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Early Effects of the Affordable Care Act on Health Insurance Coverage in Texas for 2014

Elena M. Marks | Vivian Ho

Early Effects of the Affordable Care Act on Health Insurance Coverage in Texas for 2014.

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 three reports in the series: 


The Rice University press release on the latest report, "Early Effects of the Affordable Care Act on Health Insurance Coverage in Texas for 2014," follows:

The percentage of uninsured adults ages 18 to 64 in Texas declined from 24.8 to 23.5 between September 2013 and March 2014, according to a report released April 16, 2014, by the Baker Institute for Public Policy and the Episcopal Health Foundation. The decrease in uninsured appears to be attributable to an increase in employer-sponsored health insurance.

The report also found that during this period approximately 746,000 Texans purchased health insurance through the Affordable Care Act's Health Insurance Marketplace, of which 225,000 (30.2 percent) were previously uninsured.

"Given that Texas has consistently had the highest percent of uninsured residents among the 50 states for several years, the insurance provisions of the ACA are expected to play a substantial role in providing coverage to the close to 5 million adults who reportedly lacked health insurance in the state in 2010‐2011," said Vivian Ho, the chair in health economics at Rice’s Baker Institute, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. "However, technical problems plagued the electronic websites for the Health Insurance Marketplaces in each state when they opened in October 2013, and some of these problems still exist today."

In addition, Texas declined the Medicaid expansion offered by the ACA, so most adults in families earning less than 100 percent of the federal poverty level are ineligible for any public subsidies to purchase health insurance, Ho said.

Ho co-authored the study with Elena Marks, the president and CEO of the Episcopal Health Foundation and a health policy scholar at the Baker Institute, and Patricia Bray, director of the Episcopal Health Foundation's research program and an adjunct faculty member at the University of Texas School of Public Health's Fleming Center for Healthcare Management.

"In March 2014, the percentage of uninsured in Texas had declined only slightly, and the change appears to be attributable to increases in employer-sponsored health insurance rather than the newly implemented Health Insurance Marketplace," Marks said. "The decline in uninsured is similar to that experienced by states that did not expand Medicaid under the ACA, and it falls far short of the 4- percentage-point drop in uninsured experienced by states that elected to expand Medicaid. These percentage figures mask the impact of the Marketplace on the lives of hundreds of thousands of Texans."

Today’s HRMS-Texas report is the third in a series on the implementation of the Affordable Care Act in the state. The HRMS was developed by the Urban Institute, conducted by survey company GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute.

In this brief, the third in a series examining the implementation of the Affordable Care Act in Texas, changes in health insurance status in Texas between September 2013 and March 2014 are tracked. This report contains responses from 1,595 Texans in September 2013 and 1,538 in March 2014. "We find that the rate of uninsured adults ages 18 to 64 in Texas declined from 24.8% to 23.5%. The majority of this decline is attributable to an increase in the percent of adult Texans obtaining insurance through an employer. The proportions of adults with either Medicaid or individual private insurance both declined during this period. However, these percentages likely disguise significant changes in insurance coverage in Texas over the time period. By mid-March 2014, an estimated 746,000 Texans had obtained private insurance through the Marketplace. Of these, 178,000 (30.2%) were previously uninsured.  Although a seemingly small proportion of Texans obtained insurance through the state’s Marketplace, the large absolute numbers had a substantial impact on increasing access to insurance coverage in the United States." 

Download the full report here: