Nursing Director of Pediatric Services Michael Howard walks through the pediatric trauma room of the Children's Hospital of San Antonio in 2015. Credit: Scott Ball / San Antonio Report

The six-week window to enroll in a health insurance plan on the Affordable Care Act (ACA) Marketplace started at 7 a.m. Thursday, and for the first time since the health care bill was signed into law in 2010, choosing to remain uninsured will not result in a tax penalty.

Enrollment assistance is available to help navigate through the 26 individual health plans open to Bexar County residents for coverage that begins on Jan. 1, 2019. According to the enrollment website, individual exchange plans purchased locally remain mostly unchanged from a year ago.

EnrollSA, Bexar County’s volunteer coalition of organizations that employ certified application counselors to help people enroll in ACA, will be available to help consumers navigate the process. The organization has been working to enroll San Antonio’s uninsured populations since the ACA became law, with a mission to make the process of enrolling simple and accessible to uninsured communities.

Oscar Health, Ambetter, and Blue Cross Blue Shield of Texas are providing individual and family plans to consumers, and government subsidies are available to low- or middle-income individuals or families who qualify.

The sliding scale subsidies ask consumers earning below the federal poverty level to pay a fixed percentage of their annual income toward their health insurance premium. For an individual to qualify for a subsidy, annual income would need to be at or below $12,140; the threshold for a family of five is $29,420.

The ACA open enrollment changes made by the Trump Administration in 2017 carried over into this enrollment period, including a shortened open enrollment period of 45 days, an advertising budget that is 90 percent less than in 2017, and reduced federal funding for local community outreach and sign-up support.

A planned $10 million in federal funding will go toward building market awareness for ACA open enrollment nationally, and navigator programs to help consumers wade through health insurance options and complete eligibility and enrollment forms, according to the Centers for Medicaid and Medicare Services.

While health care advocates maintain that marketplace advertising and assistance are key to maintaining and increasing enrollment, only two community organizations throughout Texas — Change Happens, a clinic based in Houston, and MHP Salud, a community health group working in the Rio Grande Valley, Laredo and El Paso — received federal funding for health insurance navigator programs in 2018, totaling $1.3 million in grants.

About 1 million Texans signed up for ACA coverage for 2018, according to CMS reports; including 73,621 Bexar County residents with adults age 55–64 leading local enrollment rates. A study by the nonpartisan Kaiser Family Foundation found that 90 percent of Texans enrolled in ACA plans were eligible for subsidies to offset the monthly cost.

For enrollment assistance, EnrollSA offers online appointment scheduling on its website. Appointments also can be scheduled by calling either 2-1-1 or 3-1-1. Enrollment assistance is available at most public library branches and CentroMed clinics, among other locations.

Enrollment runs until Dec. 15.

Roseanna Garza

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.