Significant Decrease in Uninsured Population in Texas Post-ACA

A recent study found that the amount of uninsured Texans dropped by 30% since the start of the Affordable Care Act (ACA). The decrease dropped Texas’ uninsured rate below the 1999 level.

The study, released by Baker Institute for Public Policy and the Episcopal Health Foundation (EHF), found a decline among every age, ethnic group, and income-level in the state.

"These latest numbers confirm the continuing downward trend in the number of uninsured Texans that began as the ACA was implemented," said Elena Marks, EHF's president and CEO and a nonresident health policy fellow at the Baker Institute. "For more than a decade prior to the ACA, the uninsured rate remained above 20 percent and was rising. It's now clear that it's moving in the opposite direction, and the ACA deserves the credit."

Researchers found that uninsured adults aged 50 to 64 dropped from 21% to 10% since the ACA started.

"For the older group, the ACA made health insurance much more affordable because the law limits insurers from charging older adults no more than triple the cost for the same health insurance plans as younger adults," said researcher Vivian Ho, PhD. "However, limiting premium variation by age made Marketplace policies less attractive to younger adults, which is why their uninsured rate fell less."

Researchers also found that the number of uninsured Texans who earned between $16,000 and $47,000 annually decreased by more than 42%. The rate declined from 23% in 2013 to 13% in 2016, according to the study.

"Texans with low to moderate incomes were able to use federal subsidies to help pay for health insurance premiums for ACA Marketplace plans," Dr Ho said. "Those subsidies made coverage affordable for many who could not have purchased plans without that help."

Researchers found that 84% of Texans who enrolled in ACA health exchanges received subsidies to pay for premiums.

However, researchers also found that 46% Texans with an income of less than $16,000 are still uninsured. This group is primarily people of color in working families.

"The ACA as implemented in Texas offers little hope for Texans with the lowest incomes," Marks concluded. "They make too much to qualify for traditional Medicaid and not enough to get a subsidy to help pay for their premium. They're stuck in the 'coverage gap,' and unless Texas expands Medicaid or comes up with another system of coverage for this group, they will remain uninsured."