Texas Still Lagging in Health Coverage

by Mitchell Schnurman

Source: The Dallas Morning News

Texas has contradictions. It often leads the nation in job growth, exports, corporate relocations and business climate. But on health care, it remains a laggard. Texas ranks No. 40 among states, and Dallas is 264th among metros, according to a health scorecard by the Commonwealth Fund. In smoking and suicide, Texas is among the best. But for access and affordability, it's the worst. On prevention and treatment, it's next to last. About 5 million Texans don't have health insurance. And in primary care docs per capita, Texas ranks 47th.

The Texas gap

Texas' uninsured rate has fallen since the Affordable Care Act passed in 2010, but opportunities are being missed. Over 2 million eligible for coverage haven't enrolled, even though most on HealthCare.gov get subsidies. Another 1.3 million Texans would be covered by expanding Medicaid, which lawmakers have refused to do.

How Texans get coverage

While Obamacare makes headlines, most people don't buy insurance on the individual market. Employer plans cover almost half of Americans and slightly less in Texas. And in this state, where leaders often slam Washington, over 1 in 3 residents gets insurance through a government program.

In Texas, the loss leader Texas insurers suffered deep losses in the first year of HealthCare.gov, underscoring the state's challenges:

• pent-up demand for health service;

• a shortage of young, healthy enrollees;

• and high costs for doctors and hospitals, especially in Dallas. Blue Cross Blue

  Shield of Texas lost far more than any insurer on the exchange.

The bottom line

“Everybody expected 2014 to be a really bad year [for HealthCare.gov] because of pent-up medical needs. The problem has been getting healthy people in. My hope is that this is a banner year for enrollment so healthy people balance out the pool and stabilize the market.”

Sabrina Corlette, project director, Georgetown University's Center on Health Insurance Reforms

“I don't see how the exchanges can be sustainable. I also don't see how an influx of healthy enrollees will be sufficient to stabilize the risk pools. It's not realistic to expect millions of people to pay high premiums year after year while all their day-to-day medical spending is paid out of pocket.”

Devon Herrick, senior fellow, National Center for Policy Analysis

“Texas' failings are no accident. Leaders fought Obamacare, rejected Medicaid expansion and passed on creating a state exchange. Now the Texas market looks shaky and premiums are rising. But California is making health reform work. Surely we can do better. Do we want to?”

Mitchell Schnurman, Business columnist, The Dallas Morning News