Report Confirms Alarming Trend: Fewer Children Are Insured in Texas

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The Texas Legislature hasn't stepped in to help.
Texas has the highest rate of uninsured children in the nation and it has been getting worse at an alarming rate, according to a new report released Wednesday.

Researchers at Georgetown University's Health Policy Institute analyzed 2018 census data and found that the percentage of children with no healthcare coverage in Texas increased from 9.8% to 11.2% in just two years. That's nearly the biggest percentage-point jump among all states, tied with Georgia and Utah and trailing only Tennessee. 

"Things are bad in the South, but particularly bad in Texas," said Joan Alker, executive director of the institute and lead author of the report.

Overall, the report found, 4 million children were uninsured in 2018. That's a 10% increase from 2016, wiping out years of progress as the rate of uninsured children dropped during much of the last decade.

Over one-fifth of uninsured children live in Texas, the report found.

It confirms previous reports about the magnitude of the problem in Texas' major cities. A previous analysis of the data showed that the Dallas-Fort Worth area has the worst children's health insurance rate among major metropolitan areas. Five of the 10 counties in the nation with the most uninsured children are in Texas, according to the Georgetown report. Harris County is first, followed by Dallas County. In Dallas County, 15.2% of children are uninsured, according to the report.

Alker listed three factors contributing to the national rise in uninsured children. For one, Latino families are forgoing government benefits out of fear that it will affect their immigration status. Alker's research found a significant increase in the uninsured rate among Hispanic children. Researchers and advocacy groups have argued that a new "public charge" rule proposed by the Department of Homeland Security to limit admission to the United States would have a "chilling effect" on immigrants who might apply for government benefits on behalf of their children.

Second, many working families are unable to afford the additional cost of their employer's dependent health coverage. If an employer offers an affordable individual plan, families can be denied federal subsidies that would otherwise be available if they were unemployed, a problem known as the "family glitch." 

"It continues to be one of those things that Republicans rail against because they see it as a very heavy cost to the state." — state Rep. John Zerwas

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And finally, state administrators are using red tape to limit the number of participants in government insurance programs like Medicaid and CHIP, a federally-funded program that provides insurance to families with children.

Which of those factors most impacts Texas?

"Most all of them," Alker said.

Texas has long been resistant to federal encouragement to expand its public insurance programs. It was the last state to implement CHIP after it was created by Congress in 1997, and it is one of 14 states to refuse additional federal funds earmarked by the Affordable Care Act for the expansion of Medicaid eligibility.

"Really, what this comes down to is the state of Texas needs to put out a welcome mat for children," Alker said.

Instead, the state has done the opposite. The state already has some of the strictest eligibility requirements for families with children to enroll in government insurance programs. But in 2014, the state introduced more frequent income verification checks for families enrolled in Medicaid.

A report from the Center for Public Policy Priorities, an Austin-based research institute, found that 1 out of 10 families that lost coverage because of the checks had actually begun earning more income. Rather, a vast majority ran into paperwork errors or other procedural issues.

Texas Republicans have long argued that the cost is too high to expand insurance programs to more low-income families.

"It continues to be one of those things that Republicans rail against because they see it as a very heavy cost to the state," state Rep. John Zerwas, a Houston-area Republican, told the Texas Tribune.

But the rising number of uninsured costs Dallas homeowners regardless. Parkland Hospital, funded substantially by property taxes, must step in to provide free care to Dallas families that couldn't afford it otherwise.

A spokesperson for the hospital did not mince words in describing the implications of the rising numbers of uninsured children: "This harms kids’ health, costs taxpayers hundreds of millions of dollars and means that many Texas parents may be just one doctor visit away from medical indigence."

Alker has some recommendations for Texas state legislators. "They need to do more outreach and enrollment, they need to simplify the paperwork," she said.

"This is something that the country was actually making a lot of progress on. But we have to have a commitment. And that's what seems to be missing in Texas."