Millions of Texans are at risk of losing a tax credit to help them buy health insurance on the Affordable Care Act marketplace.
There are more than 4.2 million people enrolled in ACA coverage in Texas, according to the Centers for Medicare and Medicaid Services. That means about 95% of ACA enrollees in the state rely on the tax credit that’s set to expire at the end of the year because of changes in the federal budget bill.
The enhanced premium tax credit reduces the cost of coverage on a sliding scale based on income.
Speaking at a town hall meeting in Arlington Thursday, Sharn Barbarin, CEO of Medical City Arlington Hospital, said that helps make preventive care more affordable for patients.
“So that they don't have to make difficult decisions between ‘Do I go to a doctor?’ or ‘Do I need to pay rent?,’” Barbarin said.
As people lose coverage, Barbarin said they will likely depend on more expensive emergency room care.
Stephen Love, the president and CEO of the Dallas-Fort Worth Hospital Council, said North Texas hospitals provide billions of dollars in uncompensated care. He said that will also likely increase as people lose coverage.
And not every hospital will be affected the same way.
“It's going to hit rural hospitals even harder than urban hospitals,” Love said. “And [researchers at the University of North Carolina] predicted anywhere from 10 to 15 rural hospitals in Texas would close completely.”
Love said when rural hospitals limit services or close entirely, that can add even more pressure on hospitals in metro areas.
Tarrant County Commissioner Alisa Simmons, who organized Thursday's townhall, warned that losing the Affordable Care Act tax credits could hurt patients who use the county’s public hospital.
Simmons said JPS Health Network could see an annual increase of $14 million dollars in uncompensated care.
"These costs don't just disappear," she said. "They're absorbed some way, but by the health system, which ultimately strains all of us."
"These costs don't just disappear."Tarrant County Commissioner Alisa Simmons
Simmons also said losing the tax credit could lead to broader economic impacts in the area.
Jerry Brooks depended on the federal health care marketplace when he started his construction company over a decade ago. He said without those tax credits, health care is going to become unpredictable for thousands of Texans.
“Health care already is stressful enough,” Brooks said. “Now throw on top of that, ‘Can I even go and do that? Can I even access it? If I can access it, can I even afford it? How’s my family going to budget for this increased cost? How's a small business going to budget for these increased costs?'”
Brooks said if ACA coverage had been less accessible when he first started, the construction company he runs would be in a different spot today.
“We probably would have made different moves and decisions from a planning perspective as well,” Brooks said. “It probably would've stunted from the business perspective. We probably wouldn't have hired as many people because of the increased cost.”
Currently, Brooks offers employee-sponsored health plans to several of his employees. But, he said that may not have been an option if the ACA hadn’t been available for him in the past.
“We have to make tough decisions, both as a business and then as individuals as well,” Brooks said.
If the enhanced premium tax credits expire, Stephen Love with the Dallas-Fort Worth Hospital Council said Texas could lose about 69,000 jobs.
The state already has the highest uninsured rate in the country. However, the changes to health coverage programs in the federal budget bill could increase the uninsured population of Texas by 1.4 million people.
The changes to ACA coverage accounts for 1.3 million of that expected loss.
He and other community and health care leaders at Thursday's event said people should reach out to their lawmakers about extending the credit.
Federal Democratic lawmakers said they wouldn’t sign a continuing resolution to prevent a government shutdown if it didn’t include an extension on the enhanced premium tax credit. In addition, the governors of 18 states sent a letter to House and Senate leaders in both parties to urge them to extend the tax credit.
Tarrant County Commissioner Alisa Simmons said people should reach out to their lawmakers to let them know how this will affect them. She said people can share their stories and concerns by emailing or calling their federal representatives and senators.
“If you can, schedule a meeting to meet with them, and it can be you by yourself or you can take a small group,” Simmons said. “But, they need to hear from you, see that this is important to you, and don't just touch them once.”
Brooks said it’s more important now to make sure lawmakers are hearing from the people they represent.
“It is important for them to know what is keeping you up at night,” Brooks said. “It's important to them to know how your family is affected. Whether you like that person or not, they still represent you and they still have a job to do for you and your family.”
If people don’t reach out, Brooks said it gives lawmakers the ability to say the community doesn’t care about an issue.
“But if that entire community floods them with calls, makes appointments at their offices, there is no way that they can say they have not heard from the community and they don't understand who they are representing,” Brooks said.
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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