Marketplace Enrollment Could Help Blunt Potential Uninsured Surge as Public Health Emergency Ends
By Emma Freer

A number of positive changes expanding access to and affordability of federal marketplace health plans could be coming just in time as Texas’ uninsured rate stands to worsen after the end of the public health emergency (PHE).   

Now is a good time to remind patients the open enrollment period runs until Jan. 15 and to sign up via Those who enroll by Dec. 15 will be covered at the start of 2023. 

To help patients make that connection, this year’s open enrollment period follows a historic investment in navigators – who help consumers, particularly those in underserved communities, enroll in coverage – and the implementation of new policies, which expand federal subsidies for marketplace health plans and close a pesky loophole.  

The Biden administration announced in August it would grant $98.9 million to dozens of navigator organizations across the U.S., enabling them to retain and recruit staff ahead of the 2023 open enrollment period. This is the largest funding award to date and builds on the 2022 open enrollment period, when the administration granted $80 million in navigator funding and a record-breaking 14.5 million people signed up for coverage, according to the U.S. Department of Health and Human Services. 

In addition, the Inflation Reduction Act, which President Joe Biden signed into law Aug. 16, extended subsidies for federal marketplace health plans through 2025, which the White House estimates will save 13 million Americans, on average, $800 per year on premiums. The law builds on the American Rescue Plan Act of 2021, which increased federal subsidies for certain health plan premiums.  

Helen Kent Davis, associate vice president of government affairs for the Texas Medical Association, says these subsidies could help blunt the impact when the PHE related to COVID-19 ends, which is currently slated for mid-January.  

Since the PHE was declared in March 2020, approximately 3 million Texans have benefitted from continuous Medicaid enrollment, according to the Texas Health and Human Services Commission (HHSC). This benefit will phase out starting with the end of the federal disaster declaration,  and HHSC estimates 880,000 Texas Medicaid patients could be deemed ineligible for continued coverage. Many others also stand to fall prey to “administrative churn” during the eligibility redetermination process.  

Ms. Davis says Texans who are deemed ineligible for Medicaid but remain eligible for subsidies need to get connected to marketplace coverage. Still, she adds many of the poorest Texas Medicaid patients won’t benefit from this option – largely because Texas is one of only 12 states that haven’t extended health care coverage to low-income working adults as allowed by the Affordable Care Act. 

As a result, Texas’ uninsured rate stands to worsen after the PHE. At 20.4%, Texas’ rate is already the highest among U.S. states and more than double the national average, according to the U.S. Census Bureau. 

In the meantime, another policy change could help expand access to marketplace coverage. The Biden administration issued a final rule in mid-September that closes the so-called “family glitch” loophole under the Affordable Care Act, heeding advocacy by the American Medical Association. 

Previously, families could be denied premium and cost-sharing subsidies for federal marketplace health plans if one member had “affordable” insurance through his or her employer, even if that coverage became unaffordable when extended to the entire family, according to AMA

Now, the affordability of employer-sponsored coverage for family members will be based on the employee’s cost of covering everyone, not just the individual.  

Last Updated On

November 11, 2022

Originally Published On

November 11, 2022

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Medicaid | Uninsured

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

More stories by Emma Freer