Census: TX Uninsured Rate Highest in US, Getting Even Worse

For Immediate Release
Contact: Peter Clark,
[email protected], 512-473-2274, Oliver Bernstein, [email protected], 512-289-8618

After the TX Lege passed no bills in 2019 to address the uninsured rate, advocates urge state leaders to commit to reduce the uninsured rate for kids, moms, and other Texans during the next legislative session.


Austin - Texas has the highest uninsured rate in the nation — and the rate got even worse for the second year in a row — according to data released today by the U.S. Census Bureau. The overall uninsured rate in the state was 17.7 percent in 2018, an increase from 17.3 percent in 2017. The total number of uninsured Texans rose from 4,817,000 in 2017 to 5,003,000 million in 2018, an increase of 186,000.

While updated data on the uninsured rate for Texas children will not be available until September 26, today’s Census data show the children’s uninsured rate is getting worse nationwide, driven by a decline in enrollment in Children’s Medicaid/CHIP.

“This news should be a wake-up call for state leaders,” said Anne Dunkelberg, Associate Director of the Center for Public Policy Priorities, a member of the Cover Texas Now coalition. “After Texas leaders failed to address our state’s sky-high uninsured rate during the recent legislative session, they need to make it a priority for the 2021 legislative session. The House Speaker and Lt. Governor should start that process now by directing legislative committees to hold hearings on health coverage. Texans are watching to see if our state leaders will make a commitment to reducing the uninsured rate.”

“If you care about healthy moms, healthy pregnancies, and healthy babies, this is really bad news,” said Adriana Kohler, Senior Policy Associate at Texans Care for Children, a member Cover Texas Now. “When Texas moms and other women work in low-wage jobs that don’t offer health coverage, we need to make sure they have a way to get insurance so they can be healthy before, during, and after pregnancies. We encourage the Legislature to focus on reducing the uninsured rate during the next legislative session.”

“The Legislature made education a priority during the recent legislative session,” said Laura Guerra-Cardus, Deputy Director of the Children’s Defense Fund-Texas, a member of Cover Texas Now. “But if children are uninsured and can’t get the health care they need, then we know they are going to miss school and have trouble staying focused on academics when they are in class. State leaders need to make health coverage a top priority for the 2021 legislative session.”

Reasons for High Uninsured Rates:

The Census data show that states with low uninsured rates in 2018 are the ones that previously accepted the Medicaid expansion funding that the federal government offers to states to cover janitors, cashiers, child care workers, and other low-wage workers who do not receive insurance from work. The uninsured rate for Medicaid expansion states was 6.6 percent, while the rate for non-expansion states was 12.4 percent. Texas is one of the few states that has not accepted Medicaid expansion funding yet.

With minor exceptions, Texas generally does not offer Medicaid health insurance to low-income adults unless they are seniors, pregnant women, or Texans with terminal illnesses or disabilities so serious they cannot work. Under Texas policy, Medicaid insurance for pregnant women ends approximately two months after childbirth.

Texas Inaction on Health Coverage:

The Texas Legislature passed no bills in 2019 to address the high uninsured rate.

On a contested vote, the Texas House passed legislation to extend maternal health coverage for a full year after childbirth, but the Senate declined to consider the bill and it never became law. Legislators filed several bills to expand Medicaid to low-wage adults, but none of them were approved by legislative committees, and a House vote on a budget amendment to expand Medicaid failed on a party-line vote. Additionally, Texas House members worked across party lines to pass an amendment that would reduce the excessive red tape that removes many eligible Texas children from Medicaid, but the Senate declined to consider the bill. 

Simultaneously, Texas leaders have filed a lawsuit to eliminate the health care protections and benefits that Texans receive under the Affordable Care Act (ACA), including protections for pre-existing conditions.

Several Texas organizations are launching the #SickofitTX campaign to urge Texas leaders to make health coverage a priority during the 2021 legislative session.

Reasons for Increasing Uninsured Rates in Texas and Nationwide:

Health care experts have identified multiple reasons why uninsured rates are increasing nationwide and in Texas.

Officials in Washington, DC have tried to eliminate and water down the ACA, dramatically reducing funding to support marketing, outreach and enrollment, shortening the time period for open enrollment, and taking other steps to undermine ACA enrollment. As a result, the number of Texans receiving health insurance through healthcare.gov has declined. Nonetheless, between November 1 and December 15 this year, Texans can enroll in health insurance for 2020 through healthcare.gov and receive significant financial assistance to reduce their insurance costs.

National and local experts have noted that uninsured rates have increased recently, and enrollment in Children’s Medicaid/CHIP have declined, due to a climate of fear and confusion among families that include members with different immigration statuses. That fear and confusion has been fueled in part by the administration’s new “public charge” rule, which penalizes green card applicants if they previously used certain public benefits. It is important for Texas parents to know that they can keep their children enrolled in Medicaid, CHIP, and other programs without any penalty under the new rule.

Additionally, in recent years, Texas instituted a new policy that requires many families to provide additional income documentation on multiple occasions throughout the year in order to maintain their children’s enrollment in Medicaid insurance. This additional red tape has resulted in thousands of eligible Texas children losing their insurance. Members of the Cover Texas Now coalition are continuing to work with state leaders to seek ways to reduce the red tape for families and ensure more eligible children can stay enrolled in Medicaid.