Parkland Hospital, where most uninsured Dallasites go to receive care. Photography by Leah Clausen

Health & Medicine

An Update on Dallas’ Bottom-of-the-Barrel Uninsured Rate

We are the worst. Like, literally the worst.

I’d like to point you to my colleague Will Maddox’s piece over on D CEO Healthcare. Every few months, a consumer-facing research website likes to go through Census data and make broad declarations about healthcare or finance or something else that the bureau tracks. This time, it’s WalletHub, and today’s is the uninsured rate. And Dallas’ rate of 24.42 percent ranked 539 out of 548 of American cities. That affects people of color far more than white residents: black people had an uninsured rate of 20 percent while Latinos were uninsured at a rate of almost 38 percent.

The national uninsured rate is 8.5 percent, while Texas’ is 17.7 percent. The state’s long been dubious when it comes to its uninsured rate. (I’ve been reporting that since the early days of 2015.) State leaders stubbornly refused to expand Medicaid through the Affordable Care Act, grouping it in with 14 other states who wouldn’t do so. Most of those states are our company at the bottom of the list. Our neighbor Oklahoma is No. 2.

There were problems with the expansion model, sure. Medicaid never paid doctors well, which has led many to stop accepting those patients. Hospital leaders have long maintained that the uninsured population aren’t going to primary care doctors, allowing their conditions to deteriorate until they need an emergency room. But financially, expanded Medicaid would’ve been something of a safety net for providers. As it stands, when this population gets sick, they show up at the hospital—the most expensive place to receive care. And the cost of that care either gets eaten by that hospital or, especially if they go to Parkland, it winds up being footed in part by the taxpayer. That’s not sustainable.

Dallas is the largest American city with the highest rate of uninsured residents, and, as Will notes, seven of the 10 most poorly insured cities in the nation are in Texas. We have work to do. It’s a reminder of the importance of getting an accurate, complete count during the 2020 Census. That’s how the feds dole out funding for healthcare to communities, including programs that help insure poor kids. If we undercount, we miss out on those dollars. And you can see how badly the region needs any help it can get.

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