Based on the Census Bureau’s newly released report on national income, poverty, and health insurance coverage in 2012, the rates of those without health insurance declined nationally and in many states, including Texas and California.
Considering there is much noise in annual uninsured data, let us consider two-year average data from 2009-2010 to 2011-2012. These data show that across the nation the number of uninsured fell by 1.2 million to 48.2 million, decreasing the uninsured rate by 0.6% to 15.6%.
Between these two periods, California and Texas, the nation's largest economies and populations, also noticed declines in their uninsured rates but for different reasons.
While Texas' total uninsured remained essentially unchanged at 6.3 million, the uninsured rate fell by 0.9% to 24.2%. California's uninsured decreased by 66,000 to 7.1 million, in which its uninsured rate fell by 0.6% to 18.8%. Although the greater decline in California's total uninsured compared with Texas indicates that the Golden State's health care coverage condition improved more than the Lone Star State’s (and this tends to make the headlines), this discounts the fact that the uninsured rate declined faster in Texas (see chart below) and overall does not tell the whole story.
Texas' Uninsured Rate Improves Faster than California's
There are several issues we must consider: 1. Population growth, 2. Uninsured characteristics, and 3. Access to care.
Over these two-year periods, Texas’ population increased by 3.5%, or 911,000, and California’s increased by only 2%, or 767,000. The flood of people looking for more opportunity in Texas also comes at a price of potentially more uninsured. With California’s total population totaling 1.5 times larger than in Texas, this 144,000 greater population increase in Texas reveals more about how substantial the decline in the poverty rate of 0.9% is compared with 0.6%.
We must also consider the make-up of the uninsured. A recent report notes that only a small percentage of Texans who want health insurance cannot afford it. Other uninsured Texans can afford to purchase it but choose not to, are eligible for Medicaid or CHIP but have not enrolled, or are undocumented workers.
Finally, the larger increase in health insurance coverage does not necessarily equate to an increase in health care services. This is clear from California’s Medi-Cal program that has the lowest Medicaid reimbursement rates to doctors in the nation, forcing many doctors to refuse those patients. Despite other states having a lower uninsured rate than Texas, this does not mean that individuals in those states get more health care services.
Some would like to believe that these data reveal how terrible the Texas model is because so many Texans do not have health care coverage. However, even without overlooking the issues above, Texas' health care sector has room for improvement. Through more choice given to individuals and pro-market reforms, Texas' health care services can be the best in the nation.
Vance Ginn, Ph.D.