A report released by Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation (EHF) has revealed that since enrollment began in the Affordable Care Act (ACA) in September 2013, the adult uninsured rate in the United States fell by 41%. Researchers found Texas' uninsured rate dropped just 21% during the same time.
Elena Marks, president and CEO of the EHF and a nonresident health policy fellow at the Baker Institute, said, "The good news is that Texans, like all Americans, saw meaningful drops in the rates of uninsured since the ACA began. However, Texas still has the most uninsured adults in the nation, and Texans with the lowest incomes continue to get health-insurance coverage at a rate far below anyone else."
‘Americans have seen meaningful drops in the rates of uninsured since the Affordable Care Act began in September 2013.’
The report found that the uninsured rate among low-income adults in Texas dropped 15% - the smallest decline of any group in the state. Nearly 50% of Texans with household incomes below $27,000 a year remain uninsured. Federal subsidies aimed at helping people purchase ACA Marketplace health-insurance plans are not available to these low-income Texans.
Vivian Ho, the chair in health economics at Rice's Baker Institute and director of the institute's Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine, said, "The ACA's plan for covering the poorest Americans was through Medicaid expansion. Because Texas opted not to expand Medicaid, around 1 million Texans are in a coverage gap without access to affordable health insurance. Unless the state expands Medicaid or comes up with an alternative system of coverage for those with lowest incomes, they will remain uninsured."
From 2013 to 2015, researchers found that the uninsured rate of all adults across Texas dropped from 24% to 19%. Each demographic population group experienced improvement in health-insurance coverage.
Marks said, "This is still an important development for Texas. The state has had a stubbornly high rate of uninsured residents for many years. Hispanics in Texas had the highest uninsured rate in Texas, but Hispanics are now also seeing the greatest gains in health-insurance coverage."
The report found the rate of uninsured Hispanics decreased from 39% in 2013 to 29 percent in 2015. The large decrease among Hispanics was slightly more than blacks, and almost twice as much as whites in Texas.
Nationwide, adults experienced a larger decrease in the percentage of uninsured than Texas, especially among those with the lowest incomes. The uninsured rate of adults with household incomes below $27,000 dropped 41% across the US, compared with the 15% decrease in Texas.
The report is the 16th in a series on the implementation of the ACA in Texas co-authored by Marks and Ho. The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 years that began in 2013.
Ho and Mark's report is a summary of data extracted from the HRMS surveys in Texas administered between September 2013 and September 2015.
The HRMS is designed to provide timely information on implementation issues under the ACA and to document changes in health-insurance coverage and related health outcomes. The Baker Institute and the Episcopal Health Foundation are partnering to fund and report on key factors about Texans obtained from an expanded, representative sample of Texas residents (HRMS-Texas).
The HRMS was developed by the Urban Institute, conducted by GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.