Fighting Insurance Gaps: My Testimony to Fix Healthcare Access in Texas

Texas currently maintains the highest number and highest percentage of uninsured residents in the United States, with an estimated 5 million people lacking health insurance coverage according to Census Bureau data. This uninsured rate is nearly twice as high as those found in similarly populated states, including California and Florida.

The lack of coverage has led to increased reliance on emergency rooms for both preventable and non-preventable care, which increases overall healthcare costs for taxpayers and strains the state’s medical infrastructure. Public health data indicates that when residents avoid seeking care due to medical costs, it results in worse health outcomes, including higher mortality rates and the progression of preventable diseases.

Medicaid Disenrollment and the Coverage Gap

The state’s insurance landscape was further impacted by the expiration of federal pandemic-era health protections in May 2023. This period, known as Medicaid Unwinding, resulted in the disenrollment of nearly 2.5 million Texans from Medicaid and CHIP health coverage within one year.

Of those disenrolled, 1.4 million Texans lost their coverage for procedural reasons rather than eligibility requirements. In the first month following the expiration of the protections, more than 500,000 residents lost coverage due to a combination of eligibility and procedural factors.

The debate over how to address these gaps continues to divide health policy experts. On May 14, 2024, Brian Blase, president of the Paragon Health Institute, testified before a senate committee regarding the Affordable Care Act’s Medicaid expansion. Blase argued that expansion had increased spending and caused enrollment to soar without improving population health outcomes, while simultaneously harming access to care for traditional Medicaid enrollees.

Systemic Barriers to Patient Access

Beyond the number of uninsured individuals, the Texas healthcare system faces significant infrastructure challenges. More than half of the counties in Texas currently lack access to primary care services, contributing to a growing physician shortage.

Patient advocacy groups and medical professionals have also identified barriers within existing insurance plans that limit actual access to care. The Texas Medical Association has advocated for the reform of prior authorization processes and the reduction of other burdensome health plan practices that contribute to rising costs and threaten the viability of healthcare delivery.

These concerns align with reports that some insurance plans are marketed as providing coverage but fail to offer patients practical access to medical providers. This gap between plan ownership and actual care access remains a central point of contention for healthcare reform advocates in the state.

Available Coverage Options and State Guidance

The Texas Department of Insurance (TDI) provides guidance to residents on five primary ways to obtain health insurance: through an employer, a membership or church, an insurance company or agent, the health marketplace, or a parent’s plan for those under age 26.

For those who lose employer-sponsored coverage, the state notes that COBRA provides a mechanism to remain on a plan. Students may have access to health plans provided by their college or university.

To mitigate the impact of non-healthcare needs on overall health, some innovators in Texas are working to integrate social care with medical services. The Texas Health Improvement Network (THIN) has implemented projects to screen patients for economic or social needs and link them with community partner organizations to improve general well-being.