Why Texas has the highest percentage of uninsured people in the U.S.

August 16, 2011


There are a lot of Texas statistics that we’ll hear about this campaign season. You can expect Texas Gov. Rick Perry (R), for example, to bring up how his state has generated 37 percent of the country’s new jobs since 2009.

Here’s one statistic, though, you won’t hear him touting: Texas has the highest percentage of uninsured people in the country. Twenty-six percent of Texas residents lack health insurance, compared with a national average that hovers around 17 percent. That works out to about 6.3 million uninsured Texans, a population nearly equal in size to the entire state of Massachusetts.

Texas has led the country in its percentage of uninsured residents since well before Perry took office in 2000, says Anne Dunkelberg, who directs the Austin-based Center for Public Policy Priorities. “We literally started out in the 1990s at the end of the line and nothing has moved to change that position,” she explains. “Basically, it’s everything about our job market in the state and our public programs, that really were the formula for having low levels of coverage.”

Here are four main factors that contribute to Texas’ high number of uninsured:

Many Texas jobs don’t offer insurance. Texas has a higher number of retail and service jobs, as well as a decently large agricultural sector, all industries that are less likely to offer health benefits. So while Texas’ unemployment rate of 8.2 percent beats the national average, the state falls below national trends on employer-sponsored health coverage. Seventy-one percent of the uninsured in Texas are part of a family that includes a full-time worker, according to the Kaiser Family Foundation. Put another way, 63 percent of uninsured, working-age Texans do have a job —just not an offer of insurance to go with it.

The Medicaid program is relatively limited. As I touched on in an earlier post, some states have used Medicaid waivers to cover low-income populations they’re not required to cover. Texas doesn’t do this much: The state covers some optional populations, pregnant women and those in long-term care, but largely sticks with the federally-mandated minimums. That means a decent number of residents who might receive coverage in another state don’t in Texas.

Insurance rates are largely unregulated. Texas takes a pretty hands-off approach to regulating its individual market. The state does not require insurers in the individual market to sell to anyone who applies for a policy. Nor does Texas limit “rating” of customers, where insurance carriers charge more to older subscribers and women, who tend to have higher health care costs. Taken together, those two factors can make insurance prohibitively expensive – or unobtainable — for those who are older or have a pre-existing health condition.

A large immigrant population. Non-citizens make up about one-quarter of Texas’ uninsured population, according to the Center for Public Policy Priorities’ Texas Health Care Primer. Regardless of immigration status, immigrants tend to have a higher rate of uninsurance than non-immigrants. Of the 1.2 million foreign-born, naturalized U.S. citizens in Texas, for example, 31 percent are uninsured, compared to 22 percent of U.S.-born Texans.


13 Responses to Why Texas has the highest percentage of uninsured people in the U.S.

  1. […] Why Texas has the highest percentage of uninsured people in the U.S. […]

  2. Carrie on March 22, 2012 at 12:09 pm

    Almost a quarter of people in Texas lack health insurance. We take a look at what that means for a patient struggling to get treatment for a health condition.Last year, we spent around $2,700,000,000,000 on health care. That is more than the entire economy of France or Britain. Our national health care tab is huge. We pay for it through a variety of schemes, public and private. In a few minutes, our health policy correspondent, Julie Rovner, will give us the big national picture. But given the size and diversity of the country, the economics of health care vary from state to state. We’ve going to hear stories now from two states that differ dramatically. Texas has the highest percentage of uninsured people in the nation – 25 percent. And reporter Carrie Feibel, of member station KUHF, tells us about one uninsured woman from Houston.

  3. Carrie on March 24, 2012 at 7:14 am

    The U.S. spent $2.6 trillion on health care in 2010 — more than the entire economy of France or Britain. But the amount spent and how it’s used varies from state to state.And no two states are more different than Texas and Massachusetts. At 25 percent, Texas has the highest rate of uninsured people in the nation. Massachusetts, where a 2006 law made coverage mandatory, has the lowest rate — fewer than 2 percent of people are uninsured.

    Monday’s All Things Considered takes a look at two Americans who are living the reality of that difference. In Texas, Melinda Maarouf, 55, is one of 6 million Texans without health coverage. In Massachusetts, Peter Brook, 51, is one of the 439,000 residents who now have coverage as a result of the state law.In Texas, Walking A Health Care ‘Tightrope’

    For Texans, having health problems without health insurance often means an anxious scramble for care at overcrowded charity clinics or the local emergency room. Melinda Maarouf knows that experience all too well. She’s a teacher’s aide at the Faith Christian Academy, a private school just outside Houston.

    “Unfortunately, we’re a small school and the budget doesn’t allow for insurance for the employees,” she says.

    Maarouf is divorced and has a daughter in college. The school where Maarouf works can’t afford to bring her on full time right now, so she makes just over $11,000 a year. That income puts her right around the federal poverty line, and it makes for some hard health choices.

    She has high blood pressure and has skipped pills to make her prescriptions last longer. “I can always tell when the blood pressure’s elevated,” she says. “I feel uncomfortable. I feel edgy and kind of shaky, and my ears ring.”

