In Texas, ACA has done little to expand care access

Though the Affordable Care Act has lowered uninsured rates nationwide, Texas residents may now actually have more difficulty accessing care, according to NPR.

A recent poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that 1 in 5 Texans, regardless of insurance coverage, say it's gotten harder to see a doctor in the last two years, which is "significantly more" than adults nationwide who report the same.

There are several reasons for Texas' predicament. For one, an August report from the University of Pennsylvania's Leonard Davis Institute shows that in Texas, 70 percent of insurance plans are classified as having "small" networks, UPenn health economist Dan Polsky tells NPR.

Insurers are increasingly turning to narrow-network plans--especially on the ACA exchanges--to control costs and steer members to hand-picked providers. Even the startup insurer Oscar Health insurance Corp. has embraced the strategy, which helped it gain 43,000 members in its first year in Texas, where it offered the least expensive mid-level exchange plan.

But in Texas, the rise of insurance plans that limit provider choices is problematic, as the state already has a severe physician shortage, Texas Health Institute researcher Dennis Andrulis points out. While the national average is 236 physicians per 100,000 people, in Texas that ratio is just 186 for every 100,000, he says.

What's more, the state's decision not to expand Medicaid eligibility under the ACA has led it to miss out on some of the potential care access and affordability gains experienced by Medicaid expansion states. Even those who have Medicaid coverage may have difficulty finding a provider who will accept them, as the state has set its Medicaid reimbursement rates very low, NPR notes.

An analysis published in November found that Texas had the highest rate of uninsured individuals in 2014, at 19.06 percent. The state also had the largest difference between the insured rate of low-income and high-income households.

To learn more:
- read the NPR article

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