HRMS Issue Brief 12

Hispanics and women in Texas showed the largest percentage of reductions in rates of uninsured since enrollment began in the Affordable Care Act’s (ACA) Health Insurance Marketplace, according to a new report released June 2  by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

The Health Reform Monitoring Survey (HRMS)-Texas report is based on the HRMS, a national project that provides timely information on implementation issues under the Affordable Care Act (ACA) and changes in Health Insurance Coverage and Related Health Outcomes. The Baker Institute and the Episcopal Health Foundation are partnering to fund and report on key factors about Texans obtained from an expanded representative sample of Texas residents. They have published 12 reports in the series:   

• "Change in Insurance Status of Adult Texans By Demographic Group as of March 2015" (released June 2, 2015)
• "Effects of the Affordable Care Act on Health Insurance Coverage in Texas as of March 2015" (released April 30, 2015)
• "Marketplace Plans: Premiums, Network Size and Market Competition" (released Nov. 10, 2014)
• "Preparing for the Second Marketplace Open Enrollment Period in Texas" (released Oct. 16, 2014)
• "Affordability of Marketplace Plans in the Largest Metropolitan Areas of Texas" (released Sept. 23, 2014)
• "Insurance status of adult Texans and characteristics of the uninsured as of June 2014" (released Sept. 3, 2014)
• "Affordability of Marketplace Plans for the Marketplace Target Population" (released July 8, 2014)
• "The Experience of Texans with healthcare.gov" (released June 11, 2014)
• "The Affordable Care Act and Hispanics in Texas" (released May 9, 2014)
• "Early Effects of the Affordable Care Act on Health Insurance Coverage in Texas for 2014" (released April 14, 2014)
• "The Affordable Care Act and Texas' 'Young Invincibles'" (released March 31, 2014)
• "Were Texans Satisfied with the Cost of Health Care and Health Insurance Prior to the Affordable Care Act?" (released Feb. 10, 2014)

The Rice University/Episcopal Health Foundation news release on the latest report, "Change in Insurance Status of Adult Texans By Demographic Group as of March 2015," by Vivian Ho and Elena Marks, follows:

HOUSTON – (June 1, 2015) Hispanics and women in Texas showed the largest percentage of reductions in rates of uninsured since enrollment began in the Affordable Care Act’s (ACA) Health Insurance Marketplace, according to a new report released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

The report found that from September 2013 to March 2015, the percentage of Hispanics without health insurance fell 38 percent (from 39.1 percent uninsured to 24.3 percent), more than any other ethnic group. The percentage of uninsured women fell 32 percent (from 26.4 percent uninsured to 18 percent).
“Hispanics in Texas had the lowest rates of coverage before the ACA, which meant they had the most to gain from the act’s Health Insurance Marketplace," said Elena Marks, president and CEO of the Episcopal Health Foundation and a nonresident health policy fellow at the Baker Institute. “In Texas, because so many of our residents are Hispanic, it’s important that this group become insured to increase the overall rate of coverage across the state.”

Women were more likely to be uninsured than men before the ACA, and the new report found that is still true, but the gap is closing. The survey found 16 percent of Texas men are now uninsured compared with 18 percent of women -- the gap was 6 percentage points in 2013.
As the authors reported earlier this year, the overall rate of uninsured Texans decreased from 24.6 percent to 16.9 percent from September 2013 to March 2015. The decreases in uninsured rates were not shared equally among all Texans, however. Texans with low incomes and low educational attainment experienced smaller reductions in the rates of uninsured than their peers who have higher income and are more educated.

The report found the uninsured rate of Texans earning from $16,000 to $45,000 fell 44 percent (from 21.1 percent uninsured to 11.7 percent) since 2013. However, for those earning below $16,000, the uninsured rate fell just 18 percent (from 49.7 percent uninsured to 39.9 percent), less than half as much. The same was true for Texans with the lowest education levels. While high school graduates saw a 37 percent drop in the percentage of uninsured (from 27.2 percent uninsured to 17.2 percent), the rate for those who didn’t graduate fell just 12 percent (from 40.5 percent uninsured to 35.7 percent).

“The likely explanation for this disparity is the fact that those with lower educational attainment are likely to earn less, and those with the lowest incomes were not eligible for subsidized insurance plans in the marketplace,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute and director of the institute's Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “For this population, unless and until there is some form of coverage expansion, likely within the Medicaid program, they are likely to remain uninsured.

The report also looked at the changes in rates of health insurance coverage for the same demographic groups in the U.S. as a whole. In some cases, such as the relative changes in rates of uninsured for people with income and low education levels, the patterns in Texas and the U.S. are the same.
Blacks experienced the greatest reduction in uninsured rates at the national level (by more than 5 percentage points). In Texas, blacks experienced the smallest decrease of any demographic group examined -- only 4.5 percent (0.7 percentage points) -- while Hispanics and whites experienced reductions fivefold greater.

The report is the 12th in a series on the implementation of the ACA in Texas co-authored by Marks and Ho.
The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. This issue brief is a summary of data extracted from the HRMS surveys in Texas administered between September 2013 and March 2015 with responses from 1,544 Texans.

It is designed to provide timely information on implementation issues under the ACA and to document changes in health insurance coverage and related health outcomes. Rice University’s Baker Institute and the Episcopal Health Foundation are partnering to fund and report on key factors about Texans obtained from an expanded, representative sample of Texas residents (HRMS-Texas).

The HRMS was developed by the Urban Institute, conducted by GfK, and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.