While many Texans get health care through employers, over the past few years, the number of people in Texas who've signed up through the Affordable Care Act has grown. Changes in the White House and Congress will affect both groups of Texans.
If there's one clear, consistent message from President-elect Donald Trump over the past few years, it's that he hates Obamacare. So, let's start with what could change for the roughly 1.3 million Texans who bought health insurance under the Affordable Care Act.
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Steve Love, president of the Dallas-Fort Worth Hospital Council, doesn't want to see Obamacare repealed. But he is concerned that there are fewer and more expensive coverage options in 2017. He says this is partly due to the fact that some insurance providers stopped selling products in Texas altogether.
"The Affordable Care Act has got some issues with it and some problems and even if the Democrats had taken the white house it still needed some refinements," Love says.
He says if Trump does repeal and replace the Affordable Care Act, it's crucial to maintain what is popular: coverage for people with pre-existing conditions and for children up to the age of 26. And, he hopes it would be a reasonable transition period.
‘Sea change of attitudes’
Even before a Republican administration can repeal Obamacare, Texans who get health care through their work are already seeing changes. Nearly half of all Texans buy health coverage through their jobs, and last open enrollment period, many noticed more bare bones, high-deductible plans.
"Those are gaining a lot of traction with employers," says Marianne Fazen, president of the Texas Business Group on Health. She says employers are looking for ways to stem the rising costs of health care. They're scrapping expensive, extensive options like PPOs for high-deductibles and health savings accounts.
"A survey [...] we participated in showed that about 25 percent of those that offer a high-deductible plan with a health savings account or a health reimbursement account are making it the only option now. So that's almost a sea change in attitudes of employers," Fazen says.
Health savings or reimbursement accounts make it possible for employees to put aside money and pay for their own health care while avoiding some taxes. Trump is a big fan.
Speaking on ABC News, Trump said "I'm OK with the savings accounts. I think it's a good idea; it’s a very down-the-middle-idea. It works. It's something that's proven."
If Trump relies on expanding these accounts, Fazen says employees will need to study up and learn a whole new way of paying for health care.
Smaller companies hope employer mandate goes
Individual care aside, Fazen says many mid-size and smaller companies in Texas hope a Trump administration eliminates the employer mandate. The mandate requires businesses with 50 or more full-time employees to provide affordable health insurance. Vice President-elect Mike Pence says that mandate has forced employers to fire workers.
"Obamacare's employer mandate raised the minimum cost of hiring a full-time worker to $10.30 cents an hour for larger employers without increase in take-home pay for anybody," Pence said before the election in November.
Those numbers come from a report done by the Heritage Foundation, a conservative think tank. Fazen, says some companies have had to add staff to meet reporting requirements and avoid paying penalties.
"If some of these things are relieved, that will remove a lot of the burden that employers have already invested in," Fazen says. "So I think there's probably a silver lining in the changes that will come along, but again it’s a period of adjustment."
Most people agree that period of adjustment — for employers, for patients — it'll be a long stretch not a quick sprint.