Census Bureau: Texas Has Worst Uninsured Rate in the US
Health insurance can make a world of difference — helping Texans detect cancer early and stop it, address chronic health challenges before a pregnancy, take the medications they need, avoid crushing medical bills, and much more.
That’s why we were so disappointed to see a new report released by the U.S. Census Bureau shows that last year Texas had the highest uninsured rate in the nation at 16.6 percent — over twice as high as the national rate of 8.0 percent. No other state came close to Texas. Oklahoma had the second worst uninsured rate at 11.7 percent. Texas and the nation showed slight improvements in comparison to 2021 due to federal policies that expanded financial support for health plans on HealthCare.Gov and temporarily limited states from removing enrollees from Medicaid health insurance.
Digging deeper into the data, we would like to highlight three key points:
The data show that Texans of all racial/ethnic backgrounds identified in the survey — Asian, White, Black, Hispanic, and American Indian — have higher uninsured rates than the national average. The data also show significant racial/ethnic disparities in the state. The Texas uninsured rates were 8.7 percent for Texans of Asian descent; 9.1 percent for non-Hispanic White Texans; 14.3 percent for Black Texans; 25.9 percent for Hispanic Texans; and 26.4 percent for Texans identifying as American Indian or Alaska Native.
The Census data also show that Texas had the worst uninsured rate for children at 10.9 percent. The national rate of 5.1 percent is less than half the Texas rate.
The Texas uninsured rate is much higher than the rate in neighboring states that have implemented Medicaid expansion. The uninsured rates are 6.9 percent in Louisiana, 8.2 percent in New Mexico, 8.4 percent in Arkansas, and 11.7 percent in Oklahoma.
It’s important to clarify that the high Texas uninsured rate in 2022 does NOT include the hundreds of thousands of Texans the state has removed from Medicaid health insurance in 2023 — including nearly 400,000 children the state removed before it was able to determine if they were still eligible. Removing so many Texans from Medicaid this year as part of the “unwinding” of pandemic-era Medicaid rules will likely drive up the state’s uninsured rate higher in 2023, especially for children.
Individual states’ policies make a significant difference in determining access to health coverage because so many jobs do not offer health insurance, and reduced-price insurance on HealthCare.Gov is only available to adults if their income is above the poverty line. (Medicaid expansion is intended for adults with incomes below the poverty line.)
There are a number of steps that Texas leaders can take to improve access to health insurance in the state:
Implement Medicaid expansion to provide an affordable health insurance option to adults with jobs below the poverty line.
Reduce delays in processing Medicaid applications for children and other Texans within the state’s narrow eligibility guidelines.
Improve the current Medicaid “unwinding” process to ensure that eligible Texans remain enrolled and Texans who are no longer eligible are transferred to other programs.
Approve bipartisan legislation by Reps. Bucy, Harless, Oliverson, Jetton, and Bonnen to use already-verified information to create an “Express Lane” option that facilitates health coverage enrollment for currently eligible kids. The bill passed the Texas House overwhelmingly in the 2023 session but did not receive a Senate hearing.
Ensure robust Medicaid outreach that addresses concerns of mixed-immigration-status families, including families for one in four Texas kids. Texas can’t enroll all eligible children without it. (Note that undocumented immigrants are NOT eligible for Medicaid.)
Ensure meaningful language access to Medicaid/CHIP by making applications, notices, and outreach materials available in multiple languages, not just English and sometimes Spanish.
Effectively implement HB 12 in early 2024 so that Texans enrolled in Medicaid for Pregnant Women can keep their health insurance for 12 months after their pregnancy instead of two months.