As the number of unemployment claims rises, so will the number of Texans who end up uninsured. What solutions are possible to prevent so many Texans from falling through the cracks? Judy Maggio talked with Anne Dunkelberg, a local health care policy expert, to get some answers.
Judy Maggio: How is the pandemic magnifying some of those issues that you've studied so closely?
Anne Dunkelberg: I think the first thing that jumps out is we have in the most recent year that we have census data for, we have five million uninsured Texans. That's the worst number and percentage of the country. And so, one of the ways that Covid-19 is magnifying that is by shining a light on all of those folks who don't have coverage, creating questions about how they are gonna be able to get testing? And will the subset of our uninsured who aren't U.S. citizens have special barriers to getting it? So that's one piece of it that we've been super-concerned about.
And then, just this huge concern is with, over 2.2 million Texans already have applied for unemployment. We're getting estimates that a gigantic number of those are in fact, losing their employer-sponsored coverage and have some sobering projections that half of them will not get coverage from another source.
JM: So many people are already falling through the cracks because they may be making too much money to qualify for Medicaid. What are the options for them to find insurance?
AD: One of the positive things is there are a lot of folks who can get coverage through the Affordable Care Act marketplace now. The bottom line is some of our folks who are very low income now, particularly if they're getting that extra $600 a week, that's a special unemployment benefit during the pandemic, they may temporarily be able to get coverage through the marketplace with really generous subsidies. So it's decent coverage, low out of pocket costs with a good subsidy on the premium too.
Before Covid-19, we were estimated to have about 1.5 million of our uninsured Texans, who if we did Medicaid expansion, those adults would get coverage. Now, some of these recent estimates from the Kaiser Foundation suggest that come next January when a whole lot of people will have lost their unemployment benefits unless the government changes something and extends them, they're gonna find themselves not with a new job and not with any unemployment income, and without a Medicaid option in Texas, despite that super-low income. So they're very concerned that come January, we could be looking at over two million Texans who are uninsured and can't get coverage in the ACA marketplace because they're too poor.
JM: So let's talk about solutions. Obviously one solution your organization backs is expanding Medicaid in Texas. But what about other solutions? Do you think that some of the policies that perhaps were shot down at the state capital and even the nation's capital would get more bipartisan support now that so many more people are finding themselves without employer-based health insurance?
AD: Well, I hope, I mentioned 1.5 million of our uninsured are in this problem with Medicaid expansion of not having access to it. That still leaves another three and a half million uninsured Texans. And so, we need solutions all the way across the board for them. For our lower-income folks, there's not much of a substitute for Medicaid expansion. It would bring us $10 billion a year in Federal funds. We don't really have a workaround for that. Although there may be, as you said, the fact that so many more Texans will be suffering. And in that uninsured group, that maybe the politics will shift somewhat, and we will finally get to where the majority of other states have done.
There are some problems with our uninsured situation that Congress has to fix for us. One is that we do have, again, some badly written parts of the law so that there are some people who even though their family income is low and above poverty, they still are excluded from getting subsidies in the marketplace. And we also just need more affordable coverage in the marketplace. We need a little bit more generous subsidies. People need to not have really high deductibles and really high co-payments because that discourages people from getting coverage. So, there are several pieces of public policy steps. Some of them are in the hands of Governor Abbott and the Legislature. Others are in the hand of Congress and the President. But we're gonna need both of them if we have the kind of increase in the uninsured that we're afraid we're looking at over the next nine months.
This interview has been edited and condensed for clarity.
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