After four straight years of Affordable Care Act-inspired gains, Texas' uninsured rate for adults took a step back in 2017, according to newly released numbers from the U.S. Census Bureau. About 4.8 million Texas adults, 17.3 percent of the population, do not have health insurance, up from 4.5 million and 16.6 percent in 2016.
As a result of the increase, Texas continues to have both the highest number and greatest percentage of uninsured adults among the populations of any of the 50 states and the District of Columbia.
The bad news, according to analysts with the Center for Public Policy Priorities, an Austin-based independent public policy organization, comes down to two factors: Texas' continued refusal to take federal cash to expand Medicaid for low-income residents, and changes made by the Trump administration to the way federal subsidies are promoted and handed out.
"There are two kind of big buckets of things that we know that helped to drag us down and are helping to keep us at the end among states. One of them is the fact that Texas is one of, essentially, 16 states that haven't expanded Medicaid for adults, as is funded under the Affordable Care Act," Anne Dunkleberg, the program director for CPPP's Health and Wellness team, said during a press conference. "That represents a loss of about $10 billion per year in federal funding for Texas that we could be getting, and we estimate that somewhere in the area of 1.5 million adults in Texas might gain coverage if we had that. The other states whose uninsured rate got worse this year, the majority of them, the substantial majority, haven't expanded Medicaid."
In states that have expanded Medicaid, those who lost coverage for other reasons, like losing a job, could be added to the Medicaid rolls. In Texas, they just don't have insurance anymore.
President Donald Trump's health care policies have also hurt middle-income Texans.
"There are people above the poverty line who are uninsured in Texas, too. They've been hit by changes that mostly came out of our federal administration. They did things like gutting outreach, gutting marketing, taking away all different kinds of assistance that was able to help people enroll. They shortened the enrollment period by half," Dunkleberg said.
The Trump administration also has taken away subsidies that helped those with ACA marketplace plans pay their co-pays and deductibles. With those subsidies gone, co-pays, deductibles and premiums have all gone up, according to Dunkleberg, making purchasing insurance unfeasible for some Texans.
"If you're a family of low to moderate income, you suddenly might find yourself without any sort of subsidy and not able to afford the kind of product that's on the market," she said.
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Texas state Rep. Chris Turner, the chairman of the Texas House of Representatives' Democratic Caucus, accused the White House of trying to sabotage Texans' health care.
“Under President Trump, we are going in the wrong direction and Texans are suffering. Every man, woman and child in Texas should have access to quality, affordable health care. Instead, we’ve seen purposeful efforts by the White House to wreck our health care system, and, sadly, these are the results," Turner said. “I know I join all my colleagues in the House Democratic Caucus remain committed to do everything we can to find legislative solutions here at home that will make health care affordable for all Texans.”
As Turner and his Democratic colleagues scramble to insure those who are losing coverage, Texas Republicans want to do just the opposite.
Texas Attorney General Ken Paxton continues to front the fight to end the ACA once and for all. Last week in Fort Worth, lawyers representing the attorney general argued for the law's repeal in federal court. Even if they are unsuccessful in killing President Barack Obama's signature achievement entirely, Paxton and the coalition of 20 states he represents have asked that insurers in their states be let out of Obamacare's most popular provision, which requires that insurers provide coverage to those with preexisting health conditions.