Texas Hospitals Looking Beyond ACA Website Glitches

Even proponents of the Affordable Care Act admit the rollout of its signature website, healthcare.gov, has been rocky. But the Texas Hospital Association said Monday that criticisms of the website are a distraction from more significant problems with health care in Texas: the high number of people without insurance and the state’s decision not to expand Medicaid.

“The status quo is not sustainable for the uninsured or for hospitals, and without Medicaid expansion, the rate of uninsured in Texas will remain stubbornly high and hospitals will bear the costs,” THA President Dan Stultz said.

But opponents of expanding Medicaid in Texas — including the state's Republican leadership — say that would only compound Texas' budgetary problems. The THA only wants to expand Medicaid "because it represents a short-term financial gain for its members," said John Davidson, a health care policy analyst with the conservative Texas Public Policy Foundation.

In 2011, Texas hospitals provided $5.5 billion in uncompensated care, according to the THA, a trade group that represents public and private hospitals. Health care officials say that cost reflects Texas’ singularly large uninsured population — more than 6 million people, or nearly one in four Texans, according to census data.

“If Texas wants to use the emergency room as a primary care facility … that’s not an effective way to use our system,” said Lance Lunsford, a THA spokesman. 

Effective or not, someone has to pay the bill for indigent health care services. Lunsford says it typically falls to the hospitals and to Texas taxpayers. “A lot of these costs are sometimes shouldered by the hospitals and by higher premiums from the insured,” he said. According to the THA, uncompensated care costs the average Texan insured by a private health plan roughly $1,800 a year in higher premium costs. 

Gov. Rick Perry and the Texas Legislature opted not to expand Medicaid — the joint state-federal program that primarily covers children and the disabled — to cover impoverished adults, a major tenet of federal health reform that the U.S. Supreme Court deemed optional. Texas' Republican leadership suggested such an expansion of a program they believe is already broken would bankrupt the state.

Davidson said the decision not to expand Medicaid was crucial to protecting the state's budget. "The reality is, Medicaid is an unsustainable program," he said. Davidson says Medicaid currently consumes 30 percent of the state's all-funds budget, which includes state and federal money — up from 25 percent in the previous biennium. "If we expand Medicaid, we're only going to see that trend accelerate," he said.

Though the Affordable Care Act will offer subsidies to purchase insurance to those above the federal poverty line, more than 1 million Texans will be "left behind in the Medicaid gap," Lunsford said. Federal officials have said the Medicaid expansion was intended to insure the impoverished population not eligible for ACA subsidies. 

Those seeking private coverage in the federal insurance marketplace, which opened Oct. 1, will still find the website muddled by glitches that the Obama administration promises to fix. At a congressional hearing Wednesday, U.S. Health and Human Services Secretary Kathleen Sebelius said the problems were “frustrating” and apologized for them. “I’m accountable for fixing these problems, and I’m committed to earning your confidence back by fixing the site,” she said.

THA acknowledges that the problems with the website are significant. In a statement, Stultz said: “The federal marketplace cannot work as intended if consumers are unable to sign up for coverage easily and efficiently. The federal government must get the enrollment site working.”

But he said the overwhelming attention to a broken website fails to address the underlying problems with health care in Texas. 

Texas is home to a disproportionate share of Americans without health insurance, and the percentage is projected to be even more dramatic after the health care law takes effect. According to an October report from the Kaiser Family Foundation, 1 million of the 5.2 million Americans who won’t have health insurance options available under the Affordable Care Act live in Texas. Currently, only impoverished parents whose incomes are at 19 percent of the federal poverty level — about $3,737 a year for a family of three — are eligible to enroll in Medicaid.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.