Texas Kids’ Uninsured Rate Still Highest in Nation & Getting Worse, According to US Census

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


Austin - Texas has the highest uninsured rate for children in the nation and — for the second year in a row — the rate got even worse, according to data released today by the US Census Bureau. In 2018, 11.2 percent of Texas children (under age 19) lacked health insurance compared to 10.7 percent in 2017 and 9.8 percent in 2016. After Texas' 11.2 percent, the second worst rate in the nation was Alaska at 9.4 percent, followed by Arizona at 8.4 percent. The total number of uninsured children in Texas increased by over 38,000 children to 872,794 in 2018.

The nationwide uninsured rate for children also rose, reaching 5.5 percent in 2018 compared to 5.0 percent in 2017. There had been steady progress reducing the children’s uninsured rate in Texas and nationwide prior to the reversal in 2016.

Today’s Census Bureau announcement follows the agency’s release of data two weeks ago showing that Texas has the nation’s highest overall uninsured rate, for adults and children combined, rising from 17.3 percent in 2017 to 17.7 percent in 2018.

“We are deeply concerned to see that more Texas children are missing out on the health care they need,” said Dr. Laura Guerra-Cardus, Deputy Director of Children’s Defense Fund-Texas, a member of the Cover Texas Now coalition. “This year, state leaders passed zero bills to tackle the uninsured rate for Texas children. As we look ahead to the 2021 legislative session, children’s health coverage must be a priority for Texas leaders.”

“This news is definitely disturbing, but the good news is that there are clear steps that state leaders can take to make sure more Texas kids have health insurance,” said Anne Dunkelberg, Associate Director of the Center for Public Policy Priorities, a member of the Cover Texas Now coalition. “One of the key steps Texas should take is removing the extra rounds of red tape that parents have to go through to keep their eligible kids enrolled in Medicaid health insurance.” 

“It’s time for the alarm bells to start ringing at the Texas Capitol,” said Stephanie Rubin, CEO of Texans Care for Children, a member of the Cover Texas Now coalition. “We appreciate the good steps the Legislature took this year on education, but kids also need to be healthy if you want them to do well in the classroom.”

Reasons the Children’s Uninsured Rate is Rising

The primary reason that the children’s uninsured rate is increasing in Texas and nationwide is the decline in children’s enrollment in Medicaid and the Children’s Health Insurance Program (CHIP). There has been a steady fall in enrollment in Texas Children’s Medicaid/CHIP since 2017, with participation declining from 3,404,621 in December 2017 to 3,176,182 in June 2019, a seven percent decrease, according to data from the Texas Health and Human Services Commission (HHSC).

Health coverage experts have identified three main reasons that enrollment is falling in Children’s Medicaid/CHIP and leading to higher children’s uninsured rates: 

 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 federal Public Charge rule for green card applicants.

The Role of the Texas Legislature

During the 2019 Texas legislative session, lawmakers did not pass any legislation to reduce the uninsured rate — for children or other Texans. The Texas House did pass a bipartisan amendment to reduce the excessive red tape that families must navigate to keep their eligible children enrolled in Medicaid insurance. Unfortunately, the Texas Senate did not consider the bill that included the amendment, so that measure did not become law. Advocates are calling on the Texas Legislature to pass the Children’s Health Coverage bill in 2021 to require families to provide documentation once annually to confirm their children’s eligibility for Medicaid. The bill would eliminate the additional mid-year red tape that has mistakenly removed eligible children from health coverage.

In addition to passing the Children’s Health Coverage bill, the Texas Legislature could significantly reduce the children’s uninsured rate by accepting Medicaid expansion funding from the federal government to cover uninsured low-wage adults. The experience of other states demonstrates that providing a health insurance option to parents has a “welcome mat” effect that leads to higher enrollment of children, in addition to the benefits that children experience when their parents are healthier.

A number of Texas organizations, including some members of the Cover Texas Now coalition, have launched a new #SickOfItTX campaign to ensure that health coverage is a top priority issue for candidates in 2020 and state legislators in 2021.