Census report: Texas still has highest share without health coverage
by Robert T. Garrett
September 18, 2013
Source: Dallas Morning News, Dallasnews.com
AUSTIN - Texas is still the state with the highest share of residents lacking health insurance - 24.6 percent last year, according to a Census Bureau report released Tuesday.
Just over 6.4 million Texans were uninsured during all of 2012, up nearly 350,000 over the previous year.
In 2011, a slightly smaller share of Texans, 23.8 percent, lacked coverage.
California was the only state with more uninsured people than Texas last year, with just under 6.8 million. But its uninsured rate was 17.9 percent, nearly 7 percentage points lower. California had 890,000 uninsured children, compared with 1.1 million in Texas.
"Texas has often had the highest uninsured rate throughout the country," said bureau official David Johnson.
Texas fared slightly better in new findings about income and poverty.
Its poverty rate, 17 percent, was seventh-highest among the states in a three-year average best suited for such comparisons. Since 2010, median household income has averaged $50,591, placing Texas 26th among the states.
In health insurance, though, the state remains mired, even as the national picture brightened somewhat.
Last year, the bureau's survey found a significant, if small, decrease nationally in the rate of uninsured - to 15.4 percent, from 15.7 percent in 2011. Johnson said much of the improvement is because baby boomers have begun to turn 65 and qualify for Medicare. Some were previously jobless and lacked coverage.
Among children, the national rate fell to 8.9 percent. It was 9.4 percent a year earlier. Many analysts attributed that to provisions of the federal health care law that required states to keep the same eligibility rules and enrollment procedures for youngsters applying for Medicaid and the Children's Health Insurance Program.
As it does each fall, the Census Bureau released findings from its annual survey of about 100,000 households.
This year's release, though, comes just two weeks before uninsured Americans can begin shopping for private health plans in state insurance marketplaces that President Barack Obama's 2010 health law created.
The data rekindled arguments over what is the best way to drive down the uninsured rate among working-age adults - particularly those 19 to 44, who far exceed national averages for lacking coverage.
Analysts such as Anne Dunkelberg, associate director of the liberal-leaning Center for Public Policy Priorities in Austin, said Texas needs to pitch in and help the federal law work.
"We know what works best to reduce uninsured rates," she said.
In 1996, before the state created its version of the children's insurance program, 24.5 percent of Texans younger than 19 lacked health coverage, Dunkelberg said.
By last year, CHIP and the children's portion of Medicaid helped bring down the children's uninsured rate to 16.4 percent, she said.
Dunkelberg urged state leaders to expand Medicaid for working-age adults who are poor, so they can get at least some benefit from the federal law. So far, leaders have not budged.
On Oct. 1, though, people who are well above the poverty line will be able to get federal subsidies to buy coverage in the new Texas marketplace, Dunkelberg noted.
Free-market advocate Devon Herrick said Texas would instead do better to break from the pack.
He said Texas adults slightly above the poverty line - who would have been added to the Medicaid rolls if the state had bowed to Obamacare - will have better coverage buying in the online marketplace.
"Private doctors actually will see you and treat you," he said. Herrick, a senior fellow at the conservative-leaning National Center for Policy Analysis in Dallas, noted that state leaders have set very low reimbursements for doctors and hospitals under Medicaid.
For poor adults, the state would be more prudent to wait until 2017, Herrick said. That's when federal officials might consider a partial expansion of Medicaid.
"I would support... going to the Department of Health and Human Services and asking for a waiver to tailor a program that specifically meets their needs, rather than a one-size-fits-all," he said.
While federal officials may "play hardball" and refuse now, nearly half the states have resisted enlarging Medicaid. That should "soften their stance later," Herrick said.
On Monday, Gov. Rick Perry told state Medicaid managers to ask federal officials for a block grant that would allow Texas to ignore federal rules and design what he said would be a more financially sustainable approach. Texas has never formally made such a request. But it's almost certain to be rejected as long as Obama is president.