This post was written by Kamia Rathore and it’s our second post in our Countdown to Coverage series.
Since the Affordable Care Act (ACA) went into effect, the number of uninsured veterans has dropped nationally. This trend has filtered down to Texas, but our state still has about 72,000 veterans who lack insurance—meaning Texas has the highest number of uninsured veterans in the nation. Nearly a third of Texas’ uninsured veterans are eligible for premium subsidies to purchase insurance on the Health Insurance Marketplace. Another third would be insured if Texas accepted federal dollars and expanded Medicaid or created an alternative coverage program under a waiver.
Nationally, more veterans are insured because of the ACA. The Urban Institute estimates that the number of uninsured veterans has declined from 11.9 percent in 2013 to 6.8 percent in 2015. That represents an overall decline of 42 percent in uninsured veterans in the past two years. Similarly, the percent of veterans reporting unmet medical need due to cost in the past 12 months fell from 7.3 percent in 2013 to 4.5 percent in 2015, suggesting that increases in coverage correspond to improvements in access to care.
In Texas, there has been a slower decrease in the uninsured rate for veterans. According to the Urban Institute, there was a decline in uninsured rates among Texas veterans from 11 percent in 2013 to 8.6 percent in 2014. But this drop is lower than the average for states that expanded Medicaid. The Urban Institute estimates that one third of uninsured veterans will fall into the “Coverage Gap,” which amounts to 24,000 veterans who would be eligible for coverage if Texas had expanded Medicaid. Another 22,000 uninsured Texas veterans could get tax credits for insurance plans offered in the Health Insurance Marketplace. To date, the Texas state government has done little to support outreach and enrollment in the ACA Marketplace even though it is the only affordable insurance option for many Texans.
Expanding coverage and supporting outreach efforts doesn’t just help veterans—it helps their families. Many people often assume that all veterans are covered by the VA’s insurance, but only 42 percent of veterans are enrolled in VA coverage. Eligibility for VA coverage varies, depending on several factors such as the years of a member’s service and the level of his or her disability. Moreover, VA coverage does not usually extend to family members, barring certain rare exceptions. In Texas, 63,000 family members of veterans were uninsured in 2014, a number that will decrease as more subsidy-eligible veterans enroll in Marketplace plans and if Texas closes the health care Coverage Gap.
To learn more about Veterans in the Coverage Gap, check out our new fact sheet.