For the first time in years, the uninsured rate in Texas is starting to climb again. After the Affordable Care Act went into effect in 2014, the state’s uninsured rate dropped from 22 percent to about 16 percent in 2016. However, that trend has started to move in another direction.
According to the latest figures from the U.S. Census Bureau, though, in 2017 the rate climbed back up to 17 percent.
Anne Dunkelberg, a policy analyst at the Center for Public Policy Priorities, says Texas has the biggest number and the highest percentage of uninsured people.
Texas and 14 other states had higher uninsured rates in 2017, according to the federal survey, 300,000 fewer people in Texas had health insurance in 2016 compared to 2017. For perspective, 1.2 million Texans signed up for health insurance immediately following the passage of the Affordable Care Act.
But Dunkelberg says two big factors are driving uninsured rates up.
1. Texas Didn’t Expand Medicaid
Texas is among 17 states that have opted out of Medicaid expansion under the Affordable Care Act, also known as Obamacare. Dunkelberg said that's the main reason the rate and number of uninsured Texans is trending upward.
"If you don’t have Medicaid expansion, you literally have no affordable insurance program for working people who are below the poverty line," she said. "In Texas that probably accounts for about a third of our uninsured."
2. The Trump Administration
Since taking office, President Donald Trump and his administration have been working to weaken the health care law.
During the last enrollment period for insurance marketplace created by Obamacare, the administration cut funding for navigators who help people sign up for insurance. It also cut funding for marketing and outreach, and it cut the time period for enrolling in half. Dunkelberg said all of those decisions made it less likely that people would even know when the enrollment period was – and it made it harder for people to sign up if they did.
The administration also stopped giving payments to insurance companies. Dunkelberg said those payments were created to give discounts on premiums and deductibles for families that made too much money to qualify for insurance subsidies. That decision, she says, put those particular families and individuals in a tough spot.
"They ended up looking at higher premiums and bigger deductibles," Dunkelberg said, "which obviously drives people along the margin of being able to afford [insurance] to drop their coverage."