Facing the loss of crucial uncompensated care funding, the Texas Medical Association is helping the state craft a request to the Biden administration to reinstate an extension on Texas’ Medicaid 1115 Transformation Waiver.
Texas has the highest percentage and number of people without health insurance in the United States, which could cause long-term damage to the state’s economy, says a study released this week by the Texas Alliance for Health Care.
Texas is the uninsured capital of the United States. More than 4.3 million Texans - including 623,000 children - lack health insurance. Texas' uninsurance rates, 1.75 times the national average, create significant problems in the financing and delivery of health care to all Texans. Those who lack insurance coverage typically enjoy far-worse health status than their insured counterparts.
View 2019 Health Insurance Stats
The uninsured are a diverse group that includes people who cannot afford private health insurance; who work in small businesses that do not offer insurance; who simply choose not to purchase health insurance, even though they can afford it; who are eligible-but not enrolled-in government sponsored programs such as Medicaid or the Children's Health Insurance Plan (CHIP); and recent immigrants.
According to a summary of national data by the Congressional Budget Office (CBO), groups with a high likelihood of lacking health insurance include:
Texas workers are less likely to have employment-based health insurance coverage than those in other states. 50 percent of all companies in the US offer health coverage for their employees.The 2017 stats show the U.S. average for employment based health insurance is 46.8, compared to 49.4% in Texas. The Kaiser Family Foundation reports 89 percent of the uninsured in Texas have at least one family member who works either full-time or part-time in 2017.
The average annual premiums for employer-sponsored health insurance in 2017 was $6,715 for single coverage and $19,565 for family coverage. The average annual worker contribution in 2017 was $1,427 for single coverage and $5,431 for family coverage. For family coverage, the worker contribution increased 204% ($1,787 to $5,431) from 2001 to 2017. Workers in small firms (3–199 workers) have lower average contributions for single coverage than workers in larger firms ($1,035 vs. $1,330), but contribute significantly more for family coverage ($7,805 vs. $5,271).
People making moderate and low wages are much less likely to have job-based health insurance coverage than those earning more. In Texas, an average of 47 percent of uninsured adults had incomes below 100 percent of the federal poverty in 2014.
The uninsured are up to four times less likely to have a regular source of health care and are more likely to die from health-related problems. They are much less likely to receive needed medical care, even for symptoms that can have serious health consequences if not treated. About one in six Texans lives at or below the poverty level; for children, it's nearly one in five. Extending health coverage to the uninsured could improve their overall health by 7 to 8 percent. Lack of insurance increases their dependence on Medicaid.
Financial Impact of Texas' Uninsured Crisis
Lacking a medical home, uninsured people tend to look for health care in the emergency room, the most expensive setting they could possibly choose. Nationally, patients made over 146 million emergency room visits in 2016. The U.S. Centers for Disease Control and Prevention says that about 4.3 percent (6.3 million) of ER visits are for non-urgent issues that could be treated in a doctor's office or clinic.
Texas' share of uninsured children is higher than the U.S. average. In 2017, almost 11 percent of Texas children were uninsured, compared to 5 percent nationally.
CHIP Re-enrollment Requirement in Texas
More than half of the uninsured children are eligible for public programs, but are not enrolled. In Texas, this could be a result of the SCHIP program requirement to re-enroll every six months or the lack of parent coverage in the program.
Health Insurance Coverage in Relation to Race and Ethnicity
Disparities based on race and ethnicity also exist. People of racial and ethnic minorities are more likely to go without health insurance than whites. In Texas, 29 percent of Hispanics/Latinos were uninsured, compared to 12 percent of whites.
Uninsured Among Non-Citizens in Texas
In Texas, non-citizens are almost three times as likely to be uninsured as native U.S. citizens. Immigrants, many of whom are Hispanics, often work in economic sectors less likely to offer health insurance than others, such as construction.
Foreign Born Residents and Non Citizens in Relation to Uninsured Population
Non-citizens are almost three times as likely to be uninsured as are native US citizens. Over 45 percent of undocumented immigrants went without insurance in 2018, compared to 10 percent of US native citizens and 23 percent of lawfully documented immigrants. In Texas, over 30 percent of the uninsured are non-citizens.
Another factor that increases the likelihood of being uninsured is the level of educational attainment. Texas has lower rates of high school and college graduates than the national average (Murdoch, 2003). There is a strong correlation between education and income as well as between income and insurance.
Those who have more education on average earn more money and have insurance coverage.
In 2015 estimates from the America Community Survey, Texas had a lower percentage of high school (82.4 percent vs. 87.1 percent) and college graduates (28.4 percent vs. 30.6 percent) in the 25-and-older-population compared to the national average. In addition, over half of all Hispanics in Texas over the age of 25 did not have a high school diploma (Murdock et al., 2003). This is significantly higher than other ethnic populations in the state.
Estimates of the uninsured for counties in Texas, adults 18-64, 2017
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In Texas, 35 of the state's 254 counties account for 70 percent of the uninsured. A common misconception is that the uninsured are concentrated in the counties along the Texas - Mexico border. Texas’ 28 largest cities, including Houston, Dallas, San Antonio, Austin, Ft. Worth and El Paso, had a greater percentage of their population without insurance than the collective United States.