Last year, Nancy Schmidt went to the hospital with a stomach ache.
Hours later, she was on the operating table where doctors performed a triple bypass surgery.
The life-saving operation would have cost about $500,000 if she had no insurance. But with the plan that Schmidt bought on the Affordable Care Act Marketplace, she paid $2,600.
Now, during the open enrollment period for people who shop for their own plans, Schmidt plans to continue her health coverage through the marketplace.
The open enrollment period in Texas started Nov. 1, and runs until Dec. 15, giving Texans without health insurance about six weeks to purchase a plan. Since the Affordable Care Act passed in 2010, the law has been challenged, changed and debated repeatedly, causing confusion among people who don’t know if they’ll be able to afford health insurance, said Jeanette Rojas Flores, an independent insurance agent in Victoria. Flores has taken it upon herself to urge those without insurance, or who have a plan that’s not compliant with Affordable Care Act, to see if they qualify for a tax credit that could help with their monthly premiums.
About 11.5 million Americans buy insurance through the marketplace. Most Americans get insurance through their jobs, or else qualify for public health insurance programs like Medicare, Medicaid or Tricare, the insurance program for veterans. But millions of Americans lack health insurance, which can make life-saving treatments unaffordable if they have an emergency or get diagnosed with a serious illness like cancer. Texas has the highest rate of people without insurance in the nation.
For Texans who don’t qualify for Medicaid or who have jobs that don’t offer insurance, a private plan could help protect them if they get sick, Flores said. Nationwide, the monthly cost for a plan on Marketplace has dipped slightly, although the costs vary widely depending on where you live, how much you earn, and how many people are in your household. Almost all low- and moderate-income Americans can qualify for a tax credit or subsidy to help with their health insurance cost. But if you make more than $50,000, you’ll have to pay that cost on your own.
For those Americans who make a little bit too much to qualify for a subsidy, plans on the marketplace can be wildly expensive.
“The ones that aren’t eligible for subsidies are the ones that are still really struggling with affordability in this market,” said Rachel Fehr, a research assistant at the Kaiser Family Foundation who focuses on the ACA.
During the open enrollment period, consumer advocates are urging people to make sure the health plans they purchase have the coverage they need. There’s been a huge expansion in short-term plans recently, Fehr said, which are plans that are not compliant with the ACA and are much more loosely regulated.
Short term plans often don’t cover prenatal care, mental health care or preventative care, but they usually have lower monthly premiums, making them attractive to some consumers.
“It’s really important that you understand what it covers,” Fehr said.
To make sure that you’re buying a plan that is compliant with the ACA, shop on healthcare.gov.
In Victoria County, one carrier is available on the ACA Marketplace, Blue Cross Blue Shield, which means consumers locally don’t have the same options in other areas of the state where there are more insurance companies selling plans.
More than 10 years after the ACA, also known as “Obamacare,” was passed, opinions about the law are still mixed, largely along party lines. Although overall opinions vary by party, many of the law’s core tenets are popular with voters across party lines.
Eight-two percent of people polled had a favorable opinion of the health insurance marketplace, where individuals and small businesses can buy coverage, according to the Kaiser Family Foundation’s most recent polling.
The subsidies available to help reduce premium costs, like the ones that keep Schmidt’s monthly payments low, are seen as positives by about 81% of people polled by the Kaiser Family Foundation.
Texas is leading a group of states that is trying to have the entire law declared unconstitutional. An appeals court in New Orleans could make a decision in the case any day, although officials with the Trump administration have said that people with a marketplace plan won’t see any immediate changes to their plan if the law is overturned.
Schmidt, a lifelong Victoria resident, said buying a plan through the marketplace has made a huge difference for her and her family’s health, and their medical bills.
Schmidt runs her own business, Big State Auto Salvage, with her husband, and previously had a more expensive independent plan.
“Just let them know that it could cost them nothing at all,” Schmidt said when asked what advice she’d give to those without insurance. “A lot of people are scared to do open enrollment thinking they can’t afford the fees, and if you have children you may not have to pay anything at all, or depending on your pay you may not have to pay a single penny.”