FortressPlan: New Health Insurance Rollout in Texas
A new health insurance plan, FortressPlan, has been unveiled in Texas by Presidio Healthcare. This policy aligns with ethical guidelines established by the U.S. Conference of Catholic Bishops, limiting coverage for services such as abortion, contraception, gender-affirming care, in vitro fertilization (IVF), and medically-assisted suicide. The introduction of this plan highlights key discussions around regulatory compliance and ethical considerations in the health insurance industry.
Daniel Cruz, co-founder and CEO of Presidio, stated that FortressPlan targets higher-income individuals who do not qualify for Affordable Care Act (ACA) subsidies. Designed to ensure affordability, the plan excludes coverage for pre-existing conditions and mental health services. Cruz emphasized the necessity of ensuring financial stability to benefit its members while navigating industry risk management challenges.
According to filings with the Texas Department of Insurance, Presidio obtained its license in Texas in August. Founded by Cruz and Bob Hogan, the company's Chief Legal Officer, this initiative enters a market dominated by large insurance carriers. However, as noted by Ken Janda, a former health insurance leader, smaller plans often struggle with risk pooling dynamics, where having fewer members can lead to rate instability due to significant claims.
Although current enrollment figures remain undisclosed, Cruz expressed optimism in meeting initial targets, forecasting rapid financial sustainability within the state. While adherence to religious beliefs is not required for enrollment, the plan’s offerings adhere to Catholic ethical guidelines, with complex case advice sought from the National Catholic Bioethics Center. The plan excludes services restricted by these directives, such as IVF and contraception, and complies with Texas regulations regarding gender-affirming care for minors.
Texas was chosen for the plan's rollout, given its high uninsured rates and supportive religious freedom laws. Cruz indicated that Presidio plans to expand into states like Florida, Indiana, and Georgia, leveraging a network of over 993,000 providers nationally. Although not currently available through the ACA marketplace due to regulatory compliance requirements, future inclusion is under consideration.
Unlike unregulated health care sharing ministries, Presidio operates as a registered entity with the Texas Department of Insurance. This registration subjects it to regulatory obligations, ensuring adequate funding for claims, thus providing policyholders reassurance within the existing legal framework. By bridging ethical considerations and regulatory mandates, FortressPlan represents a unique offering in the health insurance sector.