King v. Burwell: Measuring the Potential Harm to Texas

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CPPP's Stacey Pogue

The U.S. Supreme Court is preparing to issue a ruling in King v. Burwell, the case challenging Affordable Care Act (ACA) insurance subsidies for residents of states — such as Texas — that did not set up their own Health Insurance Marketplaces. Texas and Texans will suffer significant harm if subsidies are eliminated by the court’s ruling.

In many respects, Texas has the most to lose if the Supreme Court eliminates subsidies in the Health Insurance Marketplace.

Texas has the highest uninsured rate in the nation. Texas has the most people who are eligible for Marketplace subsidies, at just over 2 million people. Of the states where subsidies are at risk, Texas has the highest number of people potentially eligible for Marketplace coverage at over 3 million for 2015. Texas also has the highest number of people who would become uninsured – 1.4 million by the end of 2016 – if subsidies are eliminated.

Texas has not closed its coverage gap, so even more low-income individuals (specifically, people with income between 100 percent and 133 percent of the Federal Poverty Level) are dependent on Marketplace subsidies to keep their healthcare costs affordable.

Texas kids will be harmed if subsidies are eliminated.

According to the U.S. Department of Health and Human Services, about 10 percent of Texans who gained coverage through the Marketplace are children, meaning coverage for about 100,000 Texas kids could be placed in jeopardy. Even more children would put at risk if their parents lose health coverage as that impacts the health and financial security of the whole family.

Texans across the state will lose coverage.

The table below shows the number of Texans enrolled in Marketplace coverage with subsidies as of March 2015 for the seventeen largest counties in Texas. You can find the full table of Marketplace enrollment and related health coverage data by Texas county here.

CountyTexans At Risk of Losing Subsidies: 2015 Estimated Marketplace enrolled with subsidies
Bexar County65,622
Cameron County12,634
Collin County32,372
Dallas County88,892
El Paso County38,484
Fort Bend County29,403
Harris County157,747
Hidalgo County24,397
Lubbock County5,834
Montgomery County14,083
Potter County1,907
Randall County2,186
Smith County5,974
Tarrant County66,070
Travis County45,766
Webb County7,671
Williamson County15,707

Texas will lose billions in federal spending for health care.

A decision to end the Marketplace subsidies in King v. Burwell would mean a loss of approximately $4.4 billion in federal spending to Texas in 2016.  The loss of this funding will be felt by health care providers and communities, which will struggle with added uncompensated care costs. Texas is already losing $8-$10 billon a year because state leaders have not accepted federal Medicaid dollars to expand coverage, which has already contributed to Texas hospitals closing and cutting back medical services.

At the Center for Public Policy Priorities, we believe in a Texas that offers everyone the chance to compete and succeed in life. We envision a Texas where everyone is healthy, well-educated, and financially secure. We want the best Texas - a proud state that sets the bar nationally by expanding opportunity for all. CPPP is an independent public policy organization that uses data and analysis to advocate for solutions that enable Texans of all backgrounds to reach their full potential. We dare Texas to be the best state for hard-working people and their families.


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