Texas bill would label citizens who receive Obamacare subsidies

Last Friday, the Texas House of Representatives passed HB 1514, a bill that would label the health insurance cards of people whose plans are subsidized through the Affordable Care Act with an “S” for “Subsidy.” The bill heads to Texas’s State Senate this week.

Supporters of the bill, channelling their inner Orwell, have unironically asserted that the bill is necessary so as to “standardize” Texans’ insurance cards by singling out those whose insurance is subsidized. Others have testified that the label would remind doctors to “remind the patient about the importance of continuing his or her portion” of payments to their health insurance plan.

The coalition of physicians in support of the bill would have us believe that citizens who receive subsidies for their insurance are financially irresponsible freeloaders who don’t pay their bills, but that simply isn’t the case. Over 91 percent of Americans who have signed up for insurance through the Affordable Care Act have remained up to date on their premium payments.

Critics of the bill have pointed out that one doctor’s reminder could be another’s rejection, arguing that the label could create a “scarlet letter” effect in which doctors turn away patients whose insurance cards indicate that they are receiving a subsidy. While doctors are prohibited from turning patients away based on the type of insurance they have, public health advocates in Texas have interpreted doctors’ arguments in favor of the bill as an indication that that’s exactly what they intend to do.

As Jose E. Camacho, executive director of the Texas Association of Community Health Centers said, quoted by the Texas Tribune, “Other than creating a group that you’re going to discriminate against, I don’t see any purpose for indicating that people are getting a subsidy.”

This bill is the latest in a long line of attempts in Texas to make it harder for citizens in the state to afford their health coverage. The state has refused to expand Medicaid, and is a cosignatory of the lawsuit brought forward in King v. Burwell the Supreme Court case deciding whether a typo in the Affordable Care Act invalidates health insurance plans purchased through federal exchanges. If the plaintiffs in King are successful, HB 1514 will be unnecessary because such a ruling would invalidate Affordable Care Act subsidies for all 1.75 million Texans currently receiving them.

Health insurance via Shutterstock

Health insurance, via Shutterstock

Texas’s efforts to deny its own citizens health coverage is even less acceptable given how little financial sense they make from the point of view of, well, Texas’s state government. 30 percent of Texans are obese, 19 percent smoke and 24 percent are projected to have diabetes by 2040. Texans already spend more on health care than citizens in all but two states, California and New York, and that’s only going to go up as those obesity, smoking and diabetes rates take their toll.

And just because those citizens aren’t insured doesn’t mean they won’t be consuming health care. When citizens need healthcare and can’t pay for it, their costs are passed on to everyone else in the state. That means higher premiums for every Texan.

In other words, if there were ever a state that stood to gain by getting its citizens on private health insurance plans, that state would be Texas. In spite of this, Texas has the highest uninsured rate in the country, and is doing everything it can to keep it that way.

Stigmatizing consumers who signed up for their coverage via the Affordable Care Act doesn’t help anyone, with the possible exception of Republican state legislators who need to sponsor three anti-Obamacare bills each term in order to avoid an Americans for Prosperity-sponsored primary challenge.

Fingers crossed that the bill dies in the Senate.


Jon Green graduated from Kenyon College with a B.A. in Political Science and high honors in Political Cognition. He worked as a field organizer for Congressman Tom Perriello in 2010 and a Regional Field Director for President Obama's re-election campaign in 2012. Jon writes on a number of topics, but pays especially close attention to elections, religion and political cognition. Follow him on Twitter at @_Jon_Green, and on Google+. .

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