Inside the coverage gap maps
Texas and the Affordable Care Act: Key facts
1.5 million people would qualify for Medicaid were Texas to expand coverage to working-age low income adults. With the Medicaid expansion, the uninsured rate in Texas would be cut by half.
Texas would realize an additional $128.1 billion in federal funding over the 2015-2024 time period (a 42 percent growth) were it to expand Medicaid, with additional state outlays of only $13.5 billion (a 6 percent growth) over the same time period.
1.2 million people selected an exchange plan by February 2015, nearly 40 percent of those who are eligible. The vast majority (86 percent) of exchange plan enrollees qualify for premium tax subsidies.
Texas relies completely on the federal exchange and has established neither a partnership arrangement nor a plan management arrangement with the federal government.
In Figure 1 we present county-level data which show the percent of uninsured adult residents. Figure 1 shows that in 131 counties, the proportion of uninsured adults stands at 30 percent of the total adult population or higher; in 249 counties, the number of uninsured Texans as a proportion of all adults stands at 20 percent or higher.
Note: No Texas county shows less than 16.9 percent uninsured adults as a percentage of the total adult population.
Source: 1. U.S. Census Bureau. (2015, March). Small Area Health Insurance Estimates (SAHIE): 2013 estimates. Retrieved May 8, 2015 from www.census.gov/did/www/sahie/data/20082013/index.html;
2. U.S. Department of Housing and Urban Development. (2015). HUD USPS ZIP Code Crosswalk. Retrieved on April 20 from www.huduser.org/portal/datasets/usps_crosswalk.html
Figure 2 shows the proportion of uninsured adults by county who have family incomes at or below 138 percent of the federal poverty level. In no county is less than 24 percent of the uninsured adult population Medicaid-eligible. In 150 counties, 40 percent or more of the uninsured adult population are Medicaid-eligible.
Note: When considering Texans eligible for Medicaid expansion coverage, in no county is less than 24 percent of the adult population eligible.
Source: 1. U.S. Census Bureau. (2015, March). Small Area Health Insurance Estimates (SAHIE): 2013 estimates. Retrieved May 8, 2015 from www.census.gov/did/www/sahie/data/20082013/index.html
2. U.S. Department of Housing and Urban Development. (2015). HUD USPS ZIP Code Crosswalk. Retrieved on April 20 from www.huduser.org/portal/datasets/usps_crosswalk.html
Because Texas is a non-Medicaid-expansion state, those with family incomes between 100 percent and 138 percent of poverty can qualify for premium subsidies through the Exchange. But Medicaid coverage would offer even greater financial protection for the state’s poorest residents, because cost sharing is more modest and premiums would not be imposed. To be sure, some number of uninsured poor adults would not qualify for Medicaid under an expansion because they would not satisfy Medicaid’s legal residency requirements; at the same time, the statewide Medicaid impact estimate of 1.5 million eligible adults underscores that expanding Medicaid would aid the vast majority of poor uninsured adults.