Texas Has the Highest Uninsured Rate in the Country. Lawmakers Haven’t Addressed it This Session.

Health care advocates were optimistic that the Legislature would do something this year to address high, and rising, uninsured rates; high rates of maternal mortality; and the rural hospital closure crisis.

Texans rally for Medicaid expansion at the Capitol in March. The paper cutouts represent uninsured Texans who would be eligible for coverage under Medicaid expansion.
Texans rally for Medicaid expansion at the Capitol in March. The paper cutouts represent uninsured Texans who would be eligible for coverage under Medicaid expansion. Sophie Novack

Texas has the highest overall uninsured rate in the country, the highest rate of uninsured kids and the highest rate of uninsured women of childbearing age. Yet the Legislature is on track to wrap up for the next two years without passing bills to expand coverage.

Expanding public benefits is often considered a political nonstarter in the Republican-controlled Texas Legislature. But at the start of this session in January, advocates were optimistic that lawmakers would do something this year to address the sky-high uninsured rate and related health crises. After all, Texas is one of just 14 states that haven’t expanded Medicaid under the Affordable Care Act, and doing so would insure a million more Texans. Conservatives reticent to endorse Barack Obama’s signature law have argued that expanding Medicaid would put Texas on the hook for additional health care costs, but other red states have gotten on board, not wanting to leave billions in federal funds on the table. Advocates and medical professionals implored Texas lawmakers to accept federal funds for Medicaid expansion, saying that doing so would be a huge step in helping to address high, and rising, uninsured rates; high rates of maternal mortality; and a rural health care crisis driven by the closure of about 20 rural hospitals in the last six years, in part due to uncompensated care.

rural hospitals, closures, rockdale
The Rockdale Hospital, along with four other healthcare facilities in Milam County, abruptly closed in December, leaving a community without an emergency room and residents scrambling to find doctors.  Christopher Collins

But with less than a week left in session, measures to expand coverage for poor Texans have failed or stalled. The House voted on party lines against a state budget amendment to accept federal funds to expand Medicaid. A proposed bill from state Representative Garnet Coleman, D-Houston, would have expanded Medicaid and codified the ACA’s insurance protections. The measure, House Bill 565, got a hearing, but not a committee vote. Four bills would have let Texas voters decide whether to expand Medicaid, but none got a committee hearing in either chamber.

“If the Legislature doesn’t want to do it, well damn it, let’s let the state of Texas decide, let’s let Texans decide, let’s put it on the ballot,” said state Representative Ron Reynolds, D-Missouri City, who authored one of the four bills, at a legislative briefing this week on maternal health for black women. “We couldn’t even get a hearing on that. How could we not get a hearing on that?” He added: “We’re losing billions of dollars, but even more important than the dollars is that people are dying every day. That should be repulsive to anybody with any heart, any compassion for human life.”

medicaid expansion rally at the capitol in march
A study released Wednesday found that Texas has the highest uninsured rate among women ages 18-44 in the country.  Sophie Novack

A statewide and nationwide focus on the maternal mortality crisis over the last few years prompted a slew of proposed bills aimed at improving maternal health. More than half the births in Texas are covered by Medicaid, but coverage for new moms ends 60 days after birth. The state’s Maternal Mortality and Morbidity Task Force, whose work was extended in 2017, found that most maternal deaths occur after that two-month mark. One of several bills filed to extend Medicaid for pregnant women to one year after birth — one of the task force’s top recommendations to the Legislature  — managed to pass the House just ahead of deadline last week. But the measure, House Bill 744, from Representative Toni Rose, D-Dallas, did not get a committee hearing in the more-conservative Senate.

The bill’s failure comes as lawmakers have passed the anti-Planned Parenthood Senate Bill 22, which critics say will further limit access to reproductive health services for uninsured and low-income Texans.

Meanwhile, a study released Wednesday found that Texas has the highest uninsured rate among women ages 18-44 in the country. More than one-quarter lack coverage — a rate nearly three times higher than in states that expanded Medicaid. The national report, released by Georgetown University’s Center for Children and Families, found that health coverage led to better outcomes for moms and their kids: states that expanded Medicaid under the ACA had a 50 percent greater reduction in infant mortality than states that did not.

medicaid expansion rally at the capitol in march
With less than a week left in session, measures to expand coverage for poor Texans have failed or stalled.  Sophie Novack

“We’re deeply disappointed that our state leaders have once again failed to support the health of Texas moms in low-wage jobs and the health of their babies,” said Laura Guerra-Cardus, the deputy director of Texas’ Children’s Defense Fund who organized a Medicaid expansion rally at the Capitol in March. “Denying health coverage to so many Texas women has serious — and sometimes deadly — consequences for them and their babies.”

Even a bill to keep already eligible kids from being kicked off Medicaid due to paperwork issues didn’t make it out of a House committee. The bipartisan House Bill 342 would bring Texas in line with other states by instituting income eligibility checks annually, rather than every few months. Advocates like Guerra-Cardus say Texas’ current policy causes administrative obstacles that have resulted in thousands of eligible kids losing coverage each month. A version of HB 342 that would provide 6 months of continuous Medicaid coverage was passed by the House as an amendment to Senate Bill 1105 on Wednesday. It must be approved in the Senate by Sunday, the day before session ends.

This is all as Texas Attorney General Ken Paxton is leading a lawsuit, backed by the Trump administration, that seeks to dismantle the ACA. If successful, experts say, it would kick millions of Americans off their health insurance, eliminate pre-existing condition protections and have devastating effects across the entire U.S. health care system. Governor Greg Abbott, who has called for repealing the ACA, has said, “Under no circumstances will [Texans] lose coverage for pre-existing conditions, period.” But Abbott, like the Legislature, hasn’t approved specific policies to ensure that.

Editor’s note: This story has been updated to include an amendment that was passed on SB 1105 in the House Wednesday. The proposal would provide 6 months of continuous Medicaid coverage for eligible kids, rather than kicking them off after a few months due to missing paperwork.

Sophie Novack is a staff writer covering public health at the Observer. She previously covered health care policy and politics at National Journal in Washington, D.C. You can contact her at [email protected].

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