Commentary: How to expand access to health coverage

The most terrible toll of COVID-19 has been the lives taken from us — more than 15,200 in Texas alone. On the heels of that tragedy is a wave of economic injury to Texas families, communities and entire industries.

Without public policy solutions, if left to chance, too many Texans would see a lifetime of work, and even the work of their parents and grandparents, erased.

But there are policy tools, straightforward and doable, that Texas and the federal government can pick up to provide health care access and economic relief. Importantly, these steps would also begin to undo structural racism that has left Black and Hispanic Texans with dramatically worse uninsured rates and rates of infection, hospitalization and death from COVID-19.

Staggering unemployment — more than 3.5 million Texans have filed for relief since March — also brought a wave of lost job-based health coverage and prompted millions of Texans who never before thought of using anti-poverty programs to seek help.

Supplemental Nutrition Assistance Program, or SNAP, formerly “food stamps,” rolls have grown by more than 600,000 Texans since March. Texas had 5.2 million uninsured residents in 2019, and new research estimates it added close to 700,000 uninsured adults by May 2020. Projections for early 2021 are much worse.

As in many other areas of society, COVID-19’s devastation has laid bare the big gaps in Texans’ access to health coverage, which affects families from the poorest to middle income. A short list of the worst gaps includes the lack of any low-cost coverage for Texas’ working poor and near-poor adults. Texas’ elected officials have not “turned on” the Medicaid coverage for them that 38 other states make available.

Some Texans just above the official poverty line can get sliding-scale subsidies for insurance, which is great. But a “glitch” that Congress and the president could easily fix means other low-income Texans are locked out of financial help for health coverage.

Moving up the income scale, half of Texas households earned $64,000 or less in 2019 — less for Black and Hispanic families. At this income level, the Affordable Care Act’s discounts plummet. The average cost of a privately purchased family health plan topped $20,000 in 2019. It’s easy to see that a family earning $65,000 would be hard-pressed to cover that without sliding-scale subsidies.

More than 1 in 4 Texas children live in a family with at least one parent who is not a U.S. citizen, including parents with lawful immigration status or without documentation. In the past three years, hundreds of thousands of Texans who are U.S. citizens or immigrants with lawful status have dropped Medicaid, the Children’s Health Insurance Program and SNAP because of fears the parent’s immigration status could be harmed if the U.S. citizen child or spouse received benefits. This is a fixable problem that leaders can solve with changes in federal policy and strong outreach by Texas’ public officials.

Why care? Lack of health coverage affects Texans’ health and their ability to save, buy a home, and join and stay in the middle class. One in 4 have medical debt in collections, one of the highest rates in the country, mostly affecting Black and Hispanic Texans.

Uninsured Texans outside big cities often live in counties with no programs that provide free or low-price care — for COVID-19 or anything else. Too often, they already skip medical care because they cannot afford it and fear accumulating medical debt that could prevent them from ever getting ahead.

With the added financial strains of losing a job or work hours due to the pandemic, more Texas families need action from state leaders and Congress. Without relief for medical debt and access to health care, generations of family asset-building work would be wiped away, and new generations would be unable to move up and ahead.

For Texas officials, making health insurance a priority in Texas’ COVID-19 recovery strategy is indispensable. At the national level, the Kaiser Family Foundation offers a comparison of the presidential candidates’ positions on improving access to good affordable health care — and the distinctions are sharp: a hands-off policy that takes no steps to cover the uninsured versus an active set of solutions to close the gaps. To pave the way to a rebuilt middle class in Texas and the U.S. that is inclusive of every race and ethnicity, Every Texan advocates for the active approach.

Anne Dunkelberg of Austin is associate director of Every Texan, formerly known as the Center for Public Policy Priorities.

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