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The percentage of uninsured Texans in 2022 dropped to the lowest in a decade

Dr. Spencer R. Berthelsen, M.D., Chairman, Board of Directors at Kelsey-Seybold, who still sees patients two days a week, visits with patient Francisco Garcia (also a doctor at Kelsey Seybold) before his annual physical at their clinic in Sugar Land. Sept. 22, 2011.
Michael Stravato for The Texas Tribune
Dr. Spencer R. Berthelsen, M.D., Chairman, Board of Directors at Kelsey-Seybold, who still sees patients two days a week, visits with patient Francisco Garcia (also a doctor at Kelsey Seybold) before his annual physical at their clinic in Sugar Land. Sept. 22, 2011.

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Texas remains the state with the most uninsured Americans, but recent estimates from the U.S. Census Bureau reveals that last year’s percentage of Texans without health coverage, 16.6%, was at one of the lowest points in a decade.

Compared to 2021 estimates, when over 5.2 million Texans lacked coverage, fewer than 4.9 million individuals were uninsured the following year, according to the bureau’s 2022 American Community Survey, released on Thursday.

This positive trend can be attributed in part to an increase in enrollment in private health care coverage, which experts say is a result of federal actions that make this type of insurance cheaper to access. The number of Texans with private health insurance increased by over 700,000 between 2021 and 2022, according to the bureau’s estimates.

Over the last decade, the percentage of Texans without insurance has fluctuated between22.1% in 2013 and 16.6% in 2022. Regardless, Texas’ uninsured rate has been last in the nation for “quite some time,” said Charles Miller, a senior policy advisor for the nonprofit research organization Texas 2036.

Miller said the 2022 estimate shows incremental improvement compared to previous years.

“Improving it is always good and we don't want to diminish that aspect of things,” Miller said. “But it's not to say that the picture is rosy and everything is fine and there's no work left to be done.”

Experts attributed the 2022 improvement to several factors.

Until this year, federal regulations prohibited states from removing anyone from Medicaid during the COVID-19 pandemic. The extended coverage allowed about 3 million Texans to continue receiving Medicaid coverage when they normally would have been removed from the program.

“Texas has historically been one of the most restrictive [states] in how we handled everything having to do with Medicaid eligibility,” said Anne Dunkelberg, senior fellow at Every Texan, a health care advocacy group.

Dunkelberg also pointed to enhanced subsidies for private insurance as part of the American Rescue Plan Act, which resulted in more people signing up for this type of coverage. Between 2021 and 2022, Texas and national Marketplace enrollment grew by nearly 550,000 individuals. The subsidies made coverage more affordable, in tandem with the pause in the periodic shedding of Medicaid recipients, which bolstered the number of Texans with insurance in 2022.

“What it does show for us is that when health insurance is affordable, working Texans and low-income Texans will take advantage of it,” said Brian Sasser, chief communications officer for the community health advocacy group Episcopal Health Foundation. “But when it's not affordable, they just don't.”

In April, federal funding legislation removed protections for Medicaid recipients and Texas began the process of deciding who should remain on rolls, which mostly served children, disabled adults and pregnant women up to two months postpartum prior to the pandemic. Since then, the state has dropped over half a million Texans from the Medicaid rolls.

The Census Bureau collected the 2022 data prior to the “unwinding” of Medicaid rolls, which means the actual number of uninsured Texans is likely higher than the most recent estimates, Sasser said.

“As great as these numbers are, and it's great to see some improvement, we'll probably just be sitting here next year with the exact opposite happening,” Sasser said.

Dunkelberg described Texas’ situation — with its high uninsured rates, strict rules to qualify for Medicaid and persistent delays in verifying eligibility — as a “worst case scenario” because the state has yet to do some of the most powerful things to keep people covered.

Notably, Texas is one of 10 states that has not expanded Medicaid eligibility under the Affordable Care Act.

The bureau’s estimates confirmed that historically uninsured groups still struggle to get coverage: The new census figures show Texans between the ages of 19 and 34 were most likely to not have health care coverage and over a quarter of Hispanic Texans were uninsured. The percentage of uninsured Hispanic Texans was more than twice the rate of uninsured white and Asian individuals, at 11.1% and 8.7% respectively.

Miller estimated that nearly half of uninsured Texans are eligible for some form of subsidies for private health insurance through the Affordable Care Act. Because health care is so closely tied to employment in the U.S., Miller said, many people who don’t receive this benefit from their job assume insurance is out of reach financially. He encouraged households earning between 100% and 150% of the federal poverty level (currently $19,720 for a two-person home) to check what subsidies may be available.

Across the country, the bureau reported that child poverty more than doubled in 2022. Researchers attribute the sharp increase in poverty levels to the end of pandemic-era interventions, such as increased child tax credit payments.

The Census Bureau also released updated data on income and poverty levels for the country Thursday as part of the ACS. Between 2021 and 2022, Texas’ median household income rose from nearly $67,000 to over $72,000. The poverty rate stayed relatively constant at 14%.

Earlier this year, a separate estimate from the Census Bureau indicated that Texas passed another demographic milestone: the point at which Hispanic residents make up more of the state’s population than white residents.

The full program is now LIVE for the 2023 Texas Tribune Festival, happening Sept. 21-23 in Austin. Explore the program featuring more than 100 unforgettable conversations coming to TribFest. Panel topics include the biggest 2024 races and what’s ahead, how big cities in Texas and around the country are changing, the integrity of upcoming elections and so much more. See the full program.

William Melhado is a Poynter-Koch fellow for 2022-23 and a general assignment reporter on The Texas Tribune’s breaking news team.