Texas uninsured rate grows

The percentage of Texans without health insurance grew for the second year in a row in 2018, again placing the state No. 1 in the nation in the rate of people lacking health insurance, according to Census Bureau data released Tuesday.

Last year, 17.7% of Texans — or 5 million people — were uninsured compared with 17.3% in 2017, the first time the rate increased in consecutive years since 2009, a year before the Affordable Care Act went into effect.

Nationally, 8.5% of people lacked insurance in 2018. The national uninsured rate ticked up by half a percentage point, the first increase over the previous year since 2009. Medicaid coverage nationwide decreased slightly between 2017 and 2018, while Medicare coverage increased slightly.

“There’s a big gap between our uninsured rate and that of the next-worst states which are Oklahoma, Florida and Georgia all kind of clustered together, so we are very much an outlier,” said Anne Dunkelberg, associate director of the left-leaning think tank Center for Public Policy Priorities, a member of the Cover Texas Now coalition. “We really need action both at the state and federal level to address all of the barriers that keep Texans from getting insurance.”

Some of those barriers have come from President Donald Trump’s administration, which has cut in half the number of days available for people to sign up for coverage under the Affordable Care Act and diminished marketing of the ACA federal exchange, Dunkelberg said.

Congress also has eliminated the Affordable Care Act’s tax penalty for Americans who chose to remain uninsured.

A total of 1.13 million Texans signed up for insurance on the federal exchange during 45 days in 2018, 8% fewer than the 1.23 million who enrolled in 2017, when open enrollment lasted three months.

Dunkelberg also noted chilling effects of federal policies that she said are intimidating immigrants from obtaining coverage for their children who are U.S. citizens and qualify for public health insurance.

Nationally, the rate of children without health insurance increased from 5% in 2017 to 5.5% in 2018, driven in part by the decline in children’s Medicaid and CHIP coverage, according to the agency.

“There are lots of different factors that affect health insurance coverage, including changes in economic conditions, shifts in the demographic composition of the population, policy changes of the state and federal level,” said Laryssa Mykyta, a health and disability statistics official with the Census Bureau, during a phone call with news media Tuesday.

Tuesday’s data release does not include a detailed breakdown of uninsured people in individual states, including the rates of children or childbearing women who are uninsured. In 2017, Texas led the country in the uninsured rates of those individuals.

Focus elsewhere

Occupied with overhauling the school finance system and curbing the growth of property taxes, the Legislature this year didn't take any significant steps to reduce the number of uninsured Texans.

Combined federal and state spending on Medicaid in Texas will top $66.5 billion over the next two years. Although this reflects an $800 million increase from the current two-year budget, the state will end up spending $1.9 billion less.

Several bills addressing uninsured Texans, many of which carried hefty price tags, didn't gain traction. Among them was a measure to expand Medicaid through voter approval, something three other Republican-voting states — Nebraska, Utah and Idaho — have done. Another bill would have allowed women to maintain Medicaid coverage for a year after delivering a baby or miscarrying, instead of the current 60 days. Other efforts were made to prevent children — about 50,000 a year — from being kicked off Medicaid due to paperwork problems also did not advance.

“This is a failure of the Texas Legislature. We can’t keep pushing aside the growing uninsured rate in this state and act like this is somebody else’s problem,” said state Rep. John Bucy III, D-Austin, who pushed multiple measures this session to expand Medicaid.

State Sen. Lois Kolkhorst, R-Brenham, chairwoman of the Senate Health and Human Services Committee, did not return a request for comment.

Medicaid expansion

Generally, states that have expanded Medicaid eligibility to more individuals — an option offered under the Affordable Care Act that allows states to draw more federal dollars to enroll more Medicaid recipients — saw lower uninsured rates than those states that haven't expanded Medicaid, according to the agency.

Texas is one of 14 states that has not expanded Medicaid.

Expansion of the federal and state-subsidized health insurance program could cover 686,000 Texans who make too much to qualify for Medicaid yet earn too little to qualify for tax credits to purchase Obamacare through healthcare.gov, according to the Kaiser Family Foundation, a policy research organization.

Expanding Medicaid coverage also could make an additional 439,000 Texans eligible for Medicaid, those eligible for Obamacare but who are just above the federal poverty level.

Republican state leaders reject Medicaid expansion because they say they don’t trust the federal government to fulfill its promise to reimburse 90 percent of the cost. They also say the program is riddled with problems, including providing inferior quality of care.

Although Medicaid expansion would only affect adults, children also could benefit because the likelihood of a child obtaining insurance increases if his or her parents are insured.

Tuesday’s data bore out such a notion — the percentage of children without any health insurance increased in states that did not expand Medicaid, but did not statistically change in expansion states, according to the agency.

“Only about a third of our uninsured would qualify for a Medicaid expansion. It is not going to solve our entire problem. It’s just the biggest single tool we have, and it’s also costing us $8 billion to $10 billion a year we could be getting in federal tax funds ... that Texas taxpayers are sending in as part of our income taxes,” Dunkelberg said.

Bucy hopes more of his rural colleagues in the House will support Medicaid expansion. Rural Texans generally have higher uninsured rates than their urban peers, and hospital administrators say Medicaid expansion could help prevent rural hospitals from closing their doors.

“I think there’s fear on the other side that in a primary, anything still attached to the Obama administration could hurt them politically. We have to make sure we can get past that archaic political argument,” he said.