1.3 million Texans enroll in ACA insurance

With the 2016 Affordable Care Act enrollment now complete, Texas has exceeded expectations and signed up a record 1.3 million people for health insurance through the federal marketplace, final U.S. Department of Health and Human Services numbers released Thursday show.

The Texas tally is almost exactly 100,000 more than the 1,205,174 enrolled for 2015. About 346,000 signed up in the Houston area.

Nationally, 12.7 million people enrolled through healthcare.gov or in individual state exchanges, including 4 million first-timers. Texas does not offer its own exchange.

Texas has loomed large in the national spotlight as a state not only with the highest number of uninsured but also where its Republican elected officials have made no secret of their disdain for President Barack Obama's signature law.

It is estimated as many as 5 million Texans were uninsured when this year's enrollment period began - not only the highest actual number of any state but also the highest rate of nearly 20 percent of the population.

Health and Human Services Secretary Sylvia Burwell has made Texas a frequent destination before and during the enrollment period that began Nov. 1 as she rallied organizers and cheered their progress.

During a press call Thursday, she and other officials gave a specific nod to Texas for a burst of last-minute enrollment. Eight of the 10 markets that had the fastest rate of growth in the final week of signups were in Texas: Corpus Christi, Harlingen, Laredo, El Paso, Odessa-Midland, San Antonio, Abilene-Sweetwater and Lubbock.

"Consumers are hungry for affordable health coverage and jumped at the opportunity to protect themselves and their family," said Mimi Garcia, Texas state director for Enroll America.

Ken Janda, president and CEO of Community Health Choice, an insurance plan offered on the exchange, echoed Garcia's delight: "This is good news."

Earlier this week he said his organization had doubled the number of people enrolled from last year to an estimated 80,000 for 2016. He said he especially noticed higher numbers over last year out of Montgomery and Fort Bend counties.

He said his enthusiasm remains tempered by the work still to be done, not only in Houston but across the state.

"We still have so many Texans in the coverage gap that need help to become covered," he said Thursday.

U.S. Rep. Kevin Brady, R-The Woodlands, who has said he remains committed to repealing the Affordable Care Act, took a harsher view of this year's sign-up tally.

"I wish that number represented true, affordable health care for our neighbors," Brady said in a statement. "It's troubling that even given generous government subsidies, nearly half of Texans eligible for the exchanges are rejecting them. They would rather pay a hefty tax than be forced into expensive health care that often limits which doctors they can see and which hospitals can treat them."

More than three-quarters of a million Texans are estimated to fall into a coverage gap where they earn too much for Medicaid assistance yet not enough to qualify for the federal subsidies offered on the exchange to lower premium costs.

Part of the framework of the Affordable Care Act was that individual states would expand Medicaid coverage to include more low-income residents in their safety nets and provide health coverage. The federal government had promised to pick up the full tab through the end of 2016 and then begin reducing funding over time but never less than 90 percent.

Nineteen states, including Texas, have rejected such an expansion. Texas leaders have steadfastly called Medicaid an already broken system that should not be widened.

By some calculations, Texas stands to leave about $100 billion on the table over the next decade by not taking the federal money to expand Medicaid.

In an ongoing effort to change hearts and minds in reluctant states, the Obama administration last month said it would ask Congress to extend the 100 percent federal funding for Medicaid expansion costs for an additional three years.

An analysis of Texas enrollment by Houston's Episcopal Health Foundation through late December showed that about two in three Texans were re-enrolling, and about a third were new. The largest age group was between 45 and 64, and about 28 percent were between 18 and 34. The vast majority, 82 percent, received federal subsidies to lower premium costs, the study showed.

This year's enrollment period in Houston was thrown into turmoil at its opening as tens of thousands of consumers realized the number of plans and breadth of coverage had been greatly reduced. There were no preferred provider organization plans initially offered by the major insurance carriers. Last year there were 19. In mid-December, Humana, which had previously said it would not offer a PPO plan in Houston, re-entered the private market but did not offer such a plan on the exchange.

Most customers were switched to health maintenance organization plans, which require them to get a referral from a primary care doctor before straying from an insurer's network. HMO plans are seen as cost-savers because insurers can more tightly control where patients seek care.

"The biggest surprise this year was the move from PPO to HMOs and the hurdles people are experiencing," said Stacey Pogue, health care policy analyst at the Center for Public Policy Priorities, an Austin think tank. In offering her post-enrollment assessment, she remained concerned that the change could lead not only to confusion among enrollees but a barrier to care.