Texas Health Care

Texas Health Care:
Current Action & Policy Issues

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Latino Policy Summit
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Anne Dunkelberg, Associate Director – dunkelberg@cppp.org

Center for Public Policy Priorities
Saturday, October 19, 2013

CPPP.org
1

Most Uninsured Texans are WorkingAge Adults, 2011
81,000
3% of Texas Seniors
uninsured

65+
<2/3 are
below 200%
FPL

63% are below
200% FPL

6.1 million uninsured
Texans (23.8% of all ages)

0-18
1.2 million
Rate: 16.3% of 0-18
are uninsured

19-64

Compare to
Massachusetts:
219,000, just 3.4% of
all ages

4.8 million
Rate: 30.9% of 19-64
are Uninsured

Source: U.S. Census,
March 2012 CPS

2

Texas Uninsured by Income 2011…
89% of the 6.1 million uninsured have incomes <400% FPL
>400% FPL
>$89,400

656K

300-400% FPL
$67,050-$89,400

501K
250-300% FPL
$55,875-$67,050

<100% FPL
<$22,350/yr for
family of four

1.912 Million

6.1 million includes 1.7
million non-US
citizens; ~2/3 of these
(about 1.1 million)
likely undocumented

421K

626K
614K

200-250% FPL
$44,700-$55,875

921K

100-125% FPL
$22,350-$27,938

525K

150-200% FPL
$33,525-$44,700

125-150% FPL
$27,938-$33,525

Annual income limits given for a family of four, 2011 federal poverty level
CPS

U.S. Census, 2012
3

Figure 4

Hispanics have particularly high uninsured rates.
Insurance Coverage of Hispanics in the United States and Texas, 2011:

Employer/Other Private

Medicaid /Other Public

32%

30%

38%

25%

39%

37%

United States

Texas

Data may not total 100% due to rounding.
SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS.

Figure 5

Hispanics in Texas have particularly high stakes in the
Medicaid expansion decision.
Nonelderly Uninsured <138% FPL by Race/Ethnicity
United States

Texas

Black
17%
Hispanic

Hispanic

63%

35%
Black
11%

White
40%
Asian/
Pacific
Other
Islander
2%
5%

Total = 25.4 Million
NOTE: Totals may not sum to 100% due to rounding.
SOURCE: KCMU/Urban Institute analysis of 2011 American Community Survey

White
21%

Asian/
Other Pacific
1% Islander
3%

Total = 3.1 Million

ACA Coverage and Coverage Gap
>$94,200 for a
family of four;
>400% of FPL

Job-based coverage, or
Full-cost coverage in the exchange

Family Income

$70,650-$94,200;
300-400% of FPL

Subsidized exchange coverage: premiums capped at
9.5% of income

$47,100-$70,650;
200-300% of FPL

Subsidized exchange coverage: premiums capped at
6.3 – 9.5% of income

$31,322-$47,100;
133-200% of FPL

CHIP

<$31,322 for a
family of four;
< 133% FPL

• Job-based coverage, or
• Subsidized exchange
coverage: premiums capped
at 2% - 6.3% of income

Medicaid

Coverage Gap below
poverty line
($23,550 for family of four)

Children

Adults
(not eligible for Medicare or Medicaid today)

Family income based on 2013 federal poverty income levels for a family of four

The Texas Coverage Gap
• About 1 million U.S. citizen
adults < 100% FPL are
uninsured in Texas and will
have no coverage options.
• The average “coverage
gap” Texan works in frontline entry-level positions
such as:
– Retail trade
– Accommodation and food
services
– Healthcare and social
assistance, and
– Construction

6.1 million uninsured

Michael E. Cline, Ph.D., and Steve H. Murdock, Ph.D. , Rice University, Estimates
of the Impact of the Affordable Care Act on Counties in Texas, April 2012.

