2021 Census data provides insight into Texas’ uninsured population
The Number of uninsured Texans in 2021 was very close to the 2019 estimate, but How? ‘Or’ What Texans saw their coverage changed: The share of Texans covered by jobs declined, while the share of Texans who purchased coverage on the ACA market or signed up for Medicaid increased.
These increases were largely driven by actions of Congress that (1) made the ACA Marketplace much more affordable insurance and (2) enabled Medicaid recipients to remain covered throughout the Public Health Emergency (PHE). The PHE remains in place and is expected to continue until at least January 2023.
Texas in 2021: the worst for children and adults
- 5.2 million Texans (all ages) were uninsured in 2021, meaning that 18.0% of Texans were uninsured.
- Texas is the state with both the largest Number and percentage of uninsured residents in the United States. Texans make up 9% of the US population, but 19% of the nation’s uninsured population.
- Texas has the worst rate of uninsured large margin: Texas’ 18% uninsured rate is 4.2 percentage points lower than Oklahoma’s, the second-highest rate. The uninsured rate in the United States in 2021 is 8.6%.
- Nearly one in four working-age Texans between the ages of 19 and 64 are uninsured, making up the largest share of the uninsured in Texas, with young adults most likely to be uninsured.
- Texas children and youth (under 19) are more than twice as likely as US children to be uninsured: 11.8%, compared to 5.4% for the US Only one other state (WY) has a double-digit rate of uninsured children. Texas ranks last despite improving our rate of uninsured children from 12.7% in 2019.
- Nearly 930,000 Texan children were uninsured in 2021, and the census estimates that 495,000 of them had incomes less than twice the federal poverty income level.
- A much larger share of Texans who identify as Hispanic are uninsured. Coverage rate gaps between racial and ethnic groups are much smaller for Texas children than for adults because public insurance from Medicaid and CHIP is available for low-income children (but not adults) .
- 34% of Hispanic Texan adults of working age (19-64) are uninsured — more than three times the rate of non-Hispanic white Texans of working age (11%).
- 16% of Hispanic children in Texas are uninsuredcompared to 8% of non-Hispanic white children not covered.
- Black working-age adults are also much more likely to be uninsured, at 18%.
- Asian American children and black children in Texas have uninsured rates close to those of non-Hispanic whites: 7% for Asian children and 9% for black children.
Texas can turn the tide
Like all Texas staff describe In August, during testimony before the Texas House Select Committee on Health Reform, our state government has several powerful tools that could end our last-place ranking.
- Accepting billions in federal funds to provide Medicaid to “working but poor” adults – parents and adults with no dependent children at home. Texas is one of 12 states without coverage for poor adults. As the US Census chart shows, even very poor states have much lower uninsured rates than Texas if they embraced Medicaid expansion: Arkansas 9.2%; Louisiana 7.6%; New Mexico 10.0%, West Virginia 6.1%. Experts estimate nearly 1.4 million uninsured in Texas would be eligible for coverage if we complete this step.
- Removing Enrollment/Renewal Barriers currently eligible people on Texas Medicaid. After the estimates are applied to remove undocumented children (ineligible for Medicaid or CHIP) from census statistics, it still appears that 350,000 or more uninsured Texan children are eligible for Medicaid or CHIP but not enrolled. Additionally, COVID-19 policies since 2020 have retained more than 850,000 Texas children, improving our rate of uninsured children; however, these coverage gains for children will be at risk when the PHE ends. The Texas Medicaid agency needs clear direction from the state legislature to both remove current barriers and adopt the strongest best practices to dungeon children and eligible adults covered at the end of EPS and ensure successful transfer to other coverage for those with higher incomes.
- Maintaining our state’s record enrollment at HealthCare.gov. Texas is already on the cusp, as enrollment in 2022 rose 42% in Texas — from 1.3 million to 1.84 million — the biggest increase in the nation. This progress has been spurred by more affordable coverage and significant federal investments in enrollment assistance and marketing. Census statistics suggest that at least 1.5 million of the 5.2 million uninsured Texans are eligible for market subsidies, and even more robust marketing and support could lead to an even better enrollment outcome for the cover of 2023.
Citizenship and immigration status: 1.4 million out of 5 million uninsured Texans in 2021 were non-US citizens — a mix of legally present and undocumented residents. Texas covers legally present immigrant children in Medicaid and CHIP, but the previous federal administration’s anti-immigrant policies scared many parents into removing their children from coverage. Many undocumented parents still fear that even enrolling their U.S. citizen children in Medicaid or CHIP will prevent future legal immigration and citizenship.
- To reduce the size of the pool of uninsured noncitizens, Texas must remove barriers to coverage for legally present children and adults. This will require a strong role for the state in awareness and reassurance to enroll eligible legally present immigrant children, plus a change in Texas policy that now excludes nearly all legally present immigrant adults from Medicaid.
- Like other high-immigration states, Texas can — and should — pursue a comprehensive strategy to provide medical care to immigrants who lack legal immigration status and are excluded from Medicaid, CHIP, and the marketplace.
And after: Our next blog on this topic will provide a more detailed look at how race and ethnicity, employment status, family income, and poverty affect health insurance coverage in Texas.
*US Census releases new statistics on uninsured people for the previous calendar year each September, based on its Large American Community Survey (ACS, with a national sample of 3.5 million). These statistics will be updated again in September 2023, with figures referring to 2022.