About 5 million Texans, or 16.4% of the state’s population, lacked health insurance in 2023, according to U.S. Census Bureau data. Texas’ uninsured rate was higher than any other state, more than double the national rate of 7.9%.
“Texas leads the nation in many positive ways, but this is one thing we don’t want to lead the nation in,” said Annie Spielman, executive director of Texans for Affordable Health Care. said.
Advocates are calling on the Texas Legislature to cut regulations that have contributed to soaring health care costs in recent years. Expanding Medicaid eligibility and ensuring Texans know when they qualify for free or subsidized coverage would also help close the gap, experts say.
What you need to know
Health insurance premiums in Texas have increased more than 5% annually for three consecutive years, according to the Texas Association of Health Plans, a trade group that represents insurance companies.
“In recent years, Congress has added more requirements, so-called mandates, to health insurance that go beyond the requirements of the Affordable Care Act and the federal requirements,” Blake said. Mr. Hutson is the director of communications for the Texas Association of Health Plans. “It’s like dying from 1,000 cuts. … Employers who provide the majority of insurance in the state … will only face higher and higher costs.”
The Affordable Care Act, enacted in 2010, is a federal law designed to make health insurance available to more people through subsidies. Although states can create additional rules, the ACA sets consumer protection standards for health insurance.
Texas has the third-highest number of health care mandates in the nation, according to Texans for Affordable Healthcare. Recent state orders limit the types of health insurance small businesses can offer and prohibit certain insurance companies from directing patients to things like mail-order pharmacies.
“I think we need to take a hard look at everything that we’ve done that the government has gotten in the way of, that has stifled competition. Isn’t that an oversight?”Bob Hall Sen. (R-Edgewood) said this during a May 14 hearing of the Texas Senate Health and Human Services Committee. “I think we can think more about what we can do to solve this problem and encourage free markets without getting in the way.”
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To promote affordability, the Association of Texans for Affordable Care and the Texas Association of Health Plans will enable employers to offer a broader range of health insurance plans and create transparent assessments of costs for businesses and individuals. It’s asking lawmakers to halt any new mandates until a process is established.
“The market segment most pressured by high healthcare costs is actually small and medium-sized businesses,” Hutson said. “In fact, the state has more health insurance than any other state, but it tends to be very expensive and doesn’t offer many options for small employers. So what Congress really needs to do is , to focus on how to make insurance more affordable for small businesses.”
About 68% of Texas’ 3.2 million small businesses do not offer health insurance to their employees, according to Texas Mutual’s small business insurance company Texicare.
About half of Texans have health insurance provided by their employer. On average, Texas families pay more than $7,500 a year in employer-sponsored insurance premiums, while employers pay $15,000 per employee, according to the nonpartisan policy group Texas 2036. are.
At a May 14 hearing, senators said a lack of transparency is contributing to higher health insurance premiums. Sen. Charles Perry (R-Lubbock) said providing people with the true cost of medical services — “needles, doctors, electricity, beds” — could lead to lower premiums.
“We could be really honest about what things like insurance premiums can and should be. That would probably increase people’s ability and affordability to pay.” Perry said. “It’s really frustrating to talk about the cost of health insurance when it’s made up of things that don’t reflect reality. … Insurance companies have no incentive to pay less, and today’s Healthcare delivery systems require a lack of transparency in order to function.”
The Senate Health and Human Services Committee said in a Dec. 10 report that lawmakers will consider ways to increase “innovative and alternative” health insurance options and require insurers to increase prices to help people buy insurance. He said that the government should consider requesting that the information be made public.
“We need to make options and information for individual choices more accessible to the average person in Texas, so they know what they’re doing. “We will be able to understand what the costs are and actually see the actual costs,” Sen said. Palm Valley Democrat Morgan LaMantia said May 14.
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Texas is one of 10 states that has not expanded Medicaid, a state and federally funded program that provides health insurance to certain low-income people. Texans can qualify for Medicaid based on a combination of factors, including income, household size, pregnancy or disability, and age. In states that expand Medicaid, residents can qualify based solely on income, the federal government says.
According to Texas 2036, approximately 750,000 Texans are in the “coverage gap,” meaning they earn too much to qualify for Medicaid and receive subsidies through the federal health insurance market. This means that your income is too low to qualify. This is because the Affordable Care Act directed states to expand Medicaid, but the U.S. Supreme Court ruled in 2012 that states could decide for themselves.
Several Democratic lawmakers have introduced bills to expand Medicaid in Texas. The Medicaid expansion would cover Texans with incomes up to 138% of the federal poverty line, or about $38,300 for a family of four.
Expanding Medicaid would cost the state about $700 million a year, said Eva Deluna Castro, a budget analyst in the office of U.S. Rep. Donna Howard, D-Austin. Texas will also receive about $7 billion in federal funds, according to Deluna Castro’s estimates.
put into perspective
Comprehensive health insurance, including Medicaid, improves access to health care, said Alec Mendoza, senior health insurance associate at policy nonprofit Texans Care for Children.
“Individuals who are uninsured typically face longer wait times for medical care, worse health outcomes, and increased costs to their families and taxpayers,” Mendoza said. “A lot of times, (uninsured) families wait until their child has an emergency…and end up going to the hospital, but then our hospital doesn’t cover them because the children are uninsured. Without this, treatment costs will be high.”
Texans without health insurance can visit Federally Qualified Health Centers (FQHCs), which provide medical care regardless of insurance coverage or the patient’s ability to pay. According to the Texas Association of Community Health Centers, there are 75 FQHCs in 127 counties in Texas. These centers may provide medical, dental, and behavioral health care. Pharmacy services. We also provide support to patients.
TACHC says health centers provide care to underserved populations and can help patients avoid costly emergency room visits.
But FQHCs and other charities can’t always keep up with medical demand, Mendoza said.
“Care is unavailable in many counties, especially rural counties, and many services such as cancer treatment, children’s glasses, chronic disease support, and specialty care are only available to Texans with insurance. “There are a lot of cases,” Mendoza said. “That means valuable services that families across the state need are actually not being delivered in many areas.”
