More Texas children got insurance in ACA's first year

The number of uninsured children in Texas fell by almost 100,000 during the first year of full implementation of the Affordable Care Act, signalling a potential trend across all age groups, a new study by the Robert Wood Johnson Foundation finds.

The findings were welcomed in a place with stubbornly high uninsured rates, particularly among the poor and racial and ethnic minority groups.

"This is good news. Texas is a state with a comparably young population, so the more of them that are insured the bigger the impact for the entire population," said Elena Marks, president and CEO of Houston's Episcopal Health Foundation.

The thought is that as parents find coverage options for their children they are more likely to learn about coverage options for themselves, which will lead to higher overall coverage rates.

In 2013, as the health-care law took hold, 977,000 Texas children were without coverage, the new research shows. That equates to 13.2 percent of the state's under-18 population. By 2014, that uninsured rate had fallen to 11.8 percent.

Researchers drilled into U.S. Census Bureau information to gauge the effect the health-care law has had on children's health coverage in every state.

Nationally, about 1 million children gained health insurance between 2013 and 2014, the report found. The analysis shows that the improvement was especially pronounced among Hispanics and other minorities. Gains were also seen for children living in low-income families.

The findings echo a separate national study released last month that found the number of uninsured Hispanic children in Texas fell during the first full year of the health-care law. But that report, from the Georgetown University Center for Children and Families and the National Council of La Raza, also found Texas with the most uninsured in this demographic nationally.

The rate of uninsured Hispanic children in Texas is 15.3 percent, well above the national average of 9.7 percent, the study found.

"For a very long time, Texas has had the unfortunate distinction of having one of the highest rates and largest number of uninsured children and it's been that way approaching a decade," said Dr. Laura Guerra-Cardus, Texas associate director for the Children's Defense Fund. She has been working on the issue since joining the organization in 2007.

Still, the Robert Wood Johnson research shows Texas had the second-largest drop of uninsured children in the country, behind only California.

Typically children are insured in greater numbers than adults since states, including Texas, offer safety net coverage through the Children's Health Insurance Program, also known as CHIP, which provides low-cost insurance for children whose parents earn too much to qualify for Medicaid or do not have other coverage.

"Despite the politicking around health policy lately, I think we can all agree that coverage for kids is essential for their healthy development and to get a healthy start in life," Katherine Hempstead, who directs health insurance issues for the Robert Wood Johnson Foundation, said in an interview Monday.

Despite the gains, 880,000 Texas children - the highest number nationally - still have no coverage.

That includes 533,000 Hispanic children, Guerra-Cardus said. She added that 94 percent of those are U.S. citizens.

The Robert Wood Johnson study shows nearly half of the nation's 5 million uninsured children live in Texas and five other states: California, Florida, Georgia, Arizona and New York.

The research provides a baseline to track future children's coverage trends, Hempstead said, adding that the report will be duplicated next year.

At the recent close of the third enrollment period under due to President Barack Obama's signature health-care law, 12.7 million people signed up for insurance coverage either on the healthcare.gov federal exchange or through state exchanges. That includes 4 million first-timers, officials with the U.S. Department of Health and Human Service reported.

In Texas, which does not have a state exchange, about 1.3 million people - almost exactly 100,000 more that the previous year - enrolled on the federal exchange.

Nationally the rate of uninsured is estimated to be about 11.9 percent, according to a Gallup poll for the fourth quarter of 2015. That compares to 17.1 percent in the fourth quarter of 2013 before the health-care law went into full effect.

Marks said she expects the number of Texas children found to have gained insurance will rise because this new study looks only at the first year of the ACA, prior to the more aggressive enrollment push and before penalties for failing to have insurance rose. In 2014 the penalty for not having insurance was $95 for an adult and up to $285 per family. The penalty is now $695 per person and up to $2,085 per family.

The problems in Texas for children and their families will remain as long as the state does not expand Medicaid coverage, Hempstead said. But that is something Republican elected officials have steadfastly refused to consider because they say it is a broken system.

Currently about 4.6 million Texans are covered by Medicaid and CHIP, state records show. The state is tied with Alabama as having the most stringent Medicaid requirements under the current program, according to a Kaiser Family Foundation analysis.