Number of Texans with Health Insurance Jumps Thanks to Affordable Care Act

AUSTIN, TEXAS – Over 700,000 more Texans had health insurance in 2014 than in 2013 thanks to the Affordable Care Act (ACA), but Texas now has both the largest number and percentage of uninsured residents in the country. Today’s release of the Current Population Survey (CPS) portion of the U.S. Census, including a sneak preview of health insurance data from the American Community Survey (ACS), provides the Census’ first look at how much health insurance coverage grew in 2014, the nation’s first full year of new coverage under the ACA.

“In Texas and nationwide the Affordable Care Act has boosted health insurance coverage tremendously,” said CPPP Associate Director Anne Dunkelberg. “Regrettably Texas is missing out on the even larger health benefits and cost reductions a majority of states – including conservative states – have gained by expanding coverage for the working poor with federal Medicaid dollars.”

Texas highlights from today’s Census data release include:

*Texas saw a major improvement in its overall (all ages) uninsured rate from 22.1 percent in 2013 to 19.1 percent in 2014 (a one-year drop of 3 percentage points). This is the largest gain in health care coverage in Texas since 1999; during that period Texas’ uninsured rate fluctuated between 21 and 25 percent, and never had a one-year gain of even a full percentage point. These percentages reflect a drop from 5.7 million uninsured in 2013 to 5 million in 2014.

*Texas had a notably smaller improvement in health care coverage than did states that expanded Medicaid coverage for below- and near-poverty adults. Arkansas’ uninsured rate improved from 16 percent to 11.8 percent (a 4.2 percent drop); New Mexico improved from 18.6 percent to 14.5 percent (a 4.1 point drop).

*The main source of 2013-to-2014 coverage gains in the U.S. and Texas was direct purchase of insurance, which includes the ACA marketplace that launched in 2014. Medicaid coverage was the second largest source of gains nationally, and states that did some form of Medicaid expansion showed larger improvements in their uninsured rates for working-age adults (18-64) than Texas did. This is because non-Medicaid expansion states like Texas cover only a fraction of parents, and no uninsured adults without dependent children at home (unless over 65 or disabled, and in poverty).

*About 26 percent of working age Texans (ages 18 to 64) were uninsured in 2014, compared to a U.S. average of 16 percent. Census analysts reported today that in non-Medicaid expansion states, the uninsured rate for adults in poverty is about two times that in states with a coverage expansion for the working poor.

*For the first time, Texas has both the largest percentage and the highest number of uninsured residents. California was previously the state with the largest number of uninsured residents despite a much lower percentage than Texas, because their population is so much larger than Texas. But California has seen robust increases in both private insurance coverage under the ACA Marketplace and public coverage through Medicaid coverage for working poor adults, reducing their total number of uninsured residents below Texas’. California’s uninsured rate dropped from 17.2 to 12.4 percent from 2013 to 2014, bringing the number of uninsured down to 4.8 million.

*A much larger percentage of Texas kids (89 percent) than adults (74 percent) have health insurance thanks to Medicaid-CHIP coverage available to many low-income Texas kids. Still, the Texas children’s uninsured rate (at 11 percent for those under age 18) puts us tied statistically with Alaska and Arizona for the worst uninsured rate for children and teens in the country. There is work to be done to get more Texas children who qualify for Medicaid and CHIP enrolled, and to fix the barriers that prevent kids in families at higher incomes from getting coverage.

Stay tuned as tomorrow (Sept. 17) the Census Bureau will release more American Community Survey data, including Texas-specific data about poverty and income. To better understand the difference between the two American Community Survey (ACS) and the Current Population Survey (CPS), view our side-by-side comparison.

Background:
Until now there have only been preliminary measurements of how many more Americans have gained health insurance thanks to the Affordable Care Act, based on surveys by Gallup, the Urban Institute, and Texas’ Baker Institute. Today’s data from the ACS—with a massive sample size of about 3 million—confirm with a much higher degree of accuracy what the earlier surveys had predicted. For more information or to schedule an interview with a CPPP expert please contact Oliver Bernstein at bernstein@cppp.org.