More Tex­ans lose health in­sur­ance

New re­port says that state’s unin­sured rate high­est in country

The Dallas Morning News - - FRONT PAGE - By MARÍA MÉN­DEZ and OBED MANUEL

De­spite a boom­ing Texas econ­omy, more Tex­ans lost or dropped their in­sur­ance cov­er­age from 2017 to 2018, ac­cord­ing to a new re­port from the U.S. Cen­sus Bureau.

That marks the sec­ond con­sec­u­tive year­to­year in­crease of Texas’ unin­sured rate.

And with about 5 mil­lion unin­sured peo­ple — about 17.7% of the to­tal pop­u­la­tion — Texas re­mains the state with the high­est unin­sured rate out of all 50 states, the cen­sus data re­leased Tues­day shows.

The na­tional unin­sured rate also in­creased to 8.5% from 7.9% dur­ing that time, largely due to a drop in en­roll­ment in Med­i­caid, for the first time since the 2008 to 2009 pe­riod. The two groups with the high­est in­creases in their unin­sured rates were His­pan­ics and nonci­t­i­zens.

The U.S. Cen­sus Bureau

re­port looked at data through 2018.

Ex­perts say the Trump ad­min­is­tra­tion’s changes to Oba­macare and new rules that say an im­mi­grant’s use or po­ten­tial use of pub­lic ser­vices could hurt their chances of get­ting le­gal sta­tus are pos­si­ble causes of the in­crease in the num­ber of unin­sured.

For David Balat, di­rec­tor of the Right to Health­care ini­tia­tive at the con­ser­va­tive­lean­ing Texas Pub­lic Pol­icy Foun­da­tion, there’s “noth­ing pos­i­tive” about the data, but it’s not shock­ing.

“With how ex­pen­sive health in­sur­ance has be­come, I’m not sur­prised to see more folks are opt­ing out of health care,” said Balat, a for­mer hos­pi­tal executive and Repub­li­can con­gres­sional can­di­date.

Losses in Texas

Texas has led the na­tion in hav­ing the largest unin­sured pop­u­la­tion in the country for about two decades, said Anne Dunkel­berg of the Cen­ter for Pub­lic Pol­icy Pri­or­i­ties.

The con­sec­u­tive two­year in­crease in the num­ber of unin­sured peo­ple in Texas comes af­ter three years of progress. In 2014, 2015 and 2016, Dunkel­berg said, Texas saw a drop in the num­ber of its unin­sured.

Pres­i­dent Don­ald Trump’s ad­min­is­tra­tion has made nu­mer­ous changes to the way the law works by, for ex­am­ple, re­duc­ing the en­roll­ment pe­riod, slash­ing the Af­ford­able Care Act’s ad­ver­tis­ing bud­get and ef­fec­tively elim­i­nat­ing the in­di­vid­ual man­date re­quir­ing every­one to have in­sur­ance or pay a fine.

These changes have likely have con­trib­uted to the in­creas­ing num­ber of unin­sured peo­ple, Dunkel­berg said. She added that Texas’ de­ci­sion to not ex­pand its Med­i­caid pro­gram when the ACA was passed in 2010 also kept many work­ing­age adults unin­sured.

“We have es­ti­mated that about 1.5 mil­lion Tex­ans would gain cov­er­age with a Med­i­caid ex­pan­sion. That’s not all of them, but that’s a good chunk,” Dunkel­berg said.

Cost not a fac­tor

At the na­tional level, the 0.7% en­roll­ment drop in Med­i­caid in­di­cates that costs are not to blame for the in­crease in the num­ber of unin­sured peo­ple, said Ed­win Park, a re­searcher at the Ge­orge­town Health Pol­icy In­sti­tute’s Cen­ter for Chil­dren and Fam­i­lies. This de­cline in pub­lic cov­er­age helped push the na­tion­wide per­cent­age of unin­sured chil­dren up to 5.5%, ac­cord­ing to the cen­sus.

“It’s not about af­ford­abil­ity, par­tic­u­larly since a lot of the unin­sured num­bers seem to be driven by Med­i­caid and CHIP losses and those can re­ally min­i­mize the out­of­pocket costs,” he said.

Park said the cen­sus data, which showed no change in the per­cent­age of pri­vate in­sur­ance cov­er­age, also coun­ters the Trump ad­min­is­tra­tion’s claims that the boom in the na­tional econ­omy caused peo­ple to leave safety­net health care pro­grams Med­i­caid and CHIP in 2018.

“It’s not what the Trump ad­min­is­tra­tion has ar­gued up to this point, which is that peo­ple aren’t en­rolling in Med­i­caid and CHIP be­cause of the econ­omy and peo­ple are get­ting em­ployer­spon­sored in­sur­ance for their new jobs,” Park said. “That’s not hap­pen­ing here. Oth­er­wise, we would have seen em­ployer­spon­sored in­sur­ance go up.”

Medi­care en­roll­ment in­creased by 0.4% due to the ag­ing pop­u­la­tion.

Park said the uptick of the unin­sured rate may be the re­sult of the Trump ad­min­is­tra­tion’s re­vamped def­i­ni­tion of the fed­eral “pub­lic charge” rule, a method used to de­ter­mine whether some­one hop­ing to im­mi­grate to the U.S. may be­come re­liant on pub­lic ser­vices.

A re­vi­sion to the rule, an­nounced last month, will change the way the fed­eral gov­ern­ment de­cides how to grant im­mi­gra­tion ben­e­fits. Use of some forms of Med­i­caid, hous­ing vouch­ers and sev­eral other pub­lic pro­grams may count against im­mi­grants seek­ing a green card or some im­mi­gra­tion ben­e­fit.

Chill­ing ef­fect

Con­fu­sion around how this rule will be ap­plied, Dunkel­berg said, has likely had a chill­ing ef­fect among im­mi­grants and their fam­i­lies, prompt­ing some im­mi­grant par­ents to re­move their chil­dren from Med­i­caid.

“These are the groups that are es­pe­cially af­fected by the chill­ing ef­fect of the Trump ad­min­is­tra­tion’s poli­cies, which have cre­ated the im­pres­sion that hav­ing U.S. cit­i­zen fam­ily mem­bers on pub­lic ben­e­fits could hurt an­other mem­ber’s chances of go­ing through the le­gal im­mi­gra­tion process,” Dunkel­berg said.

Dunkel­berg said that hav­ing a high unin­sured pop­u­la­tion pre­dates both the Af­ford­able Care Act and Trump’s changes to it.

But if Texas ac­tu­ally ex­panded its Med­i­caid pro­gram and ac­cepted some $8 to $10 bil­lion in fed­eral fund­ing to do so, many unin­sured work­ing­age adults might have cov­er­age and ac­tu­ally make eco­nomic gains, she added.

Law­mak­ers passed a bill tack­ling sur­prise med­i­cal bills last leg­isla­tive ses­sion but didn’t pass any bills that could have ad­dressed the state’s unin­sured rate.

Texas is also lead­ing a law­suit to re­peal Oba­macare, which is be­ing weighed by the U.S. Fifth Circuit Court of Ap­peals. A rul­ing in fa­vor of Texas would mostly im­pact states that have ex­panded Med­i­caid un­der the ACA, ac­cord­ing to Balat.

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