Semro column: The uninsured — A tale of two states |

Semro column: The uninsured — A tale of two states

In any given state, the number of residents who have insurance is one measure of how good or bad its health care system is. People who have coverage are more likely to receive the medical and preventative care necessary to support good health.

People who are uninsured often have inadequate access to quality care and preventative services. As a result, the uninsured can have worse health outcomes, higher mortality and premature death rates. This is especially true of diseases like cancer, where the uninsured have a greater risk of late-stage diagnosis.

The uninsured also have more expensive medical bills. They’re more likely to pay higher prices than insured patients. In addition, undiagnosed or untreated chronic conditions often require more extensive and higher-cost treatment. And the uninsured are more likely to get treated in emergency rooms, where health care is the most expensive.

The Affordable Care Act (ACA) was passed in 2010. By 2016, the number of uninsured Americans dropped by almost 20 million. Since then, that trend line has started moving in the other direction. According to the U.S. Census Bureau, over 700,000 Americans lost coverage in 2017 with an additional two million losing coverage in 2018.

According to the Georgetown University Center for Children and Families, the number of uninsured children increased by 400,000 (5.2%) between 2016 and 2018. More than four million American children were uninsured last year.

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With that trend in mind, it might be interesting to look at the uninsured problem from a more local level, by comparing two different states. In 2006, Massachusetts was the state that implemented a health-care reform package that the ACA was ultimately built on. Massachusetts adopted virtually all of the new reforms offered in the ACA, including the state expansion of Medicaid.

In contrast is Texas, a red state that opposed the ACA and many of its reforms. Beginning in 2011, Texas signed on to every court case challenging the ACA, even though an additional 1.3 million Texans got insurance coverage in the six years after it became law. In April of 2018, Texas, along with 19 other red states, filed the latest challenge to the ACA’s constitutionality. The original case was titled, Texas v. United States.

So, how do these two states compare? When it comes to reducing the number of uninsured, Massachusetts ranks first in the country while Texas rates dead last.

Massachusetts has an uninsured rate of 2.7%. Only 1.2% of the state’s children are uninsured. The uninsured rate in Texas is 17.7%, totaling almost five million people. The state has the highest uninsured rate in the nation for women aged 18-44. And, 11.2% of all children in Texas, a total of 873,000 kids, are uninsured.

Texas is one of 14 states that haven’t expanded Medicaid. If the state did so, they could cover an additional 1.1 million low-income Texans. This year, Texas lawmakers once again refused to expand Medicaid or support bills that would have allowed a public vote on the question.

But, this trend doesn’t end with Texas. Seventeen states have uninsured rates higher than 10%. Fifteen of those states are red states and only two have expanded Medicaid. Only five states have uninsured rates that are 15% or higher. All five are red states. Only one of the five has expanded Medicaid.

Nine states have uninsured rates for children higher than 7%. Eight of them are red states. And the only state with an uninsured rate for children greater than 10% is Texas.

Maybe it’s not a coincidence that red states have the highest numbers of uninsured, given Republican opposition to ACA reforms. That said, the Trump administration and the previous Congress have played their parts, too.

Their list of health-care achievements includes multiple attempts to repeal the ACA and cut Medicaid funding, delays in funding the Children’s Health Insurance Program (CHIP), repealing the ACA’s individual mandate provision and federal cuts to enrollment assistance and outreach.

The administration rolled back ACA regulations in order to promote limited-benefit plans that offer substandard coverage and can exclude people with pre-existing conditions. Last month, an effort to bring those regulations back failed on a party line vote in the U.S. Senate.

Congress and the administration also cut funding to federal reinsurance programs and subsidies, something that states like Colorado have had to replace in order to reduce premium costs. Most recently, the administration’s new “public charge” rule has created a level of confusion and fear that discourages eligible immigrants from enrolling in CHIP or Medicaid.

By this one measure, at least, one could ask whether this political opposition to current health-care reform is any way productive. Are these attempts to repeal, dismantle and oppose specific reforms of the ACA really helping Americans, especially in red states? Perhaps supporters of this strategy should ask the uninsured.

Bob Semro of Glenwood Springs is a former health policy analyst for the Bell Policy Center, and a legislative and senior advocate. His column appears monthly in the Post Independent and at

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