More Texans lose health insurance
New report says that state’s uninsured rate highest in country
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.
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.