Number of Texans without health insurance drops under Affordable Care Act, study shows

The percentage of Texans without health insurance dropped after the first enrollment period of the Affordable Care Act (ACA), according to a report released today by the Episcopal Health Foundation and Rice University's Baker Institute for Public Policy.

The report found that since the opening of the ACA's Health Insurance Marketplace, the percentage of uninsured adult Texans dropped by a little more than 2 percent. The report estimates 378,000 more Texans had health insurance in June 2014 than in September 2013.

The small gain in Texans with health insurance was similar to gains in other states that did not expand Medicaid coverage. However, states that expanded Medicaid experienced the largest reductions in uninsured adults – 6 percent compared with the 2 percent in Texas.

"While the insurance gains in Texas demonstrate that people are enrolling in coverage, Texas is also the state with the highest percentage of uninsured adults in the nation," said Elena Marks, CEO of the Episcopal Health Foundation and a health policy scholar at the Baker Institute. "That means Texas had the farthest to go in reducing the uninsured rate."

Even with nearly 400,000 newly uninsured adults, the report estimates Texas has now surpassed California to become the state with the highest number of uninsured residents.

The report found the majority of the remaining uninsured adult Texans are Hispanic and low-income. Half of those uninsured are employed.

"The way to make the biggest improvement in covering the uninsured population in Texas is through Medicaid expansion," said Vivian Ho, the chair in health economics at Rice's Baker Institute, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. "In states like Texas that have not expanded Medicaid, the opportunity to reduce the percent of uninsured adults through the ACA without Medicaid expansion is limited."

An estimated 20 percent of uninsured adult Texans are undocumented and unable to take advantage of Medicaid or Marketplace plans.

The report is the seventh in a series on the implementation of the ACA in Texas co-authored by Marks and Ho.

The Health Reform Monitoring Survey (HRMS)-Texas report is based on a national project that provides timely information on implementation issues under the ACA and changes in health insurance coverage and related health outcomes. The Episcopal Health Foundation and Baker Institute are partnering to fund and report on key factors about Texans obtained from an expanded representative sample of Texas residents. Today's report contains responses from 1,595 Texans in September 2013 and 1,538 in March 2014.