Texas’ Uninsured Rate Worst in the Nation

Melissa McChesney

They say everything’s bigger in Texas, and Texas now has the biggest percentage of uninsured residents in the country—sitting just above 20 percent. Only Oklahoma (17.7 percent) and Wyoming (18.2 percent) come anywhere close.

On August 10 Gallup released their most recent data on uninsured rates by state, showing a continual decline in uninsured rates across the country as a result of the new affordable coverage options made available by the Affordable Care Act (ACA). Eight out of the ten states that have seen the largest drops in their uninsured rates (dropping their uninsured rates by 8 to 13 percentage points) have also implemented Medicaid expansion to cover adults up to 138% of the federal poverty line (FPL).*

Texas saw a decline of only 6.2 percentage points—from a 27 percent uninsured rate among all residents in 2013 to a 20.8 percent uninsured rate in the first half of 2015—despite the fact that Texas had the most to gain from the ACA since it had the highest uninsured rate in 2013. Most of the decline in Texas’ uninsured rate is due to individuals buying subsidized insurance through the Health Insurance Marketplace. During the last Marketplace open enrollment, Texas had 1.2 million people select a plan. Since the end of open enrollment in February, an additional 131,000 Texans selected plans during a “special enrollment period.”

According to Gallup’s numbers, Texas is now the only state with more than 20 percent of its residents without health insurance. Unfortunately, Texas leaders have remained stubbornly oppositional to the ACA as a whole and Medicaid expansion in particular. While other conservative-led states such as Montana and Alaska have moved forward with expansion this year, and leaders in states such as Utah and Florida have at least had public discussions about the possibility of expanding coverage, Texas’ leaders have been largely silent.

During the 84th Legislative Session this spring the only bills filed to accept federal dollars to provide health coverage to citizens below 138 percent of the FPL were filed by Democrats and not a single one was scheduled for a hearing. Early in the session Republican leaders not only said that coverage expansion was not worth discussing, they petitioned the federal government for unheard of exceptions to the state’s existing Medicaid program.

Complicating matters, Texas faces a big reduction in our uncompensated care funding through the 1115 Medicaid Waiver, which expires in September, 2016. Federal Medicaid officials have clarified to all states that the program will no longer provide federal funding to support uncompensated care for consumers who could have been covered if the state had expanded Medicaid. Based on this policy, Florida’s uncompensated care funding was reduced by 50 percent in 2016 and 71 percent for subsequent years.

A 50 percent reduction in Texas’ uncompensated care federal dollars would cost Texas communities about $1 billion each year. This new fiscal implication, added to the already-strong fiscal argument for coverage expansion, should move our Texan leaders to follow the examples of Indiana and Iowa and craft a solution.

One out of five Texans being uninsured is nothing but bad news for Texas. Texas continues to lag behind in providing its residents with affordable coverage, while other states are taking full advantage of the opportunities made available by the ACA. As a result, they have made bigger gains in providing coverage to uninsured residents and securing a healthy future for their state. It’s time for Texans to look to our state leaders and say, “We have a big problem, the biggest in the nation, what’s your plan to address it?”

*Alaska has chosen to expand Medicaid effective September 1, 2015.

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