ACA reduces uninsured in Texas, but would do more if state expanded Medicaid

Shockingly (not really), failure to expand Medicaid continues to cost poor Texans access to health insurance.

The Baker Institute at Rice University the Episcopal Health Foundation have released their latest issue brief on the latest results of the Health Reform Monitoring Survey, a quarterly survey which tracks the effects of the Affordable Care Act on individuals.  The Institute and  the Foundation implement the survey for Texas.

This report contains absolutely no surprises for anyone with more than three functioning brain cells and who hasn’t been living under a rock for the last five years.

First, the good news: The percentage of uninsured working-age adults (ages 18-64) estimated by the survey declined by nearly one third, from nearly 25 percent to 17 percent between September 2013 and March 2015. Most encouragingly, Hispanics – though still the higher proportion of uninsured in Texas – had the largest decline, with a drop of 38 percent.

This indicates that the health exchange model, supported by federal subsidies, is helping a large number of uninsured individuals get coverage.

The bad news of course, is that poor people who fall into “Medicaid gap” – those who earn income less than 100 percent of the poverty line necessary to obtain subsidies on the exchange, but higher than current Texas cutoffs for Medicaid -- are still left out in the cold.  The memo notes that respondents under 138 percent of the poverty line have increased from roughly 63 percent to 67 percent of those uninsured in Texas. This change in the two surveys isn’t statistically distinct from zero, but almost surely understates the impact of the state’s failure to expand Medicaid, because individuals between 100-138 percent of the poverty line qualify for subsidies.

Two other nuggets in the report are of interest.  First, the potential tax penalty for health insurance, also known as the individual mandate -- appears to have some effect on driving the uninsured to seek insurance. More than half (53 percent) of uninsured respondents say that the prospect of a fine for not purchasing insurance is “somewhat” or “very” important to them. (Note that the IRS is waiving the fine for households that fall into the “Medicaid gap.”

Finally, uninsured respondents overwhelming say that they can’t purchase insurance because they can’t afford it (57 percent) instead of because they don’t want it (17 percent). That’s useful because it undermines (again) the talking point that uninsured people are satisfied in their current state and that the government should just butt out.

To sum up then: Texans generally want health insurance, the ACA is effective in helping them get insurance, and the ACA would help a lot more Texans get insurance if the state were to expand Medicaid. Absolutely all these things were predicted by proponents of Obamacare.