Census Bureau: Texas Still Tops Uninsured Ranks

Texas still has the highest rate of uninsured in the nation — one in four Texans did not have health insurance in 2011, according to data the U.S. Census Bureau released Thursday.

The Census Bureau's American Community Survey found that 5.8 million Texans — 23 percent of the population — did not have health insurance in 2011. That includes 13 percent of children, 22 percent of women, 24 percent of men and 26 percent of the employed workforce in Texas.

Demographers Steve Murdock and Michael Cline at the Hobby Center for the Study of Texas at Rice University issued a report this week estimating that if Texas implemented federal health care reform — which Gov. Rick Perry has eschewed — more than half of the uninsured, about 3 million people, in the state could have coverage by 2014.

The demographers' report shows the enormous impact that federal health care reform could have for Texas families, Anne Dunkelberg, associate director of the Center for Public Policy Priorities, said in a prepared statement. Dunkelberg wrote a policy brief summarizing the demographers’ findings.

“Texas is projected to see the largest percentage gain in insurance coverage of any state under health care reform,” she wrote.

The demographers' report examined the impact of five major provisions in federal health care reform: a health insurance exchange to inform consumers of health plan options and subsidize coverage for households up to 400 percent above the federal poverty line; insurance mandates and penalties for not purchasing health insurance; an expansion of Medicaid to cover individuals and households 138 percent below the federal poverty line; allowing young adults under 26 to stay on their parents’ health plan; and tax credits for small businesses and nonprofits, which will cover at least half of premium costs for employees’ health insurance coverage.

The U.S. Supreme Court decided the federal health care reform law was constitutional, but it ruled that states had the right to refuse federal funds to expand Medicaid.

Perry called the federal health reform provisions “brazen intrusions into the sovereignty of our state,” and he said Texas would not expand Medicaid or set up a state-run health insurance exchange. Perry said he looked forward to implementing other health care solutions, but he did not specify what those would be.

Caring for uninsured Texans is a multibillion-dollar annual expense for Texas businesses and the state health care system. Texas hospitals absorbed $5 billion for uncompensated care to uninsured patients in 2010, according to the Texas Hospital Association.

Taxpayers and the insured ultimately pay those billions, said John Hawkins, senior vice president for government relations at the Texas Hospital Association. To make ends meet, hospitals either have to increase local taxes or negotiate higher compensation rates from insurers.

“That creates a vicious cycle, particularly for the individual and the small employer market,” Hawkins said. “Those shifted costs make the premium that much more unaffordable, which just adds to the uninsured.”

Texas hospitals have already helped finance federal health care reform by absorbing $14 billion in funding cuts to Medicare and other hospital reimbursements, he said.

“If we don’t take advantage of [the federal reforms], that money would potentially go to other states or just lapse,” Hawkins said. 

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