New Data Show Texas Last in US in Health Coverage — But There Are Solutions
Texans have a better chance of surviving cancer if their doctor identifies it before it spreads. Texas parents have a better chance of a healthy pregnancy and healthy baby if they get medical care they need before, during, and after their pregnancy. Kids have a better chance of learning math, reading, and other subjects if they have the glasses they need for seeing the chalkboard, the medications they need for getting back to school when they’re out sick, and the support they need for any disabilities, developmental delays, or mental health challenges. Parents also have a better chance of supporting their kids if they are not drowning in medical debt.
If we want more Texans to reach those goals, then health insurance — and the consistent, reliable health care it can provide — is essential.
Unfortunately, as reported by Roll Call and other media outlets, new data released this month by the U.S. Census Bureau show that Texas is lagging behind the rest of the nation when it comes to health insurance.
The new American Community Survey health insurance data, covering 2016-2020, show that Texas had by far the worst uninsured rate in the nation at 17.3% — about double the national average of 8.7%. The next closest state was Oklahoma at 14.4%. (The Census Bureau noted that the 2020 data included in the report were processed differently than data from other years because of the pandemic.)
The new Census Bureau data show that the exceptionally high uninsured rate in Texas included every racial/ethnic group across our state. The Texas uninsured rate for each group in the survey — Black, White, Hispanic, American Indian, Asian, etc. — was worse than the national uninsured rate of 8.7%.
The Census Bureau numbers from similar states also underscore that the high Texas uninsured rate reflects health policies decisions made by our state leaders:
Next door in New Mexico — another border state with a large proportion of people living on low incomes — the uninsured rate was 9.5%, significantly better than the rate in Texas.
Neighboring Arkansas — another state with conservative leaders in state government — had an uninsured rate of 8.3%, much lower than the Texas rate.
New Mexico, Arkansas, and other states with uninsured rates far better than the Texas rate have a key feature in common: They have accepted Medicaid expansion funding from the federal government to provide an insurance option to adults in low-wage jobs. In Texas and other states that continue to reject the federal funding, cashiers, home health aides, janitors, and others with incomes below the official poverty line are generally not eligible for insurance through Medicaid or for reduced-price insurance on HealthCare.Gov. Medicaid expansion was intended to cover this population, but Texas is one of 12 states that is refusing this federal health funding.
The decision by the Governor and Legislature to block health coverage has hurt Texans from a variety of backgrounds, as noted above, but it has fallen hardest on Texans who are Hispanic or American Indian. According to the new Census Bureau data for Texas, 26.8% of Hispanics and 21.6% of American Indians were uninsured. By comparison, 16.4% of the White population, 15.0% of the Black population, and 11.2% of the Asian population in Texas were uninsured.
Fortunately, there are several ways that policymakers can address the lack of access to health insurance in Texas:
We need to close the coverage gap — either by state leaders finally accepting Medicaid expansion or by Congress passing an alternative solution. This step would do far more to increase access to health care and reduce the uninsured rate than any other policies currently under consideration — and Medicaid expansion would actually save money in the state budget. The Build Back Better bill that passed the US House last year would have closed the coverage gap in Texas, but it did not come up for a vote in the US Senate. Here in Texas, the House and the Senate each voted down Medicaid expansion proposals during the 2021 legislative session.
State health officials need to prepare for the end of Medicaid enrollment rules that have been in place during the COVID-19 Public Health Emergency (PHE). There should be two key goals: A) avoid a huge spike in Texas children losing health insurance when they are still eligible, and B) ensure that moms and children who are no longer eligible for Medicaid can smoothly transition to Healthy Texas Women, CHIP, or HealthCare.Gov. (Learn more here.)
The Texas Legislature should provide moms with a full 12 months of health coverage after pregnancy. Texas currently provides only 2 months of health coverage postpartum. In 2021, the Legislature approved 6 months of coverage, but it has not been implemented. Federal policy allows for 12 months of coverage — as recommended by the Texas Maternal Mortality and Morbidity Review Committee — but requires states to seek a Medicaid waiver to use federal funding to pivot from 2 months of coverage to 6 months.
Community organizations, health providers, state officials, and others should confront the “Chilling Effect”. The fear created by anti-immigrant policies and rhetoric during the Trump administration resulted in many eligible Texans — including US citizen children in mixed status families — staying away from Medicaid, SNAP, and other programs for which they still qualified. We should work to inform families about the facts and help eligible Texans enroll. (Learn more here.)
State officials should improve outreach to families with eligible but unenrolled kids. While Texas adults are often uninsured because there are no available insurance options for them, Texas kids who are uninsured are often eligible for either Medicaid or CHIP. In addition to outreach efforts specific to the PHE and the Chilling Effect, Texas should improve outreach and enrollment efforts to reach these Texas families. Fortunately, in preparation for the 2023 legislative session, the Texas House Speaker Dade Phelan recently created the Select Committee on Health Care Reform and directed it to “Study ways to improve outreach to families with children who are eligible for, but not enrolled in, Medicaid or CHIP, including children in rural areas.” As part of these efforts, the Legislature should monitor the implementation of the important legislation it passed in 2021 to reduce the number of eligible children mistakenly removed from Medicaid and determine if additional steps are needed.