NCPA - National Center for Policy Analysis

Uninsured In Texas

August 29, 2000

Some 4.8 million Texas residents -- about one in every four -- are not covered by private health insurance or government health care programs, principally Medicaid and the Children's Health Insurance Program (CHIP).

But lack of insurance is not a barrier to health care. There are more than 40 federal health care programs for the uninsured in Texas. The largest single program spends more than $1.5 billion dollars a year -- the disproportionate share hospital (DSH) payment program, which compensates hospitals that serve indigent patients.

Furthermore, state law requires Texas counties to serve the indigent, which they do by forming hospital tax districts. Texas also requires nonprofit hospitals to provide indigent care equal to 5 percent of their revenue. In addition, state and local governments, charities and nonprofits provide health care.

  • According to a recent report by the Texas Comptroller, public and private organizations spend approximately $1,000 per uninsured individual per year, on the average, on charity care.
  • That equals $4,000 for a family of four -- an amount that would buy adequate private insurance in almost all Texas cities.
  • Although technically "uninsured," Texans without health insurance receive care worth almost two-thirds as much as Medicaid spends per recipient each year.

Nationally, public health programs have increased the taxpayers' burden without actually reducing the number of uninsured. For example, recent research by the Center for Studying Health System Change found that among children in families earning less than 200 percent of the poverty level -- the group targeted by CHIP -- Medicaid and other state coverage increased from 29 percent to 33 percent from 1996-97 to 1998-99.

Meanwhile, the rate of those with private insurance fell from 47 percent to 42 percent, leaving the percent uninsured virtually unchanged.

Source: Naomi Lopez Bauman (Pacific Research Institute) and Devon M. Herrick (research manager, NCPA), Brief Analysis No. 335, "Uninsured in the Lone Star State," August 29, 2000, National Center for Policy Analysis.

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