In Lieu of Federal Funds, Turkeys Used to Drive Health Insurance Enrollment in Dallas

Over the last three years, the federal government has gutted an Obamacare program designed to increase health insurance enrollment. Dallas has been hit hard: millions of dollars that had been used to help low-income households has disappeared, contributing to its status as one of least insured regions in the country.

BlueCross BlueShield, the state’s largest health insurer, is stepping in to pick up the slack. It launched a statewide campaign last month to raise awareness about the open enrollment period, which has just begun and extends until mid-December. During this time, anyone can sign up for coverage online at Healthcare.gov.

BlueCross BlueShield has been an enthusiastic supporter of the healthcare reform law since the beginning, participating in round-table meetings with then-President Barack Obama and promising to offer coverage in all 50 states on the new government-operated marketplaces. Bert Marshall, the president of the insurer's Texas branch at the time, told Kaiser Health News in 2013 that he viewed outreach efforts as a "three-year project."

The uninsured rate in Dallas-Fort Worth – 17.6% – is one of the worst in the nation. Among children, it is the worst.

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Six years later, outreach efforts continue. The insurer is hosting an event at 10 a.m. Saturday at the recreation center at Fireside Park in southern Dallas. Free turkeys will be handed out to the first 400 attendees.

BlueCross BlueShield of Texas' current president, Dan McCoy, called the event an educational opportunity for families interested in getting insured "regardless of whether or not it’s with our health plan." In a statement, he noted that 60% of the 5 million uninsured Texans would qualify for financial assistance.

Both Dallas and Texas as a whole continue to lag far behind the rest of the nation in signing up the uninsured. The uninsured rate in Dallas-Fort Worth – 17.6% – is one of the worst in the nation. Among children, it is the worst.

A central goal of the Affordable Care Act was increasing enrollment among low-income households who were not covered by employer insurance. To do this, the law established an online marketplace and provided subsidies and a vast marketing budget to encourage people to sign up.

But many people don't seek out the Affordable Care Act's benefits for a simple reason: they don't know they exist. A nationwide study released in 2017 by the Commonwealth Fund found that over 40% of low-income people were still unaware of the existence of the federal marketplace, which offers subsidized insurance plans.

The law included a strategy to address this problem: it funded Navigator programs, which are grants given to local nonprofits to help walk people through the sign-up process, which can be particularly difficult for people with low incomes, limited English proficiency or complicated family structures. In 2013, the program funneled $10 million in federal funds to Texas.

A 2015 survey found that these Navigator programs were effective, although their impact was blunted in Texas, where respondents reported the lowest rate of program assistance among surveyed states.

In the last few years, funding for the program was cut dramatically. By 2019, Texas received only $1.5 million. Neither of the two organizations that received grants operate in Dallas.

In a 2018 blog post, Anne Dunkelberg of the Austin-based Center for Public Policy Priorities wrote that this reduction in federal funds is just "the latest in a series of policies intended to weaken the individual health insurance market, make enrollment harder, and drive up premiums."

Texas is one of 14 states where lawmakers have refused to accept federal funding to expand Medicaid coverage to more low-income families.

Although Texas premiums on the ACA marketplace have increased in recent years, they dropped slightly in 2020. In 2019, BlueCross BlueShield was the only Texas insurer on the marketplace to reduce its premiums. It did so by more than 6%.