As the rollout of the Affordable Care Act—often dubbed Obamacare—goes into effect, with it comes changes and uncertainty, not just for the local health care industry, but also for Tomball and Magnolia residents.

"I don't see many major changes in our services and products with what we provide to the community," said Richard Ervin, chief financial officer for Tomball Regional Medical Center. "The changes we are seeing is basically trying to assist patients and be able to provide education to patients regarding the Affordable Care Act, but as far as patient care services, those are not changing."

Beginning Oct. 1, uninsured individuals nationwide were able to sign up through the federal health care exchange for affordable health care plans that could go into effect as early as Jan. 1. The ACA aims to provide quality and affordable health insurance to the uninsured and was designed to decrease the uninsured population, according to

However, Ervin said, if the initial rollout of the act is any indication of what the future holds in terms of how many uninsured will sign up, the outlook is bleak.

"The numbers from the first two months of sign up are not real encouraging in terms of people signing up for insurance," he said.

Texas has the largest uninsured population in the U.S. at 23 percent, according to the US Census Bureau. Of the 23 percent of uninsured Texans—4.89 million—about 92 percent could be eligible for tax credits, according to the U.S. Department of Health and Human Services.

The new law provides tax credits for individuals and families with income levels between 100 and 400 percent of the federal poverty level—$11,490 to $45,960 for individuals or $23,550 to $94,200 for a family of four.

"The exchanges will create subsidies for persons within a certain economic range from 100 to 400 percent of the poverty line," said Paul Rinnan, an attorney with Starzyk & Associates in The Woodlands. "So I think you are going to see more people enrolling when they can get their subsidies within that certain economic group."

Health care industry

Randy Johnson, CEO of the Montgomery County Hospital District, said MCHD provides public health and emergency medical services to uninsured residents of Montgomery County, who can each receive up to $60,000 worth of coverage annually. He said the Affordable Care Act could lead to a significant reduction in the number of residents eligible for MCHD's services over time as more uninsured residents obtain insurance.

Ervin said he does not foresee changes with the level of care provided by TRMC, and the hospital would continue providing certain services, including emergency care, to uninsured patients.

Ervin said the only major changes the hospital is making as a result of the act are providing the community with educational outreach services on the effect the new law has on individuals and businesses. The hospital is referring the public to available resources, helping the public get access to care and providing information on how to apply for health insurance. TRMC has counselors who are able to help with these issues, he said.

He also said he is unsure whether the hospital will see more or fewer patients under the new law, as the number of uninsured who will find coverage through the exchange remains unknown.

"What Affordable Care Act might do, and the key word is might, is it might reduce the number of uninsured patients coming to the hospital," he said. "There are so many variables that are a part of it, things like preventative care measures may actually keep people from having to go to the hospital. Only time will tell."

Joanne Ducharme, director of Montgomery County Community Development, said MCCD is constructing its second countywide clinic for underinsured and uninsured residents of Montgomery County. Both clinics are already seeing the effects of the Affordable Care Act through new clinic requirements, Ducharme said.

The existing clinic in Splendora sees as many as 20,000 patient visits a year, Ducharme said. She said she anticipates similar numbers at the Magnolia clinic and believes patient visits will continue to rise.


Under the ACA, everyone must have health care coverage and those who elect not to get coverage will pay a penalty. Texans who are uninsured can shop for insurance through the federal Health Insurance Marketplace, as Texas opted out of providing a state exchange.

Many individuals, including those with job-based insurance, Medicare, Medicaid and Children's Health Insurance Program coverage are covered under the act.

Although businesses already offering health insurance and people paying for their own insurance are not facing major changes, the debut of the ACA's insurance exchanges has some people and companies considering whether to sign up for insurance through the Health Insurance Marketplace.

Michael Starzyk, managing attorney with Starzyk & Associates, said because the individual mandate is so minimal in the first year, a number of individuals may opt out of health insurance coverage and elect to pay the penalty instead of seeking coverage through the marketplace.

He said in the first year there might actually be an increase in the uninsured population, which could cause costs to go up significantly, as those people are needed to help offset the cost of insurance.

"The fact that the fine is only $95 in the first year, I think especially for younger people in that 18-34 age group, which is the critical component of the whole act, it's not going to surprise us if we see those folks just pay the $95," he said. "In the first year there is not an incentive there for the younger population to go ahead and sign up, and again that's the key to the whole act."

Additional reporting by Matt Stephens