Two years after the major pieces of the Affordable Care Act were implemented nationwide, health care providers, residents and businesses across the Greater Houston area have adjusted to the changes brought on by health care reform.

However, with open enrollment set for Nov. 1, the ACA will affect more businesses and bring higher penalties to noncompliant residents in 2016.

The employer shared responsibility mandate—which stipulates employers of at least 100 full-time employees must offer a minimum level of coverage to full-time employees—will expand in January to employers of 50-99 employees, according to the ACA.

Concerns the mandate would cause employers to fire employees or cut hours when the first phase was implemented this year may have been overblown, said Tony Nista, vice president of medical underwriting and Analytics for G&A Partners, a Houston-based professional employment and human resources company.

“We should give [employers] credit,” Nista said. “They understand it’s probably more economical to have one full-time [employee] they have to offer benefits to than to have two part-time individuals just because they don’t want to pay the cost of coverage.”

Nista said most employers of at least 50 employees already offer insurance to their employees with the exception of some companies in the hospitality and food service industries. He estimates 75 percent of employers were already meeting most of the ACA requirements prior to the legislation’s passage.

Health care providers

With more than 300,000 residents across the Greater Houston area now insured through the federal marketplace, at least 60 percent of those patients’ health care costs are covered by health care providers thanks to the ACA, said Dennis Laraway, executive vice president and chief financial officer for Memorial Hermann.

Laraway said about half of Memorial Hermann’s patients who are insured through the federal marketplace were previously uninsured.

“That’s favorably received by the provider community because we had often been providing services previous to the [ACA] at uninsured and uncompensated levels,” Laraway said.

Despite an increase in the number of insured in the Greater Houston area, Laraway said he does not attribute overall patient growth of about 4-5 percent per year at Memorial Hermann to the ACA.

“We should give [employers] credit. They understand it’s probably more economical to have one full-time [employee] they have to offer benefits to than to have two part-time individuals just because they don’t want to pay the cost of coverage.” —Tony Nista, vice president of medical underwriting and Analytics for G&A Partners, a Houston-based professional employment and human resources company

“It’s not really as a result of the ACA,” he said. “Even though we’ve seen a pull back in the energy sector with declining prices in oil and natural gas, this is still very much a growth region. ”

The ACA has not changed the services Memorial Hermann provides or the quality of services provided to all populations, Laraway said. In fact, the hospital system—which already offers health insurance plans—plans to offer plans on the federal marketplace and private marketplaces in January 2017.

Insuring individuals

Houston and Harris County residents enrolled through the marketplace rose to 305,000 last year, said Porfirio Villarreal, public information officer for the Houston Health Department.

Villarreal said the region still has plenty of uninsured to reach as Texas leads the nation in uninsured residents. Beginning in 2016, the penalty for residents who do not have health insurance will be $695 per year or 2.5 percent of household income—whichever is higher.

HHD and other organizations in the Enroll Gulf Coast Health Insurance Marketplace Collaborative host events to inform the region about the federal marketplace and offer a call center to provide one-on-one service to residents as they navigate www.healthcare.gov.