For a second consecutive year, more people in Texas were without health insurance in 2018 than any other state, according to U.S. Census Bureau figures released Tuesday.
Texas leads the nation in uninsured residents, both in terms of raw numbers and as a percentage of the population, according to the report. The state's uninsured rate was about twice that of the nation overall.
The number of uninsured Texans climbed for a second straight year in 2018, after four consecutive years of gains, according to census data. About 5 million Texans were uninsured for all of last year, according to Tuesday's report, or about 17.7% of the state's population. That's up from 4.8 million, or 17.3%, in 2017.
Of the 14 states that, like Texas, haven't expanded Medicaid under the Affordable Care Act, all but Wisconsin and Kansas had uninsured rates higher than the national average. Anne Dunkelberg, associate director of the Center for Public Priorities, an Austin-based progressive think tank, said the numbers should serve as a wake-up call for state leaders.
While many of the problems leading to Texas' high uninsured rate would need to be solved in Congress, others could be dealt with at the state level, Dunkelberg said.
According to figures from the Kaiser Family Foundation, about 1.4 million uninsured, non-elderly Texans would become eligible for coverage if the state expanded Medicaid under the Affordable Care Act. During the most recent legislative session, a proposed budget amendment that would have expanded Medicaid was defeated in the Texas House by an 80-66 vote.
Dunkelberg noted that a Medicaid expansion would cover about a third of the state's uninsured population, so Texas lawmakers could make a sizable dent in the problem with one major policy change.
"That's the biggest and most obvious thing," she said.
Dunkelberg also pointed to the Texas Legislature's failure to pass a number of other bills related to health insurance during the most recent session. One of those bills, House Bill 744, would have allowed low-income mothers to keep Medicaid coverage for 12 months after giving birth. That bill passed the House by an 87-43 vote but died in the Senate.
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The uptick in Texas mirrors a national trend. Nationwide, the uninsured rate rose between 2017 and 2018, climbing from 8.7% to 8.9%, according to the report. Last year marked the first time the national uninsured rate has climbed since 2010, the year the Affordable Care Act was signed into law.
Last year's uptick was largely driven by a shrinking share of the population that is enrolled in public health insurance programs, according to the report. The percentage of people who were enrolled in either Medicare or Medicaid dropped by 0.4 percentage points last year, while the percentage of people who were on private insurance remained essentially unchanged.
Dunkelberg said she also suspects the uptick in uninsured people both in Texas and nationwide is being driven in part by a chilling effect brought on by the Trump administration's policies and rhetoric surrounding immigration. She said a number of healthcare providers and food banks have told the policy center that fewer families in which some members are immigrants have been seeking their services. In many cases, immigrant parents have dropped benefits for their U.S. citizen children because they think, mistakenly, that accepting those benefits could hurt the parents' chances during the immigration process.
The figures released Tuesday didn't include data on uninsured children, but according to a report released in November by the Georgetown University Center for Children and Families, Texas led the nation in the rate of uninsured children. More than 20% of all uninsured children nationwide were in Texas, according to the report.