New Report: Legislature’s Medicaid Decision Blocks Insurance for One Million Texans

Austin – A new report released by the Kaiser Family Foundation shows that the Texas Legislature could provide access to health insurance to over a million uninsured Texans by accepting Medicaid expansion funding from the federal government. According to previous analyses, Texas has the highest uninsured rate in the nation (16.6 percent) and the highest number of uninsured residents (4.5 million).


“Texas leaders have a lot of policy problems they need to address, including mental health challenges, pressure on local property taxes, the opioid and other substance use disorders, maternal and infant mortality, rural hospitals closing, and the medical bills and other financial strains faced by so many families,” said Anne Dunkelberg, Associate Director of the Center for Public Policy Priorities. “A key step to tackling all these challenges is for state leaders to develop a plan to increase access to health insurance.”

A recent poll shows that Texans want the Legislature to take action to expand access to health insurance. The survey shows that 87 percent of Texans believe it is a “top priority” or “important but not a top priority” for the state Legislature to work on increasing access to health insurance; 64 percent of Texans believe the Legislature is not doing enough to help low-income Texas adults get health care; and, echoing previous surveys, 64 percent of Texans want the Legislature to accept Medicaid expansion funding. Recent polling also shows that more than half of Texans are having trouble affording health care, while new research shows that residents of Medicaid expansion states are having fewer difficulties with medical bills.

The new Kaiser Family Foundation report shows that 638,000 uninsured Texans are in the Coverage Gap, meaning that they are left without any affordable insurance options because the one health insurance solution designed for them – federal Medicaid expansion funding for low-wage adults – has thus far been rejected by Texas leaders. In addition to those 638,000 Texans, Medicaid expansion funding would also cover an additional 439,000 uninsured Texans with incomes slightly higher than the federal poverty line.

The report found that most Texans in the Coverage Gap (74 percent) either have jobs or have a working family member.

“The Legislature should make sure there is a health insurance option available to Texans who build our homes, take care of our toddlers and grandparents, serve our food when we go out to eat, or who stay home to care for their new baby while a spouse goes to work,” said Ms. Dunkelberg. “Unfortunately, many of these jobs don’t offer insurance and don’t pay enough for Texans to buy their own insurance. The federal government is offering states expanded Medicaid funding to cover these specific families, but so far state leaders have turned down the funding without offering any alternative plans.”

Texans in the Health Coverage Gap have incomes below the poverty line designated by the federal government – $25,100 per year for a family of four – and therefore do not qualify for subsidies to purchase affordable insurance through the Marketplace. They do not currently qualify for Medicaid because the Texas Legislature largely limits the health insurance program to people with severe disabilities or near-death illnesses and low-income children, seniors, and pregnant women.

Another recent report by the Kaiser Family Foundation highlighted research showing that Medicaid expansion is linked to significant economic benefits for participating states, better access to health care, improved financial security for families, a reduction in unpaid hospital bills, and other benefits.

Many Texas business leaders, health care experts, and others have called for state leaders to accept federal funding to close the Coverage Gap. Thirty-four states (including Washington, D.C.) have accepted Medicaid expansion funding, and three additional states are currently considering expansion. The federal government pays 90 percent of the costs of Medicaid expansion while participating states pay only 10 percent.

Cover Texas Now is a coalition of consumer and faith-based Texas organizations.