Provide Meaningful Health Care Coverage for Uninsured Texans

Background: More than 5.2 million Texans – nearly 20% of our state’s population[1] – lack health insurance, the highest number in the country. Each day more Texans join their ranks. From 2018 to 2019, the uninsured number in Texas grew by 230,000. The COVID-19 pandemic has only made it worse as more Texans lose their jobs and health care coverage. While estimates vary, 659,000 workers lost their coverage this year, resulting in nearly one in three adults  under age 65 without coverage. With the current trend, Texas will have more uninsured people than the combined populations of Oklahoma and New Mexico.

When people are uninsured it harms our economy. States with high numbers of uninsured residents have experienced more rural hospital closures, taking out the economic lifeblood of many small communities. Conversely, having coverage helps workers, get and keep jobs [2], – or start a small business, [3] the engine of Texas’ economy. It also reduces employee absenteeism, boosting employer productivity.

While coverage does not guarantee access to care, it’s essential to promoting timely entry into the health care system when Texans need care. Without health insurance, people put off treatment, suffer worse health outcomes, require more expensive care, and have shorter life spans. Yet, when more people have health insurance, they can receive the care they need, when they need it. Moreover, a recent study [4]found Texas could achieve a net savings of $110 million (general revenue) over the next biennium by providing meaningful coverage to the uninsured.

Texas can no longer ignore the human, social, and economic impact of having more than 20% of our people uninsured. Health care coverage matters, resulting in healthier constituents and more economically prosperous communities.[5]

Using federal Medicaid dollars [6] together with state and federal policy solutions, Texas can substantially reduce its number of uninsured. Thirty-nine states (including Washington, D.C.) have taken steps to improve health care coverage and their economy. Texas can too.

TMA's Legislative Recommendations

  • Develop a meaningful, statewide health care coverage initiative using federal dollars to:
    • Extend meaningful coverage to low-income uninsured working-age adults, and
    • Establish a state-administered reinsurance program to reduce premiums for people enrolled in marketplace plans.
  • Provide 12-months' comprehensive coverage for women who lose Medicaid 60 days postpartum.
  • Establish 12-months' continuous coverage for children enrolled in Medicaid, the same benefit given to children enrolled in the Children’s Health Insurance Program.

 [1Health Insurance Coverage in the United States: 2019, Sept. 15, 2020

 [2The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review, KFF, March 17, 2020 

 [3Medicaid and the Supply of Entrepreneurs: Evidence from the Affordable Care Act, Kyung Min Lee, Oct. 2018 

[4State Budget Impact of Providing Health Insurance to Low-Income Adults with 90%, prepared by Randy Fritz, John R. Pitts and John R. Pitts, Jr. for the Episcopal Health Foundation, Sept. 14, 2020 

 [5] The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review, KFF, March 17, 2020 

 [6How Many Uninsured Adults Could Be Reached If All States Expanded Medicaid?, KFF, June 25, 2020 

Last Updated On

January 20, 2021

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Insurance | Medicaid | Texas legislation