premium. The deductible is roughly equivalent to one-half of our yearly income. Were I to schedule, for example, a monthly visit to a regular doctor, I would still have to pay cash for every single visit, without even coming close to meeting the deductible. Here is an example, taken directly from the list of choices in my application this morning:

Covers less than 60% of the total average costs of care: $612.62/month
Deductible $6,600 Out–of–pocket maximum $6,600

Copayments / Coinsurance $40 Primary doctor
No Charge After Deductible Specialist doctor
No Charge After Deductible Generic prescription

If I get sick, and I have the ‘catastrophic’ plan, which I cannot afford to have, I will have to pay $612.62 plus $40 plus $6000, in order to receive one single generic antibiotic tablet, let alone receive any care for a real catastrophe. At the other end of the spectrum, the best plan available, there is this:

Health care costs
Plan covers 80% of total average cost of care

Yearly premium

This yearly premium is only slightly less than our yearly income, and it does not provide full coverage. In addition, the list of medications that are covered in this best-case scenario, is limited. When I called the 800-number and spoke to a representative this morning, I asked what I should do, to prepare for the possibility of a catastrophic event, such as an accident or severe illness. She told me that I could go to a local clinic and apply for a card, so that in the event of an accident, I can present the card, and maybe qualify to be taken to a local health clinic (not a hospital), but even this is not guaranteed.

When we first moved here, I stopped by an office to inquire about low-income options for health insurance such as Medicaid, but I do not qualify. Entry-level jobs that I have applied for do not offer benefits, and the wages are too low to be able to purchase even the least expensive, catastrophic plan.

I am ineligible to qualify for Medicaid, but too poor to purchase health insurance, because Texas refused the billions of dollars it was offered, in federal subsidies. Not only that, but if it weren’t for filling out an application this morning and receiving an exemption code, I would be fined for not signing up for unaffordable government health insurance, that provides no benefits.

The human cost of Texas’ refusal to expand Medicaid

16 Responses to My experience applying to ACA in Texas

  1. Annie Cabani says:

    Here in NC, our Neanderthal legislature also “opted not to expand” Medicaid under the Affordable Care Act – which leaves a half million of our residents in the “coverage gap.” Given that Texas has a much larger population (even if a lower poverty rate) I can only imagine how huge it’s coverage gap is!

    I don’t understand why folks here want to blame this on President Obama. The fault lies with:

    1. The SCOTUS; and,
    2. STATE governments (legislatures and governors).

    It’s pretty hard to do much about the SCOTUS. But: How many of you all are well informed about your STATE legislative representation and politics (and thei outside influences)??

    As I’ve been telling my supposedly “politically astute” friends and acquaintances since 2010: If you follow national politics but not your own STATE politics, you are MISSING THE ACTION in modern politics. Political action has shifted to the states – to each and every 50 of them, individually.

    And that has been an intentional – and distressingly successful – Repugnant Party strategy. Initially dubbed the Redmap Project (or something like that) the plan pre-dated the 2010 census and targeted states whose legislatures could be turned more “red.”

    LOTS of outside money was invested in LOCAL state legislative races in such states (including NC) – which tend not to be in the forefront of most citizens’ minds – so that redistricting (which happens every 10 years after the census) could lock in BOTH state and national voting “districts” to favor the Repugnants. Accomplishing that meant ensuring control for AT LEAST ten years – but potentially much more than that.

    I learned about it long ago, but if you can learn about it yourselves. And here’s a good starting point for your research:

    Blaming Obama just feeds into the Repugnant strategy and success. So I personally recommend against doing so.

  2. owl says:

