More than 5 million Texans didn’t have health insurance in 2018, according to figures released today from the U.S. Census Bureau. The year before, about 4.8 million Texans lacked coverage.
The federal agency reports the state still has both the highest number of people without insurance and highest percentage of uninsured people in the country.
Under the Trump administration, Texas’ uninsured rate has ticked up every year. This follows years of progress. After Obamacare went into effect, the rate had been slowly improving to a low of 16% in 2016.
In 2018, though, that rate jumped up slightly to 17.7%. The previous year, the rate was slightly smaller at 17.3%. According to the Census Bureau, about 186,000 fewer Texans had health insurance between those years.
Anne Dunkelberg, program director for the Center for Public Policy Priorities’ health and wellness team, said it's not surprising that the state’s insurance rate got worse last year.
“We had a heads up that a second year of decline was likely,” she said. “We are sorry to see it, though.”
Dunkelberg said a mix of Trump administration policies and inaction from the state Legislature has led to a decrease in coverage. In particular, the state has refused to expand Medicaid to more low-income people through the Affordable Care Act. Texas is one of only 14 states that has not expanded the program.
According to the Census Bureau, “the uninsured rate in states that expanded Medicaid eligibility prior to January 1, 2018, was lower than in states that did not expand eligibility.”
The agency found that among states that did expand Medicaid, the uninsured rate in 2018 was 6.6% – that’s compared with 12.4% in states that did not expand coverage.
“Many Medicaid expansion states had uninsured rates lower than the national average, while many nonexpansion states had uninsured rates above the national average,” the report noted.
The Trump administration has slashed funding for key parts of the health care law, including outreach and assistance services for people buying insurance plans from Obamacare's online marketplace.
The administration’s cuts to subsidies for insurance companies, which are aimed at offsetting out-of-pocket costs for consumers, has also created a dip in Texans buying insurance off the marketplace, Dunkelberg said.
“In order to regain ground and get back to where we were when we had three consecutive years of record-breaking improvements in our uninsured rate,” she said, “it’s going to take not only a reversal of those policies, but some real proactive steps.”
Advocates in Texas have been sounding the alarm about the state's uninsured rate, but state lawmakers largely have not addressed the issue. In fact, during this year's session, they didn't pass any legislation aimed at lowering the rate, including a bill that could have prevented a lot of children from getting kicked off Medicaid every month due to paperwork issues.
Lawmakers also failed to pass a bill that would have expanded Medicaid coverage to women who recently gave birth. In Texas, women lose coverage two months after having a baby. House Bill 744 would have covered them for a full year – something highly recommended by a task force working to curb maternal deaths.
“We are hopeful that a second year of declining uninsured rates will get the attention of our legislature,” Dunkelberg said, "and we can make addressing coverage a major issue for the upcoming 2021 session."