Improve Health Care Coverage for Low-Income Texans

The Affordable Care Act (ACA) created two coverage options for uninsured patients with incomes up to 400 percent of the federal poverty level (FPL). One choice, which the U.S. Supreme Court made optional for states, was expanding Medicaid eligibility to 138 percent of FPL ($16,104 for an individual or $32,913 for a family of four in 2014).[24] The other was the new health insurance marketplaces, where patients go to buy private insurance. Texas is one of 21 states that chose not to expand Medicaid eligibility in 2014. As a result, more than 1 million uninsured Texans, mostly low-income adults, are left in what’s called the “coverage gap,” which means they make too much money to qualify for Texas Medicaid but not enough to qualify for the marketplace premium tax credits. Few of these Texans have access to other affordable insurance options. Texas Medicaid eligibility for parents is about 20 percent of poverty — less than $4,000 per year.

 

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Most of these Texans work. In fact, 58 percent, more than 845,000, are currently working or have worked within the past year. Of the 42 percent who are not working, a majority (24 percent of Texans who could gain coverage under the coverage gap) are classified as “not in the workforce.” They include people with disabilities, college students, non-working spouses who care for children or a family member with a disability, and people who have left the workforce. The remaining 18 percent of Texans who could be helped are unemployed.[25] Although they work, few in the coverage gap have access to employer-sponsored coverage; if they do, they frequently forego coverage because of high costs.

Texas physicians want to ensure all Texans have access to coverage and, more important, have access to physicians and other health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance often results in delayed diagnoses and treatment of chronic diseases or injuries, needless suffering, and even death. 

That’s why TMA supports allowing state leaders to work with the Centers for Medicare & Medicaid Services (CMS) to develop a comprehensive solution that fits Texas’ unique health care needs. Several states have taken this step with some success, including Indiana, Arkansas, Iowa, Michigan, and Pennsylvania. (See adjacent chart.) TMA believes the Texas Legislature too can create an ingenious solution that works for the state and helps Texans in the coverage gap get affordable and timely care. Any Texas-style solution expanding access must:   

  • Draw down all available federal dollars to expand access to health care for poor Texans; 
  • Give Texas the flexibility to change the plan as our needs and circumstances change; 
  • Clear away Medicaid’s financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program; 
  • Relieve local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors; 
  • Provide Medicaid payments directly to physicians at least equal to those of Medicare payments; and 
  • Continue to improve due process of law for physicians and other providers in Texas as it relates to the Office of Inspector General.  
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Last Updated On

January 06, 2020

Originally Published On

October 17, 2014