    i don’t even know where to begin. i’m at ground zero working in an HMO servicing both state subsidized and private-pay commercial customers. my pay is reasonably low, with high stress, high commuting costs, and i work in an oppressive environment with strict measurement of productivity and adherence to metrics. customer service is the new factory working environment.
    the good news, and what you’ve uncovered perfectly, Crane, is that our state, unlike TX, has expanded Medicaid programs….lots of fully subsidized, free insurance. but the working class, the poor slobs trying to pay to play, are taking the hit while the giveaways and handouts are substantially increasing…in this state, not yours.
    you know, i had an angry caller tell me she has been on Medicaid for her 22 year lifetime and has NEVER gotten a healthcare related bill….and WHY DID SHE GET A BILL??!!! she was outraged. so was i. why was she on Medicaid for her 22 years? able bodied, no less.
    there is a huge disparity in qualifying / eligibility determinations, state by state, since ACA, and many hard-working wanna-be middle class families are falling between the cracks. and they’re furious.
    my head spins with daily changes reported to us to implement in servicing these profiles.
    for sure, with absolute certainty, insurance carriers protect their profits, and their salaries, and move with the market to adjust benefits in favor of these profits.
    they don’t “get it right” in making management decisions and “do-overs” are notoriously wasteful and expensive.
    thankfully, i am closer to Social Security than you are, but will still have to purchase a supplement, if i can afford it, so the 80% rule doesn’t bankrupt me with one illness.
    and although i have health insurance at this moment, my employer plays games to disallow time off for medical appointments.
    assuredly, the ones who know how to game the system are best off in this state. and this state seems better than yours for access to healthcare benefits.
    when the rules change, as they do, i hope they will favor you.
    oh, and by the way, i am a minority in my working environment of “diversity”. i’ve learned that i am the outlier in a population of people hired for their “differences” from the mainstream, and where they have a greater advantage for promotion and compensation than those of us….old school….whom are educated, hard-working and intelligent. such is today’s employment culture.

  3. Nef05 says:

    I understood why partisan governors and/or legislators denied the medicaid expansion in some states. They are unmitigatingly evil in that they care so little for the people they (never) represent they would willingly watch them die, just to make a political point. What I never understood is why the people they (never) represent, let them get away with it. People who repeatedly and unhesitatingly vote against their own interests are beyond my comprehension.

    Though it may not apply to your situation, and is certainly no real comfort in this instance, you wouldn’t have to pay a fine even without the exemption. They might well assess it, but language was specifically written into the bill to make collection unenforceable. There’s no reason to believe it wasn’t done intentionally. There are basically no legal penalties for not paying.

    “No one ever really has to pay the fine in the individual mandate,” O’Donnell said, “because the IRS has been specifically forbidden, in writing, in law, in the Affordable Care Act, from ever actually pursuing either civil or criminal remedies to collect those fines from anyone. The individual mandate is the only provision in the tax code that was written deliberately to be essentially unenforceable.”

  4. cielo62 says:

    Texas sucks for many, many reasons. This is just one. Why, of all the decent states in the northeast, did you opt for such a hate filled armpit like Texas??

  5. Two sides to a story says:

    I,m in similar straits in Cali, although the Covered California site worked quite well last year and the folks on the phone were also helpful. I was kicked back into the state medicaid-type program after my Obamacare app because of my lowish self-employed income, but the share of cost is actually a large chunk of my income, so generally I can’t see a doctor anyway, except for a stray month or two per year when my share of cost suddenly and inexplicably goes down, sometimes to 0 but usually only for a month and I tend to find out halfway through the month, which is crazymaking.

    Ironically, if your income is high enough in Cali for the Obamacare spectrum of coverage, you can get help to pay your premiums if you’re at the lower end of that income spectrum, but there’s no help if you’re referred back to the state program and can’t afford your monthly share of cost. So you;re really penalized for your income status, and basicially left without healthcare even though you officially have health care.

    And why the only remedy is a national single-payer system that covers anyone of any income level, something that the Dems have been trying to implement for 25 years. In Canada, for example, the highest yearly premium for healthcare is around $900 a year per individual, with the average being about $200-300 per year per individual. At one point the state of Cali wanted $998 per MONTH from a $1500-1800 a month income, impossible to come up with. Now I’m down to $298 a month, also impossible many months. Grrr.

    • bettykath says:

      If the Dems have been trying for years for single-payer why was it not even considered when the ACA was passed?

      Stupid racists reps in too many states refused to accept the medicaid expansion. Another example of playing politics instead of working for the people. And, no, ACA is not a good program.

      Single payer is what we need although I expect Congress would underfund it, just like they underfund the VA. It would be great if they provided proper funding for the VA and turned it into the single-payer system that we need.

      • Obama declared right out of the box before there were any discussions that it was off the table.

        His explanation: it didn’t have a chance, so it wasn’t worth arguing about.

        “Don’t let the perfect be the enemy of the good.”

        • bettykath says:

          If you don’t ask for what you want you for sure won’t get it.

        • MedicineBear says:

          Plus, Obama is a Dino–to the right of his hero St. Ronny the Reagan, King of exploiting the Least Among Us. The ship representing Democratic principles has sailed (or been sunk) leaving us in a fascist (let’s see if “fascist” can still get past 1984 Orwellian censors and make it into print) wasteland where our elections have disintegrated into “choice” between Candidate Bad or Candidate Worse.

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