The bad news keeps coming for Texas’ uninsured rate.
Between 2016 and 2018, Texas tied for the second-highest jump in the rate of uninsured children among all 50 states, according to a study released Wednesday by Georgetown University's Center for Children and Families in Washington, D.C.
Texas' rate of uninsured children rose 1.4%, behind Tennessee with 1.5%, and tied with Georgia and Utah. Though the percentage increase may seem small, that means the number of uninsured children in Texas rose from 752,000 in 2016 to 873,000 in 2018, the report said.
Nationally, the number of uninsured children exceeded 4 million in 2018, the highest level since 2014, when major coverage expansion under the Affordable Care Act (ACA) of 2010 first took effect, says Joan Alker, executive director of the center and the report's lead author. The 5.2% uninsured rate for children in the U.S. also marked its highest point since 2014.
"Many of the gains that came about because of the ACA have now been reversed," she said on a conference call with reporters announcing the study.
Wednesday’s report follows Census Bureau data released last month that shows that Texas has continued to lead the nation in uninsured residents over the past two years. In 2018, a little more than 5 million Texans, or 17.7% of the population, lacked health insurance. That’s up slightly from 2017, when 4.8 million (17.3%) Texans were uninsured.
In addition, Texas continues to have the highest rate of uninsured children in the nation by far at 11.2%.
"No other state is even in double digits,” Ms. Alker said.
The Georgetown University report, which defined children as those 18 years old and younger, also showed that:
- Texas is now home to 21.5% of the nation's uninsured children, the highest percentage in the nation, way ahead of Florida at 8.4% and California at 7.4%.
- Texas had five of the 10 U.S. counties with the highest number of uninsured children in 2018:
- No. 1, Harris County, with 166,019 uninsured out of a total child population of 1.3 million;
- No. 2, Dallas County, with 110,627 uninsured out of 725,809;
- No. 5, Tarrant County, with 62,622 uninsured out of 579,751;
- No. 7, Hidalgo County, with 46,530 uninsured out of 297,617;and
- No. 8, Bexar County, with 44,137 uninsured out of 537,946.
- Nationally, the loss of coverage was most pronounced in children younger than 6 and those who live in low- and moderate-income families (those that earn between $29,435 and $53,325 per year for a family of three).
- African American children nationwide saw a slight improvement in their uninsured rate, which fell from 4.6% in 2017 to 4.4% in 2018.
- However, all other U.S. racial groups held even or saw uninsured rates increase, with the biggest increases coming among Native American/Alaska native children, whose rate rose from 12.9% to 13.2%; Hispanic children, whose rate rose 7.9% to 8.2%; and white children, whose rate rose 4.9% to 5.2%.
Recent efforts to discourage immigration have made it harder for Hispanic children to get insurance, the report said. For instance, a controversial change in the public charge rule, which the Texas Medical Association opposed, has caused immigrant parents to shy away from getting benefits for their citizen children.
However, the overall rise in the number of uninsured children stems from several causes, including recent federal policies designed to make access to health coverage more difficult; attempts to repeal the ACA and cut Medicaid; cuts to outreach funding; and an increase in administrative barriers to families enrolling or renewing Medicaid or Children's Health Insurance Program (CHIP) coverage, the report said.
For instance, Texas Medicaid requires families of children who are eligible for Medicaid to gather and submit increasing amounts of paperwork throughout the year to keep confirming their eligibility, says Adriana Kohler, senior health policy associate for the advocacy group Texans Care for Children, who also spoke on the conference call. This frequently trips up families and causes children to lose their coverage.
Fortunately, state leaders are now aware of this problem so there is hope to provide Medicaid coverage to more children, she says. However, the state still has a chronically high rate of uninsured children.
"[Lack of insurance] is a problem for children of all backgrounds in communities throughout the Lone Star State, with huge uninsured rates in communities from Amarillo to Brownsville, Odessa to Longview, and Houston to Dallas," Ms. Kohler said. "There isn't a community that is immune to this issue."
During the 2019 legislative session, TMA advocated vigorously for reforms to eliminate the burdensome red tape that contributes to children unnecessarily losing Medicaid. But the legislation died in the waning days of session. Reducing Texas’ uninsured rate remains a top priority for TMA, which will continue to push for common sense approaches to increasing availability of meaningful health insurance for working Texans.