Texas leads the nation in medically uninsured residents – by a lot.
There are more Texans without health insurance than there are residents of Louisiana: about 4.9 million people, or 16.6% of the population of the Lone Star State. That’s more than twice the nationwide rate.
The state Legislature has famously refused to expand Medicaid eligibility even though it would be federally funded. And not doing so means nearly 1 million Texans today don’t have access to free health insurance that they could have. However, there are also Texans who are eligible for Medicaid who aren’t signed up, as well as those who are eligible for subsidies to cover insurance purchased through the healthcare.gov marketplace.
The deadline to enroll for insurance through healthcare.gov is Jan. 16.
Will Bostwick, who’s been covering this issue for Texas Monthly, said about 400,000 Texans – about 8.3% of uninsured Texas residents – are currently eligible for Medicaid but not enrolled.
“Though if the state were to expand Medicaid, that adds another 15%,” he said. “So that’s a significant chunk. But the big percentage of folks who could still have free health insurance, or would be able to get that through the Affordable Care Act marketplace.”
Bostwick said it is hard to say which barriers are keeping people from enrolling in the healthcare they are eligible to receive.
“One is that the marketplace can be difficult to navigate. All of your subsidies are based on your sort of projected income for that coming year. And a lot of folks don’t know that,” he said. “You might be a freelancer, or you might be unsure what your job is going to be two months from now. And so it’s hard to predict your income, and that can be a challenge. The other is that a lot of folks, I think, just don’t know how much is available in subsidies.”
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Bostwick said it is fairly simple to enroll online and get more information.
“The way to figure out what you’re eligible for on the marketplaces is to log on to healthcare.gov and apply,” he said. “Though there are some barriers there, it is a fairly straightforward process. And there are folks through the website who can help you kind of navigate that. If you’re uninsured, there’s a really good chance that you are eligible for some kind of subsidy.”
Bostwick said one takeaway from his story is there are not a lot of statewide efforts aimed at connecting people with insurance coverage.
“I’m not aware of significant efforts on behalf of the state to get this information to folks,” he said. “I think one of the giant takeaways of this report that I’m looking at is that a lot more could be done right. There’s a lot of low-hanging fruit here. And the programs exist. There are people without insurance, and a lot of them want insurance. All we’ve got to do is sort of connect the dots.”
When it comes to Medicaid expansion, Bostwick said there are political roadblocks stopping Texas and other conservative states from going through with broadening the program.
“Folks think it would be a really good idea, both financially and health-wise, to expand Medicaid. That’s sort of the professional folks who look at this, not necessarily the politicians. I think pretty much everyone has concluded that it would be a good financial deal for the state,” he said. “But there are roadblocks: The health care marketplaces is known as Obamacare. It’s an Obama program. And I think in a lot of conservative states like ours, that has sort of accounted for some of the resistance to the program, unfortunately.”
Bostwick said that given the limited scope of Medicaid, only certain categories of people are eligible beyond the elderly.
“Coverage for Medicaid is going to be restricted to a limited group of low-income folks, including some who are pregnant, have disabilities or are children,” he said. “The best place to check if you are eligible for any kind of subsidy from the federal government [for non-Medicaid insurance] is through the healthcare.gov website.”