According to initial findings from an ongoing study by Texas 2036, Texas has the highest rate of uninsured residents and there are several reasons why.
Most of the roughly five million uninsured Texans already qualify for a government health program or federal subsidies that would help pay for coverage, but they have not signed up.
Texas uninsured rate is 18 percent; Odessa’s rate is 18.9 percent and the rate is 8.6 percent for the U.S., Census Bureau data shows.
Among uninsured adults age 18-64 in 2020, the most uninsured county is Presidio at 44.5 percent and the least uninsured is Borden at 12.6 percent. Eighty-two percent of people uninsured were age 19-64 in 2021; 17 percent were children; and 1 percent were age 65 and over, according to the 2021 U.S. Census Bureau American Community Survey.
Texas 2036 surveyed 2,000 people.
In their early survey findings, 30 percent of people surveyed said they didn’t have coverage because they weren’t currently employed.
Twenty-seven percent said they had a job that didn’t offer health insurance; 22 percent said they did not qualify for Medicaid, CHIP (Children’s Health Insurance Program) or Affordable Care Act subsidies; 16 percent said they couldn’t qualify for health insurance; 15 percent had other reasons.
Twelve percent said they didn’t know how to get health insurance; 8 percent thought enrolling in health insurance was too complicated; 7 percent said they thought health insurance did not provide a good value; another 7 percent said they had a job that offered health insurance, but did not currently qualify for it.
Six percent said they did not want or need health insurance; 3 percent had other strategies to obtain healthcare and 3 percent had immigration concerns.
Odessa premiums for a 40-year-old single person making $41,000 a year would cost $68 a month; $195 for silver and $152 for gold for 2023.
In 2022, the bronze plan was $116; and $216 each for silver and gold.
Asked why the gold plan was less expensive in 2023, Texas 2036 Vice President of Communications Merrill Davis said the gold plan is less expensive than the silver plan as a result of bipartisan legislation, authored by Sen. Nathan Johnson and Rep. Tom Oliverson, and passed unanimously by the legislature last session.
“That law requires silver plans offered in Texas on the ACA Marketplace to reflect actual costs so that Texans could maximize available federal subsidies (which are calculated based on the premium of silver plan compared to household income). This law prevents artificially lower-priced silver plans that lower the amount of subsidies available to Texans,” Davis said in an email.
“It’s too soon to see the full results specific to each area, but the early data is showing that, statewide, the amount of gold premiums relative to silver premiums has dropped dramatically, which should result in the phenomenon you noticed in the sample Odessa net premiums. It’s worth noting that a similar effect is occurring with bronze net premiums, which should be less expensive than they have been in the past as well,” she added.
“This drives home the point that every Texan who is looking for health insurance for themselves or their families in 2023 should check out the ACA Marketplace between now and Jan. 15th — even if they have looked in the past and not found a plan that they could afford or want, they may be surprised at what they see on the exchange this year,” she added.
Charles Miller, senior policy advisor at Texas 2036, said 17 of the uninsured population are children. He added that children’s eligibility for insurance from Medicaid or CHIP is much higher than for adults.
“It’s much easier to qualify as a child, so there’s a big opportunity for kids who are probably eligible but unenrolled. There’s this big group of people who are eligible for subsidies, but unenrolled. We have it listed 43 percent and that’s a little over 2 million people as of that 2019 number,” Miller said.
That 2 million figure will probably be a little bit higher now because of a couple of changes to the law in the last couple of years, he added.
During the pandemic, as a part of the American Rescue Plan Act, they increased the amount of federal subsidies that were available.
“And crucially, when the ACA was started you were eligible for subsidies if you earned between 100 percent of the poverty level and 400 percent of the federal poverty level. They’ve removed that ceiling, so there’s no longer a hard cap,” Miller said.
The federal government also announced a change to the “family glitch,” which refers to “a 2013 ACA implementation rule that based eligibility for a family’s premium subsidies on whether available employer-sponsored insurance was affordable for the employee only, even if it’s not actually affordable for the whole family,” the HealthInsurance.org website says.
That rule was changed in time for 2023 enrollment, the site said.
“That subsidy eligible population is probably the largest group of uninsured Texans and those are people who could sign up for an ACA plan and get subsidies for it, but are currently not,” Miller said.
He added that another part of the data that struck them was when they looked at income level, it wasn’t just people who were below the poverty line that were uninsured.
“It really goes across a large swath of income ranges. About a third of the uninsured in Texas are making between 200 percent and 400 percent of the federal poverty level for a family of four. That’s a family that’s making between roughly $50,000 a year and $100,000 a year, so it’s middle class families that are making up one of the largest groups of folks who are uninsured. We wanted to figure out why is this. This goes against a lot of what we’ve heard and a lot of what the political debate has been over the last decade,” Miller said.
Miller said about 16 percent of Texas’ uninsured fall into a coverage gap.
“These are the people that if the state were to expand Medicaid would be newly eligible for coverage, so if the state did that … which we think is a cost effective solution, you solve for 16 percent of the uninsured population,” Miller said. “But you still have the remaining 84 percent and that number, as a percentage of the overall state population would, even if we got rid of the 16 percent, that number would still be the nation’s highest number and percentage of uninsured people in the country. So even expanding Medicaid would not make us go any higher than No. 50 out of 50 states in terms of uninsured population.”
