ACA falters across Texas, nation

Uninsured rises after attacks on Obamacare

The historic gains in Texas and the rest of the nation are now slipping away as the uninsured rate starts to rise again, a new national health care report has found.

The rate of working age adults without health coverage — those between age 19 and 64 — has ticked up to about 15.5 percent so far in 2018, up from 12.7 percent in 2016, according to the latest Commonwealth Fund tracking survey released this month.

That translates to about 4 million people nationwide once covered who no longer are insured, the survey found.

“This is not an insignificant change,” said Sara Collins, an economist and vice president for health care coverage and access at Commonwealth, a New Yorkbased private health policy foundation. “What’s important is the direction it is going.”

And for those who were heartened by the success of the 2010 health care law known as “Obamacare” in insuring those who did without, that trajectory is headed the wrong way.

“Sadly, recent actions by Congress and the ad-

ministration to repeal, defund or weaken the Affordable Care Act, the Children’s Health Insurance Program, Medicaid, and other avenues of health coverage hurt all Americans. Texas is particularly vulnerable to the erosion of health coverage,” said Ken Janda, president and CEO of Houstonbased insurer Community Health Choice.

Texas continues to lead the nation in the rate and number of uninsured, according to health statistics. About 4.5 million people in the state are uninsured, including nearly 700,000 children.

While the Commonwealth survey did not specifically break out current erosions in Texas, the data showed that the biggest reversals were happening in the South, in Republican-led states, and in the 19 states that did not expand Medicaid. Texas is three for three.

Still, not everyone sees the report as necessarily grim.

Dr. Deane Waldman, director for Health Care Policy at the right-leaning Texas Public Policy Foundation and a retired pediatric cardiologist, maintains that uninsured rates grab headlines but do not tell the whole story. He said on Monday he would only be concerned if a spike in uninsured rates translates into a reduction in care but the two are not always linked.

Government bloat

Waldman and other critics have long complained “Obamacare” creates bureaucratic bloat and is unduly restrictive on types of affordable coverage available. He applauds the action by Congress late last year to remove the penalty next year for those who choose not to buy coverage which he believes will promote a free market solution to the nation’s health care problems.

The Commonwealth survey found that roughly 5 percent of insured adults will probably drop coverage once the repeal of the individual mandate’s penalty goes into effect next year.

“They made that sound like a bad thing. I don’t see that as a negative at all,” he said, calling the mandate “government coercion.”

Under the ACA, the individual mandate was considered a necessary pillar to help broaden the risk pool. The idea was that if everyone, including those who did not use much health care, were required to buy broad coverage it would help offset the cost to cover those who were sicker and needed more treatment.

The national uninsured rate prior to Obamacare was about 16 percent. The situation was even more dire in Texas when more than one in four people — by some estimates as many as 26 percent — lacked coverage, according to data from the U.S. Census Bureau.

But by last year as the law entered its seventh year the national rate had dropped to a historic low of around 9 percent national from ly and around 17 percent in Texas.

Overall health may decline

The new survey found a nearly 6 percent rise in the number of working-age adults who lacked insurance in non-expansion states, climbing to 21.9 percent in 2018 from 16.1 percent in 2016.

There was a similar 6 percent rise in states where adults identify as Republicans, increasing to 13.9 percent this year. For those who said they were Democrats the rate of uninsured stayed steady at about 9 percent.

And about one in five adults, or about 20 percent, living in the South are now uninsured, the survey found.

“We’re already seeing a decline in the substantial gains in Texas,” said Joe Ibarra, a member of Get Covered Texas, a grassroots organization helping enroll people for health coverage in the state.

He said the overheated rhetoric that has surrounded the law its beginning only contributes to the confusion people feel. And while the majority of the law’s provisions remain in effect, many now believe it has been repealed which only makes it harder to enroll people in coverage.

Last year the Trump administration rolled out of series of actions that were seen as sabotage to the ACA, including shortening the enrollment period by half, dramatically reducing funds used in reaching those eligible for coverage, slashing the advertising budget and promoting a series of testimonials from people who said they were harmed by the law.

The president has also erroneously stated that the law has been eliminated.

“Absolutely I’m worried,” said Ibarra. “If those numbers shoot back up the overall health of an entire community is going to go down.”