For the past week, we have heard about health insurance marketplaces, enrollment, computer glitches, insurance pricing and essential health benefits. Hopefully, the enrollment process for health insurance will go more smoothly over the next few weeks as the volume levels out. We recall the initial Part D Medicare enrollment experienced similar problems with computer glitches corrected in about 30‐45 days.

We certainly want to maximize the enrollment in the insurance marketplaces and help current Medicaid eligible (but not enrolled) participants receive Medicaid benefits for health services. However, some of the poorest Texans who need medical care will receive no help at all. The original intent of the 2010 Affordable Care Act was designed to provide Medicaid coverage for individuals and families making less than 100 percent of the federal poverty level. Since those Texas citizens were Medicaid eligible, they would not qualify for the federal tax subsidies on the insurance marketplace. Generally, children, pregnant women and disabled adults are the only eligible participants in the current Medicaid program. Other adults do not typically qualify for coverage. The Affordable Care Act would expand those covered by Medicaid.

The Supreme Court decision altered that provision in the Affordable Care Act and left Medicaid expansion up to each state. Texas chose not to expand Medicaid and, consequently, some of the most vulnerable citizens (many with severe chronic disease) are left out of the equation with no coverage. This is a problem only our state can fix, so we need to work collaboratively to ensure our system is fair and equitable to all Texans. This inequity in coverage must be a top priority for all stakeholders.