Countdown to Coverage: Opening Day

Today’s opening of the new Health Insurance Marketplace is kind of a big deal–for health care access, for Texas, for the nation, and for CPPP.  Many of you know that the Center was founded in 1985 by the Benedictine Sisters of Boerne with a mission to improve health care access for “poor and disenfranchised Texans.”
Given that mission, and having worked here at CPPP for nearly 19 years, I am excited about the roll-out of new health coverage in 2014 under the Affordable Care Act (ACA) because, for the first time, our nation is creating a system to make comprehensive health care available to nearly all Americans, not for free, but at a “sliding-scale” price that works for your budget.  It’s not a perfect system, and I know that there will be bumps and delays as the new systems roll out.  But the fact that the U.S. is finally trying to break down the financial barriers to a decent standard of health care is of enormous significance.  And with the Census reporting Texas still has more than 6 million (one in four) uninsured, no state has more to gain than ours!
Most Texans who are already insured through work will not interact with the new Marketplace, but folks who are uninsured today or buying directly from an insurance company really owe it to themselves to go the and check out new options.
Health plans in the Marketplace won’t leave out major parts of health care–every plan will include prescriptions, mental health, maternity, and must cover any pre-existing condition—so you won’t have hard choices about benefits.  Instead, one of the biggest choices will be whether you prefer a lower monthly premium (with the risk of paying more out of pocket later when you need care), or a higher monthly premium but less out of your pocket at the doctor’s office or pharmacy.  Another big choice is to pick a plan that includes the doctor or clinic that you want to use, and will give you access to any special medications or services you need.
As Megan Randall blogged here last week, the sneak preview of Texas Marketplace rates provided by US HHS last week showed that with the “premium credit” discounts available, some low-income Texans will have the option to get a “bronze” plan with zero monthly premium cost!  That will be tempting, no doubt, but may not really be the least expensive choice for a person who needs regular health care visits or prescriptions.  It is really important that folks facing the trade-off between low monthly premiums on the one hand, and higher costs when you need care on the other hand, take a careful look at their health care needs, and get any help they need to make a good choice.
Texans must first submit an application to get those premium and co-pay discounts, and that can be done online at, over the phone, by mail, or in person at a local community agency.  You can look up place to get in-person help at, with a special link to search by zip code at
It is important to know that thousands of Texans working for community-based agencies across Texas have been trained and certified to help out with the new systems, and to help individuals and families sort through the choices so they can make their own decisions.  Our governor has said he opposes the ACA, and he wants to add Texas requirements for the specially trained “Navigators” helping Texas consumers under federal grants to community-based agencies.  But you should know that privacy and protection of personal information is a big focus of the federal training for Navigators, and that in-person help from Navigators and other trained and certified in-person helpers is moving on ahead, despite his actions.
Today is a big day!  Celebrate, tell your friends and families, and do your part to help folks in your community learn about their new choices for affordable health care, and where they can get the information and help they need.

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