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My experience applying to ACA in Texas

Open enrollment for obtaining affordable health insurance to take effect in 2015 begins today. Even though I have an undergraduate degree in Biology and an associates degree in a medical field, as well as a reasonable grasp of reading and writing, my attempts to navigate previous versions of ACA enrollment websites proved futile. Knowing that the government website was problematic in the beginning, and being directed to return on November 15, I was eager to get an early start this morning, to review my options, and sign up for affordable health care at the earliest opportunity.

It is not meant to be. If you can conjure in your mind the most egregious exploitation of the poor in exchange for no medical benefit whatsoever, it might just be the Affordable Health Care Act, which is not affordable nor is it health care, at least in Texas. Because I am too poor to qualify for tax credits, and since Texas has declined to expand Medicaid, my entire health insurance coverage can be summed as follows: using an exemption code printed in the Eligibility Notice, I won’t have to pay a fine to the government, in April, at tax time. My eligibility notice states:

You recently submitted an application to the Health Insurance Marketplace. We reviewed your application to see if you can get health coverage through the Marketplace and help paying for coverage and health services.


Based on the information you provided, the new federal health care law provides that you could be eligible for free or low cost health care through Medicaid. However, the state of TX has chosen not to offer you this new health care coverage at this time.

You are not required to pay a penalty for not having health insurance because of your income and because the state of TX declined to expand Medicaid to cover individuals in your situation.

Your household’s yearly income is too low for a tax credit. Generally, individuals and families whose household income for the year is between 100 percent and 400 percent of the federal poverty line for their family size may be eligible for the tax credit.

• You don’t qualify for Medicaid or the Children’s Health Insurance Program (CHIP) in your state.

Since our yearly income is too low for a tax credit, I was anxious to locate an affordable plan, for purchase. I reasoned that there might be coverage available that would be affordable, in case of a catastrophic event, in the least. My husband and I could figure the cost for purchasing the plan into a new monthly budget that we are working on, given our recent move to Texas. After completing my application, the site directed me to an available 33 plans for purchase. Not one plan is affordable. In fact, some of the plans exceed or nearly exceed our monthly income. The lowest-cost plan available calls for nearly half of our monthly income, just for the premium. The deductible is roughly equivalent to one-half of our yearly income. Were I to schedule, for example, a monthly visit to a regular doctor, I would still have to pay cash for every single visit, without even coming close to meeting the deductible. Here is an example, taken directly from the list of choices in my application this morning:

Covers less than 60% of the total average costs of care: $612.62/month
Deductible $6,600 Out–of–pocket maximum $6,600

Copayments / Coinsurance $40 Primary doctor
No Charge After Deductible Specialist doctor
No Charge After Deductible Generic prescription

If I get sick, and I have the ‘catastrophic’ plan, which I cannot afford to have, I will have to pay $612.62 plus $40 plus $6000, in order to receive one single generic antibiotic tablet, let alone receive any care for a real catastrophe. At the other end of the spectrum, the best plan available, there is this:

Health care costs
Plan covers 80% of total average cost of care

Yearly premium

This yearly premium is only slightly less than our yearly income, and it does not provide full coverage. In addition, the list of medications that are covered in this best-case scenario, is limited. When I called the 800-number and spoke to a representative this morning, I asked what I should do, to prepare for the possibility of a catastrophic event, such as an accident or severe illness. She told me that I could go to a local clinic and apply for a card, so that in the event of an accident, I can present the card, and maybe qualify to be taken to a local health clinic (not a hospital), but even this is not guaranteed.

When we first moved here, I stopped by an office to inquire about low-income options for health insurance such as Medicaid, but I do not qualify. Entry-level jobs that I have applied for do not offer benefits, and the wages are too low to be able to purchase even the least expensive, catastrophic plan.

I am ineligible to qualify for Medicaid, but too poor to purchase health insurance, because Texas refused the billions of dollars it was offered, in federal subsidies. Not only that, but if it weren’t for filling out an application this morning and receiving an exemption code, I would be fined, for not signing up for unaffordable government health insurance, that provides no benefits.

The human cost of Texas’ refusal to expand Medicaid

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