Full ACA Expansion Would Cut Local Uninsured Rate By Half, Study Finds

Full expansion of the Affordable Care Act (ACA) in Texas would cut the uninsured rate in the four-county Dallas-Fort Worth metropolitan area by more than half, according to an estimate by two Rice University demographers.

A recent U.S. Census Bureau survey found that 23 percent of Texans lacked health insurance in 2011, which represents the nation’s leading uninsured rate.

Demographers Steve Murdock and Michael Cline assert that about 3 million out of 5.9 million uninsured Texans would have insurance in 2014 if the state embraced health reform.

Locally, that would mean more than 600,000 in Dallas, Tarrant, Collin and Denton counties would be covered.

Gov. Rick Perry has declared that Texas would not participate in the ACA’s Medicaid expansion. Not doing so would cut those coverage gains by half—meaning a quarter of the current uninsured would be covered. The Medicaid expansion would have covered Texan adults up to 138 percent of the federal poverty level (FPL). Without expansion, those between 100-138 percent of FPL are eligible to participate in the health insurance exchanges. Those below 100 percent FPL would have to fend for themselves.

The demographers estimated that Dallas County’s 14.1 percent uninsured rate under full expansion would be the second-highest among Texas urban counties—trailing only Hidalgo at 15 percent.

They called the estimate the “moderate” assumption. They also calculated a more conservative “limited” and a liberal “enhanced” assumptions, indicative of possible but less likely outcomes. Under the limited assumption, about 276,500 in the four-county area would gain coverage. The “enhanced” assumption would yield more than 900,000 newly insured.

The report weighed the impact of five key ACA provisions:

• a health insurance exchange that subsidizes households up to 400 percent of FPL;

•  mandates and penalties for not buying insurance;

• Medicaid expansion;

• allowing young adults under 26 to remain on their parents’ health plan;

• and tax credits for small businesses and nonprofits, which would cover at least half of premium costs for employees’ health insurance coverage.

In an interview, Cline said Denton and Collin counties already have a relatively high insured rate so coverage expansion will have less impact. Two key factors that would elevate uninsured rates after ACA implementation is having a higher percent of lower-income residents and greater undocumented populations. Cline said Dallas and Harris counties have the state’s largest concentrations of undocumented immigrants.

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.