Updated Interactive: Measuring Texas' Uninsured Population, Obamacare Enrollment

For more than a decade, Texas has maintained the highest rate of people without health insurance in the nation. More than 6 million Texans don't have health insurance. The Affordable Care Act requires most people to obtain health coverage in 2014, and sets forth a variety of ways to assist the uninsured. So far, only 207,500 Texans have obtained coverage through the federal health insurance marketplace. To measure the impact of ACA enrollment efforts, this interactive provides context on Texas' uninsured population.

While California, a more populous state, has a larger uninsured population, Texas has the highest rate — one in four Texans lacks health coverage — and the greatest number of children, 852,000, without coverage. The graph above shows the percent of people without health insurance in 2012 in the five most populous states and the nation based on five-year estimates from the American Community Survey conducted by the census.

Select Graph:

    There isn't a simple explanation for why Texas' uninsured rate is so high. Texas has a relatively large number of retail, service and agricultural-sector jobs, which traditionally don't offer employment-based coverage. The state's lax regulatory approach to the individual insurance marketplace has led to high premium prices for people who are older, female or have pre-existing conditions. Although poor children may receive coverage through state programs, Medicaid eligibility in Texas is extremely limited for adults, especially compared to states like New York and Pennsylvania. And Texas has a large immigrant population, which accounts for more than 1 million of the state's uninsured.

    These factors help explain why the majority of Texas' uninsured population is employed, and between the ages 18 to 34. To help this population find coverage, the Affordable Care Act allows young adults up to age 26 to stay on their parents' health plans, and offers tax credits to adults between 100 to 400 percent of the federal poverty threshold to purchase a health plan on the federal health insurance marketplace. The law initially required states to expand Medicaid eligibility to adults at or below 138 percent of the federal poverty threshold, but the U.S. Supreme Court ruled that provision should be optional.

    Texas' Republican leadership has strongly opposed the law, and refused to aid enrollment efforts by expanding Medicaid eligibility or setting up a state-run health insurance marketplace. As a result, more than 1 million Texans fall into a "coverage gap," and don't have any assistance available under the Affordable Care Act. Still, local governments and community organizers are promoting enrollment in the federal marketplace.

    Eligibility for Assistance Through the Affordable Care Act
    Of the 6.2 million uninsured Texans:
    • 874,000 are eligible for Medicaid/CHIP.
    • 1,046,000 are in the coverage gap.
    • 1,756,000 are eligible for tax credits.
    • 1,264,000 are ineligible because of their income or access to employer benefits.
    • 1,226,000 are ineligible because of their immigration status.

    As of Feb. 2, 207,500 Texans had picked a health plan on the federal marketplace. The U.S. Department of Health and Human Services has released limited enrollment data that doesn't distinguish whether the people who've purchased health plans were previously uninsured. While most of Texas' uninsured popultion is younger than 34, the majority of the people who've enrolled are between the ages of 45 and 64.

    As this Tribune animation explains, the plans offered in the federal marketplace are tiered. Bronze plans have the lowest premiums but cover fewer services and have higher deductibles, while platinum plans have the highest premiums, cover more services and have low deductibles. For people who are eligible for tax credits, the amount of the credit is based on their income and the cost of the second-highest-priced silver plan in the region. That partially explains why the majority of Texans have purchased silver plans.

    Select Graph:
      United States Texas California Florida
      Marketplace type 17 state-based; 7 state-federal partnership; 27 federally facilitated Federally facilitated State-based Federally facilitated
      Expanding Medicaid eligibility in 2014? 25 states + D.C. expanding; 25 states not expanding No Yes No
      As of Feb. 2...
      Individuals determined eligible for marketplace plan 7,267,230 586,342 1,003,516 748,434
      Individuals determined eligible for Medicaid/CHIP 3,181,155 80,368 850,000 99,746
      Individuals who've selected a marketplace plan 3,299,492 207,546 728,086 296,892
      Of those who've selected a health plan...

      Without health insurance, many low-income Texans don't receive necessary health services. Although anyone can seek care at hospital emergency rooms, federal law only requires hospitals to stabilize a patient and usually won't provide treatments for serious diseases, such as cancer. Federally qualified health clinics that receive grants to subsidize basic care for low-income patients often have long wait times for an appointment and charge patients sliding-scale fees to cover their care.

      Ultimately, hospitals, taxpayers and businesses foot the bill for people without sufficient health coverage. Texas hospitals reported $3.2 billion in charity costs and $2.1 billion in bad debt in 2010, according to the Texas Health and Human Services Commission. Although hospitals receive tax revenue, federal grants and donations to cover uncompensated care, the residual costs of caring for the state's uninsured or underinsured still topped $1 billion in 2010. Those additional costs lead to higher prices, and higher premiums for people who are uninsured.

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