Texas Medicaid/CHIP: Who is Helped Today

CHIP,
591,756

January 2013, HHSC data

Disabled,
422,467

Elderly,
326,501
Poor Parents,
144,040

Medicaid
Children,
2,547,199

Total enrolled 1/1/2013:

3.6 million Medicaid;
TANF Parent,
83,772
Maternity
86,975

592,000 CHIP
1 in 7 Texans,
but 42% of Texas kids

8

8

Status of State Action on the Medicaid Expansion
Decision, as of September 30, 2013

Source: KFF.org
9

Large Urban Counties & Medicaid Expansion
2014-2017: Share of $6 billion new statewide annual federal
health care spending
El Paso

Dallas

Harris

Lubbock

Travis

$222
million

$580.1
million

$935.3 million

$77.7
million

$224.1
million

Uninsured
NOW

208,379

601,492

1,025,922

66,405

233,067

Estimated #
Gaining
Medicaid

51,462

131,042

223,165

19,693

55,676

Yearly Avg.
NEW Fed $

Sources: Texas HHSC projections of ACA Medicaid expansion costs; THHSC
historical Medicaid spending by county, 2010. Cline & Murdock estimates of
ACA insurance gains by county.
10

Largest South Texas Metro Counties & Medicaid
Expansion: 2014-2017 Share of $6 billion new statewide annual
federal health care spending
Bexar

Cameron

Hidalgo

Nueces

Webb

NEW Fed $

$ 503.5
million

$ 198.4
million

$ 404.7
million

$ 127.1
million

$92.0
million

Estimated
# Gaining
Medicaid

179,654

27,987

50,509

22,403

16,031

One-year
Avg.

Sources: Texas HHSC projections of ACA Medicaid expansion costs; THHSC
historical Medicaid spending by county, 2010. Cline & Murdock estimates of ACA
insurance gains by county.
11

Subsidies in the Marketplace
• Advanced Premium Tax Credits
– Individuals and families b/w 100 and 400% of
poverty (FPL)
– Sliding scale relative to income
– Must be used to purchase inside the
Marketplace
– Can be paid directly to insurer, so you only owe
the balance as a monthly premium

• Cost-Sharing Reductions
– Individuals and families b/w 100 and 250% FPL
– Lower deductibles and copays
– Must select a silver-level plan to qualify

Family
Size

Annual income range –
premium credits

1

$11,490-$45,960

2

$15,510-$62,040

3

$19,530-$78,120

4

$23,550-$94,200

Family
Size

Annual income range –
cost sharing reductions

1

$11,490-$28,725

2

$15,510-$38,775

3

$19,530-$48,825

4

$23,550-$58,875

13

Coverage Level Options in the
Marketplace
Essential Health Benefits

ambulatory services;
2. emergency services;
3. hospitalization;
4. maternity and newborn
care;
5. mental health and
substance use disorder
services;
6. prescription drugs;
7. rehabilitative and
habilitative services and
devices;
8. laboratory services;
9. preventive and wellness
services and chronic
disease management
10. pediatric services dental
and vision care
1.

% paid by
enrollee

% covered by plan

Platinum
Gold

90%
80%

Silver

70%

Bronze 60%
0%

20%

40%

60%

10%

20%
30%
40%
80%

100%

Catastrophic plan for people under 30; or if no other
coverage is affordable
14

In-person Assistance to Enroll in
Marketplace

In-person assistance:
• Agents/Brokers
• Navigators
• Certified Application
Counselors (CAC)

15

Get Involved, Stay informed!
Unless our leaders take action , on January 1, 2014:
• an uninsured parent with two children living on $18,000 will have NO
help from ACA for health coverage, but
• another uninsured parent with 2 children earning $20,000 a year will
qualify for full coverage on a sliding scale for $33 a month or less.

A Diverse network of Texans and Texas organizations will keep working
to find health care for the Texans in the “Gap Group,” to tell their
stories, and to seek inclusion of Texas’ working poor in the ACA’s
health reform.
www.cppp.org You can link to all the websites below from our CPPP
website:
www.covertexasnow.org; www.TexasLeftMeOut.org
www.texaswellandhealthy.org
16

FAMILY BUDGETS

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© CPPP
Center for Public Policy Priorities
7020 Easy Wind Drive, Suite 200
Austin, TX 78752
P 512.320.0222 F 512.320.0227

CPPP.org

Figure 18

The Texas Medicaid expansion decision has important
impacts for the overall uninsured and Hispanics
nationally.
Distribution of Total Uninsured <138% FPL

Distribution of Uninsured Hispanics ≤138%
FPL

CA
15%

CA
26%

TX
12%
FL
9%
Other
States
49%

GA
5%
NY
IL4%
NC
4%
4%

Total : 25.4 Million
NOTE: Totals may not sum to 100% due to rounding.
SOURCE: KCMU/Urban Institute analysis of 2011 American Community Survey

TX
22%
Other
States
43%

FL
9%

Total: 8.9 Million

Texas Health Care

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