Health gains elude Texas women
Study finds 1 in 4 still uninsured since ACA rollout; half can’t pay bills
Lauren Holston, a 31-year-old single mom, has been uninsured for years. Even when she worked, before losing her job a few months ago, her employer did not offer coverage. She has diabetes and Crohn’s disease but rations her treatment like any other household extra these days, turning a need into a want.
On Thursday, a national foundation that studies the U.S. health-care system released a snapshot of the progress women are making under the Affordable Care Act. The Commonwealth Fund report was upbeat overall, but buried deep within the data were troubling numbers coming out of Texas.
One in four Texas women remain uninsured — nearly five times the rate of uninsured women in New York and almost 1½ times higher than those in California. The Commonwealth findings show they also lag far behind in affording treatment and are struggling with medical debt.
It could’ve been written about Holston’s life. She is three for three.
For months the Houston woman tried to ignore the unexplained bleeding, the weight loss, the exhaustion that never went away.
“I knew there was something wrong, but without insurance I just pushed through,” she said.
Finally, in January she could not avoid the doctor any longer. At the Legacy Community Health clinic she got the diagnoses which, while serious, felt
like relief to know what she was up against. But then she lost her job. The $50 for a doctor visit or the $150 for tests to monitor her conditions soon became occasional things if not out of reach completely.
“I skip all the time,” she admitted. “I choose which tests to get and let the rest go.” The last thing she needs is another medical bill in collections. She already has one unpaid tab from an emergency room visit for her daughter before the 11-year-old got coverage under CHIP, the insurance plan for low-income Texas children.
Holston lives with her mother and makes the unemployment checks stretch while she looks hard for a job with insurance.
“Absolutely, it scares me,” she said Thursday. “This is no way to live.”
The Commonwealth Fund 2016 Biennial Health Insurance Survey reported solid progress for women across the country since the law known as Obamacare was enacted. In 2010 the number of women, ages 19 to 64, without insurance nationwide had spiked to 20 percent or about 19 million. By 2016 it had dropped by almost half to 11 percent.
But in Texas the gains for women have been minimal, dropping only 1 percentage point from 25 percent since 2012, the report showed.
Some of the differences between states can be explained because many chose to expand Medicaid while Texas did not.
Gender-based costs
Researchers said that does not tell the whole story.
For instance, in Florida, which also did not expand Medicaid, the uninsured rate for women is 17 percent, lower than in Texas.
Overall, Texas continues to lead the nation in the number of uninsured, with an estimated 4.5 million people without coverage.
One of the biggest changes under the current law is that insurers can no longer charge women higher premiums or deny them outright simply based on gender, researchers found.
“To insurers, women’s gender was in effect a preexisting condition that signaled the potential for higher health use and higher costs,” the Commonwealth study’s authors wrote.
In many states, including Texas, it was once common for a healthy, non-smoking woman to pay more for a health plan than a man the same age who smoked, according to a separate 2012 study by the National Women’s Law Center.
The justification was that women typically went to the doctor more than men, had more checkups and annual screenings, and, of course, had babies.
Back then, maternity coverage was often elusive if not nonexistent. In Texas, of the 118 insurance plans offered to a 30-year-old woman in the individual market in 2012, zero came with maternity coverage, the National Women’s Law Center research found.
Tiffany Hogue, now at the Texas Organizing Project, found out the hard way in 2007 just how difficult it was to get maternity coverage in Texas.
Pregnant with her first child, she had insurance. It was a $500-per-month policy she bought as she was moving to Houston so she figured all was well when she made her first obstetrics appointment. Then the bills started rolling in. None of the tests done early in pregnancy were covered nor was the doctor visit.
“What do you mean maternity is not covered?” she sputtered at her insurer.
She thought she would just buy a different policy but kept striking out.
“They said no one is going to cover you,” she remembers one company telling her.
Hogue began negotiating with her doctor to lower costs. She skipped visits as well screenings and ultrasounds. Looking back she remembers how frightening it was since those are the very tools to catch potential problems.
She eventually got a job with employer-sponsored insurance that covered maternity, but there was a waiting period for it to take effect. She was not fully covered until late in her pregnancy. Her out-of-pocket costs had climbed into the thousands of dollars.
‘Way behind in caring’
Maternity coverage became a requirement in all individual plans under Obamacare. Lately, though, critics have taken aim, complaining its inclusion has not only has driven up premium prices for everyone but also is inherently unfair to those who did not need it.
Sara Collins, vice president for health care coverage and access at the Commonwealth Fund, said such complaints are based “on a myth.”
Maternity coverage raised premiums on average only about 4 percent while the potential harm to women and families would be dramatic. Without the requirement, out-of-pocket costs for families wanting to have babies could rise 1,000 to 3,000 percent depending on the type of delivery and how complicated it was, she said.
Health-care advocates fear such a return, saying Texas women’s health could serve as a cautionary tale.
In 2016, half of Texas women still reported having trouble paying medical bills during the previous 12 months compared with 29 percent in California and 31 percent in New York, the Commonwealth research found.
Also, the study showed that 52 percent of Texas women had failed to fill a prescription, skipped a test or follow-up appointment or did not get needed specialist care because of cost. That compares to a third of women in both California and New York and 46 percent in Florida.
“It points out the sad fact that we’re still way behind in caring for all of our population, particularly women,” said Jose Camacho, executive director and general counsel for the Texas Association of Community Health Centers.
He called it a confluence of events that has hit Texas women hard but is not wholly unexpected because of a series of events.
Texas chose not to expand Medicaid to cover the state’s poor and near-poor and it also made enrollment and outreach difficult when Obamacare was introduced in the state, he said. At roughly the same time lawmakers slashed funding to family-planning clinics in an apparent effort to defund abortion.
Camacho said one of the consequences was that women, especially in remote areas, lost their only access to health care.
“This is the picture of what eventually comes down the pike when there are so many interruptions,” he said.