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Texas’ Uninsured Problem Is About to Get Worse

The end of the public health emergency could spell trouble for those who have qualified for Medicaid coverage during the pandemic.
Courtesy: iStock

The end of the national public emergency may bring about a crisis of a different kind: a jump in Texas’ uninsured population.

During the pandemic, 1.3 million Texans received health insurance through Medicaid because of additional federal funding during the pandemic. The 6.4 percent funding increase was meant to keep everyone who was on Medicaid at the beginning of the pandemic on the rolls.

There are several ways to qualify for Medicaid, but the most common way is to be low-income. But Texas’ Medicaid criteria are such that if one has a full-time job, they are likely to make too much money to qualify. When not in a public health emergency, the registry of those receiving Medicaid is regularly checked to ensure that everyone receiving coverage qualifies. So if a child ages out or an individual is making more money, they lose their insurance.

Over the last couple of years, no one has been taken off the Medicaid rolls, but as people apply and qualify, many more have been added. In March 2020, the federal government extended the public health emergency and allowed millions of Americans to receive Medicaid coverage, coronavirus testing, and telehealth services. The public health emergency was most recently extended to mid-July amid an increase in COVID-19 cases around the country.

But if the public health emergency is allowed to end next month, more than a million Texans could be in jeopardy of losing their health coverage. Texas is already the worst state in the nation for its uninsured rate and is just one of 12 states that have yet to expand Medicaid and accept federal funding to provide health insurance to low-income Texans. However, many states with similar political leanings have found a way to expand Medicaid in recent years, including Texas’ neighbors Arkansas, Louisiana, and Oklahoma.

Research says that expanding Medicaid would save the state money by allowing Texans to address their health issues before they become more expensive and get treated in the hospital. The economic analysts at the Waco-based Perryman Group found that every $1 spent by the state of Texas to expand Medicaid coverage under the Affordable Care Act (ACA) would provide a $1.29 return in state government revenue over the first 10 years.

Providing health coverage and access to primary care makes fiscal sense, but if people are kicked off the Medicaid rolls who have been receiving healthcare for the last two years, their treatment could be interrupted. That would signal disastrous consequences for the health and finances of the state.

“Many of those people are going to be in the middle of their treatment, and they may not get their treatment, or they may end up in the emergency room,” says Steve Love, CEO and President of the DFW Hospital Council.

Other states have found bipartisan solutions to expand coverage and accept federal funding, but the issue has been a political football in Texas, with resistance to what is considered government overreach and unfounded worries about the cost of expanding Medicaid.

Dallas state Sen. Nathan Johnson presented a plan in the last legislative session to expand coverage called Live Well Texas, targeting those who make too much to qualify for Medicaid but don’t get insurance through their employer. This population usually doesn’t make enough to afford insurance on the Affordable Care Act marketplace, leaving them in the lurch.

“It has proven to increase not just public health but family financial stability,” Johnson said in a press conference about the plan last year. “And that bleeds over into public education, and it bleeds over into racial equity, it bleeds over into job creation and economic productivity. It has been a big win for the nation, and we want to take part in that.”

Love thinks the public health emergency will extend until after the election in November, but, as of now, Texas is just weeks away from a significant jump in its uninsured population. He is hoping to address the issue in next year’s legislative session, just as he has hoped since the Affordable Care Act was passed in 2010. “We’re going to continue to advocate during the upcoming session, and we’re focusing on the economic impact.”


Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…

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