Gap between Texas and U.S. in Health Coverage Continues to Widen, Census Shows

/, Health care, Health Insurance and Reform, Medicaid & CHIP/Gap between Texas and U.S. in Health Coverage Continues to Widen, Census Shows

Today’s U.S. Census data release confirms that the number of Texans without health insurance continued to decline in 2016, with uninsured Texans dropping by 70,000 from the 2015 number, and by over 1.2 million since 2013.  But despite the progress, Texas still has both the largest number (4.5 million) and percentage (16.6 percent) of uninsured residents in the country.

Today’s release of the Current Population Survey (CPS) by the U.S. Census, including a sneak preview of health insurance data from the American Community Survey (ACS), provides the third year of Census data showing how much health insurance coverage has grown since the launch of new private and public coverage options under the ACA in 2014.  Nationally and in Texas, uninsured rates dropped by smaller margins from 2015 to 2016 than in the first two years of ACA coverage implementation.

“We are really pleased to see that in 2016, the Affordable Care Act continued to boost health insurance coverage in Texas,” said CPPP Associate Director Anne Dunkelberg. “But too many hard-working, low-income Texans are still left uninsured, and the long-lasting effects of Hurricane Harvey have now created new need among Texas families. Today’s release underscores the need for both rapid health care relief for those affected by Harvey, and long-term solutions to provide free or low-cost health coverage to a newly-enlarged population of poor and low-income working families. All Texans will see health benefits and cost savings if Texas follows the lead of the majority of states – including very conservative states –by expanding coverage for these families using federal Medicaid dollars.”

Today’s Texas highlights from the Census Bureau’s Uninsured data:

*Texas saw another year of improvement in our overall (all ages) uninsured number and rate:
**2013 = 5.7 million Texans (22.1 percent)
**2014 = 5.0 million Texans (19.1 percent)
**2015 = 4.6 million Texans (17.1 percent)
**2016 = 4.5 million Texans (16.6 percent)
Note: Percentage declines in 2016 are statistically significant changes from 2013, 2014 and 2015.

*The Census findings for 2016 add to the important gains we saw in for 2014 and 2015. From 1999 to 2013, Texas’ uninsured rate fluctuated between 21 and 25 percent, and we never had a one-year improvement of even a full percentage point. But since 2013, our state’s uninsured rate has dropped a total of 5.5 percentage points, with 1.2 million fewer uninsured Texans since new ACA coverage options started up in 2014.

*Texas again had a notably smaller improvement in health care coverage than did states that have expanded Medicaid to cover below- and near-poverty adults. New Mexico’s uninsured rate was cut in half from 18.6 percent in 2013 to 9.2 percent in 2016 (a drop of 9.4 percentage points); Louisiana dropped from 16.6 percent uninsured to 10.3 percent; and Kentucky improved from 14.3 percent in 2013 to 5.1 percent in 2016, (a huge drop of 9.2 percentage points).

*The main source of coverage gains in the U.S. and Texas since 2013 has been direct purchase of insurance by individuals and families, including through the ACA marketplace or directly from an insurer (direct purchase coverage grew by 4.8 percentage points for the U.S., about 16.2 million Americans). Medicaid coverage was the second largest source of gains nationally (nationally, coverage under Medicaid grew 1.9 percentage points, by about 7.4 million Americans).

*States that did some form of Medicaid expansion showed larger improvements in their uninsured rates for working-age adults (18-64) than Texas did. This is because non-Medicaid expansion states like Texas cover only a fraction of parents, and cover no uninsured adults without dependent children at home (unless over 65 or disabled, and in poverty). About 23 percent of working age Texans (ages 18 to 64) were uninsured in 2016, compared to a U.S. average of 12.1 percent. Census analysts report that in non-Medicaid expansion states, the uninsured rate for adults in poverty is almost twice the rate found in states with a coverage expansion for the working poor.

*Texas remains the state with both the largest percentage and the highest number of uninsured residents. Prior to 2014, California was the state with the largest number of uninsured residents despite a much lower percentage than Texas, because their population is so much larger than Texas. But California has seen robust increases in both private insurance coverage under the ACA Marketplace and public coverage for working poor adults due to the state’s Medicaid expansion, reducing their total number of uninsured residents below Texas’. California’s uninsured rate dropped from 17.2 to 7.3 percent from 2013 to 2016, bringing the number of uninsured down to 2.8 million, or 1.7 million fewer uninsured than in Texas.

*A much larger percentage of Texas kids (90.2 percent) than adults (77 percent) have health insurance thanks in large part to Medicaid-CHIP coverage available to many low-income Texas kids. Still, the Texas children’s uninsured rate (at 9.8 percent or about 752,000 uninsured for those under age 19) leaves us at the bottom of the rankings with Alaska for the worst uninsured rate for children and teens in the country. Texas needs to do more to get more children who qualify for Medicaid and CHIP enrolled and to fix the barriers that prevent kids in families at higher incomes from getting coverage.

Stay tuned as Thursday (Sept. 14) the Census Bureau will release more American Community Survey data, including Texas-specific data about poverty and income. To better understand the difference between the two American Community Survey (ACS) and the Current Population Survey (CPS), view our side-by-side comparison.

Background:
Last year’s Census release of 2015 data confirmed that the ACA was allowing millions of Americans to gain affordable health coverage. Today’s release of 2016 estimates gives us one more year of data on the downward trend in the uninsured. Today’s data from the ACS—with a massive sample size of about 3.5 million people across the U.S.—confirm with a much higher degree of accuracy what earlier, smaller-sized surveys had predicted. For more information or to schedule an interview with a CPPP expert please contact Oliver Bernstein at bernstein@cppp.org.

Anne Dunkelberg joined the Center in 1994. She is one of the state's leading experts in policy and budget issues relating to health care access. In 2007, she was named Consumer Advocate of the Year by Families USA in Washington, D.C. Before coming to the Center, she served as Program Director for Acute Care in the Texas Medicaid Director's Office and spent six years with the Texas Research League, where she authored numerous reports on Texas health and human services issues and tracked state health and human services budget issues. She earned dual degrees from The University of Texas at Austin—a Bachelor of Arts (Plan II), magna cum laude, in 1979 and a Master of Public Affairs from the LBJ School of Public Affairs in 1988.

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