Texas, for example, allowed insurers to charge women higher premiums than men (a practice that was prohibited or restricted in 12 other states, mostly in the Northeast). Individual market insurers may deny coverage to those with pre-existing conditions. The average individual market plan at that time had a monthly premium of $ 222. The plan was not required to cover costly benefits such as delivery or prescription drugs.
Texas did have a high-risk group, established in the late 1990s, in which those who declined in the individual market could seek coverage. But patients seeking coverage would face a one-year waiting period to enroll and premiums twice as high as those in the general insurance market. The Duke Health Justice Clinic estimates that the plan had only 24,972 members as of 2011, a small part of the 4.5 million Texas residents with pre-existing conditions.
Since the start of the Affordable Care Act markets in 2014, the Texas uninsured rate has dropped about five percentage points. The number of Texans insured has increased by about one million people, according to data from the Kaiser Family Foundation.
Coverage gains were highest among middle-income people, older people, and racial minorities. The insurance rate for Hispanic Texans increased by 10.9 percentage points between 2013 and 2016, according to a study published in the American Journal of Public Health. During that same period, coverage increased 12.1 percentage points for Texans between the ages of 50 and 64, and 10.2 percentage points for those who described their health as “fair or poor.”
Most Texans who obtain coverage have done so through the health law insurance markets. Premiums in Texas have tended to be lower than in other parts of the country, but there have been some big increases in recent years. The monthly price of a mid-tier individual market plan has increased to $ 462 this year, from $ 359 in 2017.
Prices are significantly higher than those that existed before Obamacare, and nationally, costly premiums have long been a pain point for the Affordable Care Act. But plans that exist now offer a broader set of benefits and cannot limit annual or lifetime benefits. That’s a key tradeoff that the Obamacare architects deemed worth doing – a requirement that insurers cover a wide range of medical conditions, even if it means the plans became more expensive.
It is not entirely clear that Texans who buy their own coverage are also paying more. In Texas, 91 percent of Obamacare members receive federal subsidies that lower the cost of their monthly premiums, and 59 percent receive financial aid that reduces their deductibles and copays.
