• Affordable Care Act Resource Center

    • TMA Takes on Marketplace Madness

      Confused by all you’ve heard about the Affordable Care Act marketplace insurance plans? Do you know whether you’re in — or out — of the narrow networks? How will you tell if a patient is on an exchange plan? What happens to you if patients don’t make their premium payments? What, if anything, can you do about all of this? TMA answers these and other tough marketplace exchange questions. Updated: December 2014 MembersOnlyRed
  • Affordable Care Act in the News

    • Agency Went Too Far; and Painkiller Change Is a Pain
      This month’s Texas Medical Association’s (TMA’s) Texas Medicine magazine, featuring a legislative preview, is packed with health care stories, including these: Texas’ Sunset Advisory Commission said the agency investigating potential Medicaid fraud overreached its charge; expanding health insurance coverage would help the working poor; lessons learned from the Ebola crisis; the impact of reclassifying a popular painkiller; and a year after implementing the federal insurance marketplace, what trends are emerging? 
    • Minding the Gap
      Texas chose not to expand Medicaid eligibility in 2014 under the Affordable Care Act, leaving more than 1 million uninsured Texans in the coverage gap. Now that several states have succeeded in finding alternative solutions to cover the working poor without expanding Medicaid, some lawmakers are optimistic Texas, too, can develop its own unique plan to draw down the roughly $100 billion in federal funding available over 10 years.
    • Smoother Sailing?
      As medical practices prepare to adjust and help care for the newly insured in round two of the Affordable Care Act marketplace, some uncertainties linger. The Centers for Medicare & Medicaid Services says it ramped up outreach efforts and largely smoothed out the technical problems from last year that complicated not only patients' enrollment through healthcare.gov, but also physicians' ability to track their coverage. Still, the prevalence of high-deductible plans and "narrow" networks that limit the doctors and hospitals patients can use contribute to persistent concerns over access to care.
    • How ACA Exchanges Impacted Physicians and Their Patients
      The ACA brought both challenging administrative changes and decisions that must be made. Texas physicians were glad to have more of their patients covered, but that new coverage compounds and highlights the many administrative challenges that physicians and their staff currently experience with their existing patients covered by commercial and government programs today.
    • Better Care Quality; Docs Volunteer; and Caring for Low-Income Patients
      Improving health care quality and increasing patient safety; health care heroes serving thousands of immigrants on the border; whether to continue special funding to help underserved Texans; and physicians’ pessimism about their profession’s future highlight this month’s Texas Medical Association’s (TMA’s) Texas Medicine magazine. 
    • Who Can Enroll?
      The marketplace was designed for individuals who are buying their own insurance and who cannot get affordable coverage through their job or other sources. Small businesses also will be able to buy coverage for their employees through the marketplace.
    • Improve Health Care Coverage for Low-Income Texans
      The ACA created two coverage options for uninsured patients with incomes up to 400 percent of the federal poverty level (FPL). One choice, which the U.S. Supreme Court made optional for states, was expanding Medicaid eligibility to 138 percent of FPL ($16,104 for an individual or $32,913 for a family of four in 2014). The other was the new health insurance marketplaces, where patients go to buy private insurance. Texas is one of 21 states that chose not to expand Medicaid eligibility in 2014. As a result, more than 1 million uninsured Texans, mostly low-income adults, are left in what’s called the “coverage gap,” which means they make too much money to qualify for Texas Medicaid but not enough to qualify for the marketplace premium tax credits. Few of these Texans have access to other affordable insurance options. Texas Medicaid eligibility for parents is about 20 percent of poverty — less than $4,000 per year.
  • Hot Topics

    • ''Hey Doc'' Gives You Answers to Patients' ACA Questions
      Americans' physicians are their most trusted source for information on the Affordable Care Act (ACA), according to a new national poll, but that's not where they're getting their news.
    • Health Insurance Exchange: Business Impact
      With the Affordable Care Act (ACA) health care exchange up and running, officials expect it to make a dent in the state’s high uninsured rate. Roughly 6 million Texans — a quarter of the population — are uninsured. The Texas Health and Human Services Commission estimates 40 percent of those people are eligible for exchange subsidies. For physicians, that could mean more patients walk in the door with health coverage. But the exchange still holds a lot of questions for doctors, especially exactly how the new marketplace health plans will play out in your practice. You need to figure out if you are participating in the plan(s) offered in your area and if they will affect your current payer contracts. You’ll need to learn how to identify patients on the exchange plans and what happens if these patients fail to keep current on their premium payments.
    • PPACA Employer Mandate Delayed
      Physicians who have 50 or more employees have another year to comply with the "employer mandate" of the Patient Protection and Affordable Care Act (PPACA). The law requires employers with 50 or more employees to offer health insurance coverage or pay a penalty.
    • Find It, Fix It, Keep It: Patient Protection and Affordable Care Act
      Patient Protection and Affordable Care Act: Find What’s Missing. Keep What Works. Fix What’s Broken.
    • TMA: Don't Make Docs Pay For Inaccurate Plan Directories
      Calling it either "an enormously unfortunate oversight" or "a government grab at discount health care services," TMA is vehemently opposing a new federal policy regarding physician participation in the Affordable Care Act exchange marketplace health plans. 
    • Marketplace Means Decision for Doctors
      The opening of the health insurance marketplaces under the Affordable Care Act (ACA) on Jan.1 means you must be vigilant in your dealings with the health insurance companies. Or you could face major problems.
    • What Qualified Health Plans are Operating on the Marketplace in My County?
      As of Oct. 1, 2013, there were 12 insurance companies offering 96 different qualified health plans on the Affordable Care Act marketplace exchange in Texas. Each plan is offered on a county-by-county basis. Here is the list of plans, sorted by county.
    • ACA: From Theory to Boots on the Ground
      New report from the Physicians Foundation examines the implementation of key provisions – in particular the health insurance exchanges – and ongoing challenges of health reform. It is the first installment in a series of reports on ACA coverage expansion and key mandates.
  • TMA Help for You to Survive and Thrive in the New Health Care Landscape

  • Congressman Mike Burgess, MD: The Case Against the ACA

    The Case Against Obamacare from texastribune on Vimeo.

    "The Case Against Obamacare" panel with U.S. Rep. Michael Burgess moderated by Scott Braddock at The Texas Tribune Festival September 24, 2011.

  • Full Text and Analysis of the Patient Protection and Affordable Care Act

    • Read the Full Text

      Read the entire bill, amendments, official summary, and legislative history at Congress.Org
    • TMA's Health Reform Bill Executive Summary

      Prepared by TMA experts, this analysis reviews what the bill does and does not do.
    • TMA Complete Summary

      Use this TMA staff summary of the bill and amendments to find which provision of the law may pertain to a particular question or issue. Then turn to the full text.
    • TMA Guiding Principles

      House of Delegates' guiding principles TMA followed as it made Texas physicians' voices heard in Washington during the debate.