News Ticker

Come and Take It

Texas, and many other states, challenge poor patients to obtain health care coverage. (Volume 9, Issue 22)

The Affordable Care Act (ACA) and the future of health care in America sits in the crosshairs of Donald Trump and the Republican party. Even in Texas – a state in the heart of conservative America that chose not to expand Medicaid, the ACA still led to a 6% increase in insurance rates. But three million individuals living in Texas are still uninsured, a quarter of whom could be covered through expansion of Medicaid under the ACA.

Studies have shown the ACA to be . Texas itself has seen an increase in insurance rates comparable with other Medicaid non-expansion states. These gains are most pronounced for several subgroups in Texas, including individuals with fair-to-poor health, those aged 50-64 years, Hispanics, and those with English as a dominant language. Hispanics in Texas received the largest benefits from passage of the ACA, due to a combination of outreach targeting Hispanic communities and worse pre-ACA insurance rates.

But Texas continues to represent a large proportion of our nation’s uninsured. Further expansion of Medicaid would provide immediate coverage to an additional 750,000 individuals within the state.

Analysis of post-ACA insurance rates showed large increases among individuals who were English-dominant speakers and had Internet access. These facts highlight the need for further outreach to non-English speaking communities as well as improving access to information and technical support for individuals in poor settings.

The Texas legislature will soon find itself at a political crossroads. The election of Donald Trump as president and appointment of Dr. Tom Price to the Department of Health and Human Services makes a repeal of the ACA very likely. Federal payments for Medicaid services and uncompensated care provided in Texas hospitals will decrease in 2018, placing the state’s medical system at financial risk. These financial burdens will grow exponentially with the loss of the ACA. Texans will be faced with a choice between the financial health of their medical system and the patients it serves versus fighting for government programs that have been politically demonized in recent years.

commentary by Orlando Sola


OBJECTIVES: To examine the effects of the Affordable Care Act’s (ACA’s) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least.

METHODS: We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016.

RESULTS: Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74.7% to 80.6%; P?=?.012) after implementation of the major insurance provisions of the ACA. The 4 subgroups with the largest increases in adjusted insurance coverage between 2013 and 2016 were persons aged 50 to 64 years (12.1 percentage points; P?=?.002), Hispanics (10.9 percentage points; P?=?.002), persons reporting fair or poor health status (10.2 percentage points; P?=?.038), and those with a high school diploma as their highest educational attainment (9.2 percentage points; P?=?.023).

CONCLUSIONS: Many population subgroups have benefited from the ACA’s Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA’s Medicaid expansion is a means to address the lack of coverage.

PMID: 27854535 

Pickett, S, et al. Am J Public Health. 2017 Jan; 107 (1): 120-126.

Orlando Sola, MD, MPH
About Orlando Sola, MD, MPH

Orlando Sola is an assistant clinical professor in the Department of Family Medicine at SUNY-Downstate Medical Center. He trained at the Institute for Family Health/Mount Sinai Hospital. He obtained his medical degree from Columbia University’s College of Physicians and Surgeons and completed his Masters in Public Health at Johns Hopkins Bloomberg School of Public Health. Contact: Website | Facebook | Twitter | More Posts