In 2016, The Commonwealth Fund’s Scorecard on State Health System Performance ranked Texas 44th (up a few spots from 47th in 2009) out of the 50 states and the District of Columbia. It earned especially low marks in the categories of access and prevention and treatment. For the scorecard’s data year of 2011 to 2012, 32 percent of adults ages 19 to 64 were uninsured and 16 percent of children ages 0 to 18 were uninsured. The percentage of adults with a usual source of care was 68 percent – the all-state median was 78 percent. More details about how the state was rated are available in the Texas Scorecard.
In the 2016 America’s Health Rankings, Texas climbed to 31st after holding 36th in the nation in terms of overall health. This may have been helped by a 13 percent decrease in smoking from one year to the next. The state’s strengths include a low prevalence of smoking, low rate of drug deaths and high immunization coverage among teens. However, it faces challenges that include a high prevalence of physical inactivity, a high percentage of children in poverty and limited availability of primary care physicians. Poor mental health days were a key challenge for Texas based on previous rankings, but from 2013 to 2016 the state saw a decrease of 11 percent in this realm, too.
Trust for America’s Health provides another look at overall public health in Texas in their 2015 listing of Key Health Data About Texas, which includes information on specific diseases and health outcome predictors. The Robert Wood Johnson Foundation has also compiled health factors and outcomes data in Texas on a county level; you can use this interactive map to see how the counties in Texas compare with one another. You will find many top health clinics in Lakeway Texas.
Texas and the Affordable Care Act
In 2010, Texas’s U.S. Sens., John Cornyn and Kay Hutchison, Republicans, both voted no on the ACA. In the U.S. House, 20 Republican representatives from Texas voted no, while 12 Democrats voted yes. Ted Cruz has since replaced Hutchison in the Senate, and is one of the country’s most outspoken opponents of the ACA. In the House, representatives from Texas currently include 12 Democrats and 24 Republicans.
Gov. Rick Perry is also staunchly opposed to the ACA and has a state legislature with a strong Republican majority. The state opted to let HHS run the exchange, has refused to expand Medicaid, and has even worked to make it more difficult for navigators to do their job in Texas.
How did Obamacare help Texas residents?
Before the ACA was implemented, the uninsured rate in Texas was 27 percent, giving Texas the dubious honor of having the highest uninsured rate in the country. Unfortunately, that rate is still hovering at nearly a quarter of the state’s population: 24 percent of Texas residents were still without health insurance as of the end of June 2014, six months after full Obamacare implementation. After the first half of 2015, a Gallup poll showed Texas’ uninsured population had fallen to 20.8 percent.
This is still by far the highest rate in the nation. Texas is the only state with more than 20 percent of its population uninsured. Wyoming has the next-highest rate with 18.2 percent of its population uninsured.
Texas leaders have been vocally opposed to the ACA, and the state has thus far refused to expand Medicaid, so a cornerstone of the law’s ability to reduce the uninsured rate is unavailable in Texas. Despite having a long ways to go, the state continues to have the third highest exchange enrollment in the country, following California and Florida.
Texas enrollment in qualified health plans
Texas went into the 2016 open enrollment with a much larger uninsured population and pool of potential exchange enrollees than most states. In November 2013, the Kaiser Family Foundation estimated that 3,143,000 Texas residents were potential exchange customers, and that 2,049,000 of them would qualify for premium subsidies.
By mid-April 2016, when the first open enrollment period ended, 733,757 Texans had finalized their enrollment in qualified health plans through the exchange, and HHS reported that 84 percent of them had their premiums reduced with subsidies.
As of March, HHS reported that 1,205,174 had enrolled in private plans through Texas’ exchange during the 2015 open enrollment period. However, that number dropped to 943,218 by June 2015 due to people dropping coverage or failing to make their premium payments. Of the remaining enrollees, 85.3 percent were receiving advanced premium tax credits and 59.1 percent were receiving cost-sharing reductions.
For the 2016 coverage period, eight Texas exchange 15 carriers requested double-digit rate increases for some of their plans. Among them was Time Insurance, which belongs to Assurant Health and exited the individual market for the upcoming year. Time Insurance had proposed rate hikes up to 65 percent in Texas. HHS reviews proposed premiums for exchange plans in Texas and four other states.
One Texas carrier, Blue Cross Blue Shield of Texas, announced it will stop offering individual PPO plans in 2016 and will only offer HMO options in the individual market.