Monday, January 18, 2016

Texas and Florida illustrate Obamacare enrollment contrasts; being rural poses some obstacles

Southern states are lagging in the percentage of eligible people who have bought subsidized health-insurance policies under the Patient Protection and Affordable Care Act, with three big exceptions: Arkansas, Kentucky and Florida. Kentucky and Arkansas embraced Obamacare in ways other Southern states did not, expanding Medicaid and creating state-based exchanges to buy insurance (only for small businesses in Arkansas).

Florida didn't take either step, but "It fielded a bigger, centrally managed army of trained helpers" than Texas, the largest Southern state, reports Robert T. Garrett of The Dallas Morning News. Research indicates that's one reason "nearly 60 percent of Floridians eligible to buy policies in the online state exchange actually purchase them, only 36 percent of eligible Texans do, the nonpartisan Kaiser Family Foundation estimates. Nationally, the take-up rate is 41 percent, it says." For state-by-state data, click here.

A recent study of Texas, Arkansas and Kentucky found that "receiving assistance in filling out the applications was the strongest predictor of successful enrollment in coverage," Garrett notes. In Texas, nonprofit-group workers wanting to provide assistance were required to pay for additional training, fingerprinting and additional background checks.

Garrett writes that's an example of the "roadblocks" Texas’ Republican leaders have erected, more so than in Florida. He also notes that state is more compact and less rural than Texas, making outreach easier.

Rural enrollment in Obamacare has lagged, and that is the case in rural West Texas, reports Enrique Rangel of the Lubbock Avalanche-Journal. He quotes Don McBeath of the Texas Organization of Rural and Community Hospitals: “Our association does not have any hard data, but as we talk to the rural hospitals, the sense that they continue to share with us is that any increase in the number of insured under the exchanges is very minimal. This is not an issue just in Texas; it is nationwide.”

Rangel notes that rural residents often pay more for Obamacare policies because few insurance companies offer them, lacking competition that holds down prices, and a Rice University study that found most of the uninsured population in Texas is Hispanic.

Immigrants in Texas are more likely than those in Florida to be unauthorized, making them ineligible, and the Texas director of Enroll America, a nonprofit pushing signups, said families with unauthorized immigrants "often fear to sign up for Obamacare because they must provide the names of everyone in their household," Garrett reports, even though the information is confidential.

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