During COVID, Texas Should Reduce Uninsured Rate and Seek Federal Health Funds

Texans want moms to have healthy pregnancies and Texas babies to have a healthy start to life. We want our fellow Texans to get the health care they need to address concerns like depression, a lump that could be cancer, a second grader’s ear infection, or a toddler’s speech delay. And we want them to get that help early — when care is often cheaper and more effective — instead of waiting until things get worse.

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Amid the current pandemic and economic meltdown, we also want our neighbors to be able to quickly seek medical attention for COVID if they need it. And we want some financial stability for the waiters and small business owners who have lost jobs, work hours, or sales.

But we know that these goals will remain out of reach for many Texans if they don’t have access to health insurance. Unfortunately, before COVID struck, Texas already had the highest uninsured rates in the nation for children, adults, and women of childbearing age, with those rates headed in the wrong direction over the last two years. The problem continues to grow during the pandemic and recession, with an estimated 1.6 million Texans losing job-based health insurance by May 1, a number that keeps increasing as more Texans lose their jobs.

Additionally, we know that reducing the state’s uninsured rate will help Texans of all backgrounds while also taking an essential step to combat racial injustice. Because of state policy decisions, there is a high uninsured rate in every Texas community — from Longview to McAllen to Amarillo and beyond — and among Texas children of every racial/ethnic background. At the same time, there are significant racial disparities in Texas when it comes to access to health insurance, infant mortality, coronavirus, and more.

Finally, this is a critical time to bring federal health care dollars to Texas. The funding will help the state economy through the recession and help Texas leaders fully fund — not cut back — the many services in the state budget that Texans need now more than ever.

There are several key steps for Governor Abbott and other state leaders to take, both now and during the 2021 legislative session, to reduce the uninsured rate and bring federal health care dollars to Texas:

This Summer and Fall

  1. Push Congress for more federal health funding to states (Medicaid FMAP). Congress increased Medicaid FMAP funding to states as part of the coronavirus relief passed this spring, but it is now clear that states need a greater increase and that the increase should remain in place for the duration of this crisis. The funding will help meet the health care needs of Texans during the pandemic and recession. In the midst of decreased state revenue, increased federal funding is also one of the main tools that state leaders can use to help fully fund critical services in the state budget — services that Texans particularly need during our public health and economic crises.

  2. Don’t start kicking eligible Texas kids off Medicaid. Prior to the pandemic, Texas used a flawed process to review children’s Medicaid eligibility a few months after a robust review found them to be eligible. That process resulted in the state mistakenly removing eligible children from health coverage every month. Texas suspended the process in response to the federal Public Health Emergency declaration. Texas should not reinstate the inaccurate mid-year removals of children.

  3. Align the state’s health insurance outreach with the realities of COVID. HHSC should remove barriers to remote enrollment in Medicaid and CHIP so that Texans can maintain social distancing while signing up for insurance. The Texas Workforce Commission should provide information and referrals about health coverage options to applicants for unemployment insurance.

  4. Ditch the Health Care Repeal Lawsuit. The Texas Attorney General, in collaboration with the Trump administration, is attempting to eliminate protections for pre-existing conditions and other health benefits provided by the Affordable Care Act (ACA). That’s a terrible idea under any circumstances, but especially during a pandemic and recession. Texas leaders should drop the lawsuit, which is now before the U.S. Supreme Court.

During the 2021 Legislative Session

  1. Permanently end the inaccurate mid-year removals of eligible children from Medicaid. Building on the second recommendation outlined above, the Legislature should officially end the inaccurate reviews and provide for 12 months of continuous, uninterrupted coverage for children in Medicaid.

  2. Improve outreach to families regarding children’s health coverage options. Many uninsured children in Texas are eligible for either Medicaid or CHIP but not enrolled. The state’s outreach and enrollment efforts aimed at reaching these families are not as robust as they once were or nearly strong enough to meet the heightened need during a pandemic. The Legislature should boost funding and take other steps to improve outreach.

  3. Provide Medicaid health coverage for new moms for 12 months after childbirth rather than leaving them uninsured after two months. In 2019, the Texas House passed a bill to take this important step, HB 744, but it stalled in the Senate. As part of its response to the pandemic, Texas temporarily suspended the removal of mothers from health insurance two months after child birth. Texas should make that change permanent, as recommended by the state’s Maternal Mortality and Morbidity Review Committee.

  4. Provide full funding for health services in the state budget. During the pandemic and recession, Texans need well-funded state health services more than ever. To fully fund these services during a period of reduced state revenue, state leaders should proactively pursue additional revenue sources, including the Economic Stabilization Fund (Rainy Day Fund) and increased federal health funding.

  5. Expand Medicaid to cover essential workers — such as grocery store workers and child care teachers — and other low-wage Texas adults, including those who have lost jobs or work hours due to COVID. Texas is one of the only remaining states where there is essentially no health insurance option for working age adults below the poverty line who do not receive insurance from their employers. The federal government is offering Texas an estimated $8 to $10 billion per year to cover 90 percent of the cost of providing Medicaid health insurance to these low-wage adults. Recent Medicaid expansion discussions in Texas have assumed that the funding for the remaining “non-federal” 10 percent share of the cost would be financed by local governments and health care provider taxes, similar to the way Texas covers the state’s share in the current 1115 Medicaid Waiver.

We look forward to working with state leaders and our partners on these critical recommendations.