Public Release: 

Survey: Costs of ACA health insurance in Texas vary significantly depending on income

Rice University

HOUSTON - (Sept. 24, 2014) - The cost of monthly premiums for health insurance plans for Texans under the Affordable Care Act (ACA) can vary by hundreds of dollars, depending on a person's income and the level of coverage chosen, according to a report released today by the Episcopal Health Foundation and Rice University's Baker Institute for Public Policy.

The report found Texans earning about $17,000 a year were offered free premiums on some ACA Marketplace health insurance plans because of federal tax credits. However, a person who makes around $35,000 a year would pay around $150 per month for the same plan.

Researchers discovered that where a person lives could also affect monthly premium costs. They found a person making $35,000 a year in Dallas would pay $80 more each month for the highest-level plan than if that same person lived in San Antonio.

"More than 1.5 million people in Texas who make between $16,000 and $46,000 a year remain uninsured," said Elena Marks, CEO of the Episcopal Health Foundation and a nonresident fellow in health policy at the Baker Institute. "People living on incomes of $35,000 a year may still find it difficult to set aside $150 a month to pay for health insurance, particularly if they rarely seek health care. And that's for the lowest-cost plan."

The more money individuals make, the more they pay for Marketplace insurance plans, as intended by the ACA. For example, a person in Houston making $17,000 a year paid $50 a month for a "Silver" plan. A Houstonian who earns $23,000 paid $114 a month for the same plan and a person making $35,000 paid $211.

Without tax credits, "Bronze" plans are similarly priced across Texas cities, the report found. Costs for plans with other levels of coverage varied more widely across the state. For some plans the price difference was just a few dollars a month. For the "Gold" plans, the difference could be more than $50 a month.

"In previous research, we reported almost half of the target population for the ACA in Texas didn't buy a policy because costs were too high or they said they didn't have enough money to spend on a plan," said Vivian Ho, the chair in health economics at Rice's Baker Institute, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. "As we move toward the second year of the Marketplace, penalties rise if you don't buy health insurance. For someone making $35,000, the new penalty would be $700. We'll be interested to see whether more in the target population purchase plans when those penalties rise."

The report is the eighth in a series on the implementation of the ACA in Texas co-authored by Marks and Ho.

The Health Reform Monitoring Survey (HRMS)-Texas report is based on a national project that provides timely information on implementation issues under the ACA and changes in health insurance coverage and related health outcomes. The Episcopal Health Foundation and Baker Institute are partnering to fund and report on key factors about Texans obtained from an expanded representative sample of Texas residents. Today's report contains responses from 1,595 Texans in September 2013 and 1,538 in March 2014.

The survey was developed by the Urban Institute, conducted by the company GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute.


The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the views of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.

For more information or to schedule an interview with Marks, contact Brian Sasser, director of communications at the Episcopal Health Foundation, at or 832-795-9404.

To schedule an interview with Ho, contact Jeff Falk, associate director of national media relations at Rice, at or 713-348-6775.

Related Materials


The Episcopal Health Foundation:

Marks bio:

Ho bio:

Founded in 1993, Rice University's Baker Institute ranks among the top 15 university-affiliated think tanks in the world. As a premier nonpartisan think tank, the institute conducts research on domestic and foreign policy issues with the goal of bridging the gap between the theory and practice of public policy. The institute's strong track record of achievement reflects the work of its endowed fellows, Rice University faculty scholars and staff, coupled with its outreach to the Rice student body through fellow-taught classes -- including a public policy course -- and student leadership and internship programs. Learn more about the institute at or on the institute's blog,

The Episcopal Health Foundation is a new entity established through the 2013 transfer of the St. Luke's Episcopal Health System to Catholic Health Initiatives. The foundation supports the work of the Episcopal Diocese of Texas and has assets of $1 billion. The mission of the foundation is to advance the Kingdom of God with specific focus on human health and well-being through grants, research and initiatives in support of the work of the diocese. Episcopal Health Foundation embraces the World Health Organization's broad, holistic definition of health: a state of complete physical, mental and social well-being and not merely the absence of disease.

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