SAN ANTONIO - The Affordable Care Act Health Insurance Exchanges go live online Oct. 1. This is where many people without health insurance can pick a plan and enroll. Policies vary by state, but in Texas state leaders are unabashed in doing all they can to hobble what both sides refer to as "Obamacare."
At a community information meeting recently held in a San Antonio westside neightborhood, community organizer Sevi Laura of the Texas Organizing Project addressed a room crowded with people looking to learn more about the rollout of the Affordable Care Act.
"Today we're here to give information about the exchanges that will be happening in October, to make sure everyone has the correct information and knows all the avenues to be able to receive health care," Laura said.
At the meeting people took turns telling their personal stories about life without health insurance. These are stories of budget-busting premiums, denials of coverage due to pre-existing conditions and frustration that the state of Texas refused to expand federally funded Medicaid. That would have helped many of the poorest in the room.
Enrique Maydon said he needs Medicaid to be expanded.
Maydon explains that he has diabetes, arthritis and was hurt on the job. Now he can't work. And he has no health care.
It was Texas Gov. Rick Perry who decided not to expand Medicaid in the state. Perry is one of the nation's loudest opponents of the Affordable Care Act. He made that clear while being interviewed on Fox News.
"We're not going to expand Medicaid we're just not going to be a part of socializing health care in the state of Texas and going in direct conflict with our founding fathers' wishes and freedom for that matter," Perry said.
Recently Perry took another step to hinder the Affordable Care Act. He directed the Texas Department of Insurance to establish strict rules to regulate the so-called navigators.
Navigators are people hired across the country trained to help folks enroll in Obamacare. Many are focused on going into Spanish-speaking neighborhoods and helping minorities.
Josh Havens of the Governor's Office said most of the requirements have to do with issues of competency, "Including requiring navigators to complete a number of hours of state training in addition to the federal training. We ask that they pass an exam based on that training. Refrain from influencing a customer's decision or a consumer's decision on which insurance to choose."
Texas isn't the only state regulating navigators -14 other states are also doing so. But Texas announced its intentions just days before the start of enrollment and these new Texas regulations won't be in place until Jan. 1. That will keep the navigators from doing their jobs for three critical months of the enrollment window.
Jose Ibarra is a Texas coordinator for Enroll America. He said not having those navigators is going to make his job tougher.
"So the navigators play an integral role in this whole process. They are there to help folk enrolling in insurance step by step, help them find an insurance plan that's best for them and best for their family that they can afford," Ibarra said. "So without a navigator it will be difficult for the public."
If fewer people sign up in Texas that could strike at the heart of what is supposed to make the Affordable Care Act economically viable.
"The entire scheme of these exchanges in Obamacare depends upon as many people as possible signing up for coverage to dilute the risk pool and the theory is the more people who sign up the more it will drive prices down," said John Davidson, a health care policy analyst at the conservative Texas Public Policy Foundation.
Davidson said the opposite also works. If not enough people sign up, then the Affordable Care Act could go into a death spiral.
"This happens in insurance markets when not enough healthy people sign up and there's too many sick people in the insurance pool with too high of an insurance claims: premiums go up, more healthy people drop out, premiums continue to go up until the market collapses," he said.
State Rep. Mike Villarreal, a Democrat from San Antonio, claims that's exactly what the state's Republican leadership wants.
"What they are attempting to do is to discourage, make it harder, make people jump through more hoops, who are particularly younger to sign up and participate in the health care market places and that's not helpful for anyone," Villarreal said.
One out of four Texans don't have health insurance, the largest percentage of uninsured in the nation. And in real numbers that is more than six million potential customers for the Affordable Care Act.
If the opponents to Obamacare have a strategy to discourage enrollment in the health care exchanges in order to cause the program to collapse, then Texas would be the best place to make that happen.