*Editor's note: This story has been updated to include additional responses to the study.
The rate of Texans without health insurance has fallen 8 percentage points since enrollment in the federal Affordable Care Act began, according to a new study.
Texas’ sky-high rate of adults without health coverage — previously about 25 percent, the highest rate in the nation — was down to 17 percent in March, according to a report from the Episcopal Health Foundation and Rice University’s Baker Institute for Public Policy.
But Texas remains the state with the highest percentage of uninsured people, the study found, and for the first time, the state has the largest raw number of uninsured residents in the country.
The amount of change was unequal among income levels. The poorest Texans saw a less dramatic improvement — the uninsured rate for people earning less than $16,000 fell by 20 percent, while the uninsured rate for people earning more income fell by 45 percent.
In a statement, Vivian Ho, one of the study’s authors, said the survey showed a widening “coverage gap” among poor and middle-income Texans. Texas leaders have declined to expand the state’s Medicaid program to provide health insurance to impoverished adults — a central tenet of President Obama’s signature health care law — criticizing the public program as “inefficient.”
“Unless Texas participates in an expanded Medicaid program or develops some other mechanism for covering the lowest income Texans, the number who remain uninsured is not likely to change,” Ho said. “Right now, those at the lowest incomes must rely on health care that is highly subsidized by county and state tax dollars, or get by without needed health care.”
The 31 percent decrease in the rate of uninsured Texans was similar to drops in other states that did not expand Medicaid coverage. For expansion states, the average decrease in the rate of uninsured was 53 percent, according to the study.
John Davidson, a health policy analyst for the conservative Texas Public Policy Foundation, said the results were misleading because not all survey respondents were previously uninsured before they got coverage under the Affordable Care Act.
"When you mandate that people buy health insurance and then subsidize its purchase, you’ll get more coverage. That’s not surprising," Davidson said in an email. "But one of the persistent problems we’ve had with ACA data since the beginning is measuring how many of those covered by exchange plans were previously uninsured."
The report’s findings are based on quarterly survey data from a 7,500-person sample of adults ages 18 to 64 meant to be representative of the population.
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
Disclosure: Rice University was a corporate sponsor of The Texas Tribune from 2011 to 2013. A complete list of Tribune donors and sponsors can be viewed here.