What low-income Texans need to access healthcare

Wouldn't it be great if Texans earning low-to-medium wages had a step up to self-sufficiency on the health care ladder? If they didn't have to rely on public assistance, go into debt or fall into the trap of not getting health care until it's too late? Imagine that these hardworking Texans are able to earn into the system while learning how to take responsibility for their own health and learning the roles that copays, deductibles, monthly premiums and other payment mechanisms play in our coverage system.

We don't have to imagine this at all. A way into healthcare for lower-wage Americans exists already, and the concepts that created it were embraced by Republicans and Democrats. This ladder works well when not sabotaged by the folks who are supposed to protect and steward it: Congress and the Administration.

Welcome to CSRs, one of those healthcare acronyms you never thought you'd need to know. Cost-sharing reductions help low-to-medium wage earners afford copays and deductibles for doctors' visits, and the CSRs go straight through insurers to physicians, nurses, hospitals and clinics.

Here's how CSRs work: Insurance companies participating in the Marketplace established by the Affordable Care Act (ACA) are required to make CSR payments to doctors up front, so qualifying members can afford their copays. "Qualifying" means individual Texans who make between $12,060 and $30,150 a year, depending on their family's size; a qualifying family of four might make between $24,600 and $61,500.

Up until recently, insurers had a fair amount of confidence the federal government was going to honor our agreements and reimburse us for those CSR dollars.

Insurance companies are not allowed to keep a single dime of funding for cost-sharing reductions. As the CEO of a nonprofit insurance company, I know this well: My organization sent money back to the federal government last year, when not all of the CSR funding we received was used by patients for doctors' visits.

Cost-sharing reductions are a brilliant conservative idea, formulated by policy makers to help working Americans take more responsibility for their own health care. And this brilliant idea is under siege.

It's under siege because President Trump believes he can damage the ACA by refusing to reimburse insurers for these copays and deductibles. He keeps threatening to withhold payment. The nonpartisan U.S. Congressional Budget Office reported in August that withholding payments to insurers for the CSR subsidies will drive up Marketplace premiums so much that the other federal ACA subsidy (the one for premiums) will balloon, resulting in net cost increases to the federal government (and taxpayers) of $194 million over the next 10 years.

And the CBO estimates that withholding CSR payments will take coverage away from more than a million people.

So, yes, withholding CSR payments will damage the ACA, but more clearly it will hurt Americans and the very fiscal responsibility we're trying to practice and teach others.

See all the Texans in this graphic with no or difficult access to health care? Some are the poorest of the poor, mostly children, pregnant and nursing mothers, the elderly and disabled. Others grew up poor or in challenging financial circumstances, but these Texans are working hard for a better life — often with minimum-wage jobs, part-time or seasonal work — while putting themselves through college or a technical school.

Currently 747,076 Texans are approved for CSRs, including 152,868 in Harris County alone. These folks work in our restaurants, build our homes, cut our hair and care for our elderly. They're not looking for a hand-out, they're looking for a hand up — a helping hand to climb up the ladder as they work to feed their families and build their part of the American dream.

The lowest wage earners fall into the "Coverage Gap" because Texas didn't expand Medicaid, but under the ACA once you're earning at least $12,060 a year in Texas, you qualify for help with health coverage. These hard-working Texans are the fabric of our state, and it makes sense to help them upward and forward.

While Congress has given healthcare a wild ride this year, there are bipartisan groups in the Senate and the House — supported by a bipartisan group of state governors — working towards commonsense fixes that can stabilize the healthcare system markets. These proposals include funding CSRs, establishing reinsurance, enforcing the individual mandate and re-funding enrollment outreach to set the record straight about how and when to get covered.

I am traveling to Washington, D.C., this week with leaders from other nonprofit health plans to meet with members of Congress, sharing more information about CSRs and these sound fiscal approaches to covering more Texans with access to care. I hope our elected officials will embrace this brilliant conservative idea, as well as respond to Texans' requests for them to work together to solve issues like access to care.

Ken Janda (@HealthyTexans) is president and CEO of Community Health Choice, a nonprofit insurer covering the health of nearly half a million Houstonians. He is an adjunct professor at Rice University's Jones School of Business and an active board member for community and philanthropic organizations.

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