Texas tops states again in uninsured rates, but Travis County improves


U.S. Census Bureau figures show that 17.3 percent of Texas residents didn’t have health insurance in 2017.

In Travis County, ranks of uninsured declined from 14.4 percent in 2015 to 11.9 percent in 2017.

While Texas continued to top out as the state with the highest percentage of uninsured residents, Travis County saw its percentage of insured people increase nearly three points in 2017, according to new U.S. Census Bureau numbers released Thursday.

About 11.9 percent of Travis County residents were uninsured last year, compared with 14.4 percent in 2015, the Census Bureau reported.

Among the 10 most-populated metropolitan areas in Texas, the Austin-Round Rock area had the second-lowest uninsured rate at 11.7 percent. That figure was about a third of the 30 percent uninsured rate for the McAllen-Edinburg-Mission metro area, the highest percentage in the state.

“Obviously I’m always excited to hear that we are trending up instead of trending down in the insurance status of the county,” said Kit Abney Spelce, senior director of eligibility services for Travis County’s health district, Central Health.

The area’s improvement came in a state where 17.3 percent of its residents, the largest share in the nation, were uninsured in 2017. Zoom out and look at the top 40 metropolitan areas in the United States, and Austin-Round Rock ranked ninth for uninsured residents.

Houston, at 18.2 percent, led the country for the highest percentage of uninsured residents, and San Antonio-New Braunfels (14.5 percent) ranked fourth. Nationwide, 8.7 percent, or 28 million Americans, weren’t insured in 2017, virtually matching the overall percentage reported by the Census Bureau for 2016.

With an uninsured rate of 8.9 percent, Williamson County ranked first among Texas counties with at least 65,000 estimated residents in 2017. Bastrop County’s rate of 16.5 percent was nearly double that figure.

In Travis County, Abney Spelce said the health district has continually funded organizations that assist with Affordable Care Act sign-ups. The district also puts advertising dollars toward educational campaigns promoting enrollment in the program.

“Central Health has always realized it is in our best interest and the community’s best interest to get folks into insurance, and we’re a payer of last resort,” Abney Spelce said.

The health district works to fill in the gaps for people who can’t afford insurance by offering the Medical Assistance Program, or MAP, she said. While not an insurance plan, the program provides health care coverage for residents at or below 100 percent of the federal poverty income line.

Anthony Turner, 56, said the program helped him find care for his formerly untreated diabetes and alcoholism at a time when he was not sure if he would ever find coverage. Turner, an Austinite who has been homeless and has been in and out of jail, said the program was a lifeline.

“MAP was there for me when I needed it,” Turner said, adding that, with his improved health, he’s been able to apply for a job for the first time in years. “If it wasn’t for MAP, I probably wouldn’t have gotten the treatment I needed.”

About two months ago, Turner was able to move off MAP and onto disability insurance.

The number of MAP enrollees increased by about 6 percent in the past year, Abney Spelce said.

That was largely because of a change in Central Health policy in January 2017, she said, which raised the income level requirement for non-legal-permanent residents to 50 percent of the federal poverty level and to 100 percent for those with two or more chronic conditions.

Texas’ repeat designation as the state with the highest percentage of uninsured residents didn’t surprise Abney Spelce, nor Dr. Clay Johnston, who’s dean of the University of Texas Dell Medical School. They attribute it to Texas’ decision not to expand Medicaid eligibility as allowed under the Affordable Care Act.

The numbers released Thursday show that the uninsured rate in states that expanded Medicaid eligibility before 2017 was lower, 6.5 percent, than in states that did not expand eligibility, where it was 12.2 percent.

“There are billions of federal dollars going to other states that are helping to support their health care systems,” Johnston said. “We are losing out on that because we can’t come up with a solution that extends support to more people.”

Aside from expanding Medicaid, Johnston said one of Dell Medical School’s founding goals was to develop new models of care that would reduce costs by focusing spending on holistic, preventative treatment. 

Dr. Deane Waldman, director of the Center for Health Care Policy at the conservative-leaning Texas Public Policy Foundation, agreed that a change in health care spending could improve Texas’ uninsured rate, but he disagreed that Medicaid expansion is the way to do it.

Waldman said the Affordable Care Act creates unnecessary costs and doesn’t necessarily lead to better care.

“We’re looking at coverage when we should be looking at access to care,” Waldman said. “We can create a safety net with a little personal responsibility thrown in as long as we get rid of all the waste that is going on.”

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