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Texas (again) has the highest uninsured rate in the country

Gabriel C. Pérez

Texas leads the country in the share of residents without health insurance, according to figures released by the U.S. Census Bureau this month. Health care advocates say that underscores the need for the state to expand Medicaid.

The census showed 18% of Texans went without insurance last year. That number paints a familiar picture: Texas has had the highest proportion of uninsured residents in the U.S. for years.

Anne Dunkelberg, a policy analyst with the left-leaning nonprofit Every Texan, said the state also, again, leads the nation in the share of uninsured children — with more than double the national average.

"Texas has a hugely problematic uninsured rate," she said. "We ... have the worst uninsured rate for kids in the country, which is huge. The uninsured rate average for all 50 states is 5.4%, and here in Texas our uninsured rate for kids was 12%.”

Dunkelberg said the numbers were similar to the last estimate from the Census Bureau in 2019. She said federal protections that prevented clients from being removed from the Children's Health Insurance Program and Medicare helped forestall a larger increase of uninsured Texans.

Brian Sasser, chief communications officer with the Episcopal Health Foundation, said he worries those expiring protections may mean a higher uninsured rate next year.

"The bottom line is that these advantages have helped," he said. "They’ve made a dent in the uninsured rate in Texas, but we’re still by far the worst. It’s really not that close."

Oklahoma ranks second to last in the new census numbers, with 13% of its population uninsured compared to Texas' 18%. Texas is dead last in both insuring adults and children.

The numbers showed nearly 1 in 4 working Texans went without insurance last year. Sasser expressed concern that those Texans, who are between the ages of 18 and 64, may not make enough money to afford plans under the Affordable Care Act. They're also too old to qualify for the Children's Health Insurance Program and too young to qualify for Medicare.

Sasser said the "obvious solution" to get those folks insured is to expand Medicaid. His Episcopal Health Foundation released a study in 2020 with the Texas A&M Bush School of Government and Public Service showing that expansion could bring in $5.4 billion in federal dollars to insure Texans.

But GOP lawmakers have refused to expand the program, arguing it's mismanaged and that the state should provide an alternative. Bills calling for expansion didn't even get hearings in Texas House and Senate committees last legislative session.

"I think the argument has been made over and over again. It seems like the hang up [has] nothing to do with all the facts of the case," Sasser said. "The frustration is that there's a tool out there to help fix this issue, but it's not being used."

Sasser said the foundation's recent polling has shown nearly 70% of Texans support expanding Medicaid.

Dunkelberg also noted the lion's share of those working Texans without insurance are people of color.

"The fact that, of the uninsured and working poor in Texas, 75% of them are Texans of color suggests to us that we need to be paying more attention to making public policy choices," she said.

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Andrew Weber is a general assignment reporter for KUT, focusing on criminal justice, policing, courts and homelessness in Austin and Travis County. Got a tip? You can email him at Follow him on Twitter @England_Weber.
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