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The Affordable Care Act

The purpose of this page is to help you understand what the new health reform law, the Patient Protection and Affordable Care Act, means to you. The questions are divided into subjects that depend on whether you have insurance now or not and, if you do, what kind of insurance. We will update the site as new information becomes available. We want to be your local resource on health reform.

Travis County Residents Served by Central Health and the Potential Impact of the Affordable Care Act

Current Need and Residents Served:

• Central Health has historically supported the provision of services to individuals under 200% of the Federal Poverty Level (FPL) in keeping with the precedent set by the City of Austin and Travis County prior to the creation of the hospital district. During FY12, Central Health funded healthcare services for over 86,000 people in Travis County.

• Central Health serves approximately 24,000 Medical Access Program (MAP) enrollees who live at or below 100% of the Federal Poverty Level (FPL) and do not have other health insurance. These patients have access to a full array of services, similar to health insurance coverage, including primary care, specialty care, emergency, inpatient, and pharmacy. MAP enrollees are counted insured by the US Census Bureau.

• In addition, Central Health also subsidizes primary care services (on a sliding fee scale) for uninsured Travis County residents up to 200% of the Federal Poverty Level. During FY12, Central Health subsidized primary care for approximately 35,000 uninsured patients. These individuals are considered uninsured by the US Census Bureau.

• Central Health also subsidizes the care of all individuals who are seen through our affiliated network of CommUnityCare federally qualified health centers.

Enrollment Scenarios:

• According to the Census Bureau’s 2011 American Community Survey 1-year estimates, more than 209,000 people in Travis County do not have health insurance (19.8%). Approximately 130,000 of these live below 200% of the Federal Poverty Level.

• The Center for Public Policy Priorities (CPPP) estimates that the uninsured rate in Travis County could decline to 11.7% under a “moderate” enrollment scenario if Texas participates in the Medicaid expansion. If Texas does not participate in the Medicaid expansion, the uninsured rate may only decline to 17.1%.

• A portion of those who gain health insurance coverage under the Affordable Care Act would be patients whose care is currently subsidized by Central Health.

o An internal 2011 analysis by Central Health estimated that 40% (conservative estimate) to 55% (aggressive estimate) of MAP enrollees may convert to Medicaid if Texas participates in the Medicaid expansion. Because MAP enrollees are already considered to be insured by the Census Bureau, the shift of enrollees from MAP to Medicaid is not expected to affect the overall uninsured rate in Travis County.

o The same analysis estimated that up to 10% of uninsured patients currently subsidized by Central Health on a sliding fee scale may shift to Medicaid and up to 5% may shift to private health insurance exchanges.

Summary/Conclusion:

• Central Health is not currently able to fully serve the needs of uninsured and underinsured residents at or below 200% of FPL.

• The expansion of Medicaid would provide coverage for a greater percentage of individuals in Travis County; however, the healthcare services infrastructure currently in place is not adequate to meet the care needs of newly covered individuals. A 2012 Texas Medical Association survey found that only 22% of Travis County physicians accept new Medicaid patients without limitations (35% accept with limitations, and 43% accept none).

• Central Health has the responsibility to expand healthcare services to address the large numbers of Travis County residents who need access to care.

• The potential shift of residents served by Central Health to Medicaid or health insurance exchanges under the Affordable Care Act would result in savings to Central Health that could be used to provide additional services or serve additional patients in the future.

Download a PDF with more information on the local impact of the ACA

For information from the Federal Government, please visit www.healthcare.gov.

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