    Maarouf knows that if she doesn’t keep her blood pressure under control, she could have a stroke, heart attack or kidney damage. She recently found help at a charity clinic where she pays only $25 per visit. Even so, Maarouf says the blood pressure is all she can afford to treat right now.”I haven’t had a Pap smear — goodness, I couldn’t even tell you — probably since my daughter was born, and she’s 26,” she says. “I haven’t had a well-woman exam. And I’m sure it’s time for some routine blood work.”

    Maarouf has never had a mammogram and she’s continued to push off some needed dental work — but medical bills scare her. In 2010, she went to the emergency room with chest pain. Doctors didn’t find anything wrong, but she ended up with $3,000 in bills.

    Maarouf couldn’t keep up with the payment plan, so she simply shoved the bills into the bottom of a drawer and swallowed her anxiety.

    “Oh, my credit’s pretty much shot, as far as that goes. But there’s not much I can do about it,” she says. “You just have to move on, do what you have to do to survive.”

    Like millions of other working Texans without minor children, Maarouf can’t get Medicaid. And she’s years away from Medicare.Hospitals in Texas spend over $4 billion a year treating uninsured patients like Maarouf. Some of the cost gets absorbed by county taxpayers and some gets shifted onto insured Texans, who pay higher premiums for their own coverage.

    Maarouf says she feels stuck and exposed. “It’s like you’re sort of walking a tightrope. I sometimes feel like I’m on the edge of a cliff. As long as everything is status quo and there’s no glitches or bumps in the road, I feel OK,” she says. “But I sometimes feel like I’m one emergency room visit away from a catastrophe.”

    In Massachusetts, Uninsured Get Relief

    Five years before Massachusetts started offering free and subsidized coverage, Peter Brook couldn’t afford health insurance or the daily insulin and needles he needs to treat his diabetes. Things have changed for Brook since the Massachusetts health care law, the same one that helped shape the federal Affordable Care Act.”When I didn’t have health insurance, I’d use a needle for 30 days, like 150 shots or something, so it gets a little bit dull,” says Brook, who does odd jobs like landscaping to cover his basic needs.

    When he had health complications related to his diabetes, he didn’t have money for care. The worst was a digestion problem that would bring on crippling stomach pain.

    “I would tend to hole up in a fetal position at home, and then over the course of week or two, my skinny body would lose 25 to 30 pounds and then I’d end up looking like a death camp survivor,” he says.

    And then there was the time Brook fractured a pinkie and set it by taping the broken section to his ring finger. The pinkie is still crooked, but today Brook has free health insurance and a regular doctor at the South Boston Community Health Center. His only expense is a $3.65 copay for prescriptions, which adds up to about $14 a month.

    “I now have good health care, so that is a weight off of my mind,” he says. “It’s been a year and half since I’ve been in a hospital, and for the first 50 years of my life I never went six months without an inpatient hospital stay for one thing or another.”
    Hear Peter Brook’s Story

    March 19, 2012
    Mass. Boasts Highest Insured Rate In U.S.
    [3 min 6 sec]

    Brook’s care is free, but Massachusetts — with help from the federal government — spends roughly $182 million more every year on health coverage for low-income residents than it did before 2006, according to the Massachusetts Taxpayers Foundation. And Brook worries about those costs.

    “Who’s paying for it? Where’s that money coming from?” he asks. “If society were a human being, then they’re dragging a ball and chain down the street on their ankle.”

    Brook has joined the Greater Boston Interfaith Organization in lobbying Massachusetts legislators to control health care cost increases so that coverage will be affordable. And as lawmakers finalize bills, there’s a vigorous debate under way about what state government can or should do to about limiting spending.

  4. Jon on March 27, 2012 at 4:47 am

    This rise in the number of uninsured is for the most part not the fault of the Obama administration. It is primarily the result of long term trends, rising health care costs, and the huge spike in unemployment during the economic crash, as workers lost their employer-provided insurance. Some smaller aspects of the Affordable Care Act, like young adults staying on their parents’ plans, have even helped keep the level of uninsured from going even higher.

    Still this development is deeply problematic for Mr. Obama. One of his biggest accomplishments that supporters tend to point to is his passage of the Affordable Care Act and its health insurance reforms.

    I simply don’t know how the Administration can successfully campaign on passing a law to expand coverage, when the level of uninsured has increased significantly during Obama’s tenure. It is tough for people to see such a law is any form of a real accomplishment when over a year after its passage it hasn’t even begun to accomplish its main promises and the exact opposite is taking place in people’s lives.

    Instead of campaigning on delivering for the American people with his signature legislation, Obama will be forced to explain that even though the insurance situation has gotten worse, voters need to trust his claims that his signature law will eventually improve things in the future.

    “Eventual change in the future I hope you believe me about” just doesn’t have that nice campaign ring to it.

    The decision to delay the start date of the primary expansion in the Affordable Care Act until 2014 should be remembered as one of the most idiotic political and policy decisions ever made. I would argue that if Obama narrowly loses in 2012, it could be the single decision that is most responsible.

    The Administration reportedly supported the delays to hold down near-term costs and achieve a more favorable 10-year cost estimate from the CBO. Almost no one will remember the bill’s official CBO score come November 2012, but plenty of people will remember they haven’t seen any tangle benefits from the law Obama spent a year working on in the middle of an economic and unemployment crisis.

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