The Affordable Care Act is designed to expand coverage to a large number of low-income individuals seeking health insurance in Texas. Although the expansion of Medicaid was supposed to be adopted nationwide, the Supreme Court ruled in June 2012 that the decision to expand Medicaid to a larger number of low-income citizens was left up to the discretion of each state. Sadly, health insurance in Texas remains unavailable for at least 25 percent of people living in this state.

Several states, including Texas, have opted not to expand Medicaid coverage. This has resulted in many individuals falling into a coverage gap, where their income is too high for them to be eligible for Medicaid but too low to qualify for premium tax credits under the Marketplace. Only a small percentage of people qualify to receive welfare health insurance in Texas which also has a large population of uninsured citizens.

For many living on a limited income, the options for receiving health insurance in Texas depend on where their income falls. If their yearly income reaches above $11,670 as a single person or about $23,850 as a family of four, they will be able to buy a private health insurance plan in the Marketplace and may be eligible for premium tax credits and other savings based on their household’s income and size.

However, if an individual makes a yearly income of $11,670 as a single person or about $23,850 as a family of four, they will not qualify for lower costs for private insurance based on their income. Based on Texas’ existing rules, there is the possibility that a single person or family could still qualify for Medicaid if they apply, even without the expansion. Health insurance in Texas is usually available for someone who has a disability, has children (CHIP) or is pregnant by contacting their state’s Medicaid office.

If an individual or family still has difficulty obtaining adequate health insurance in Texas, they can seek primary care through community health centers which are funded by the health care law. These centers provide services on a sliding scale based on income. While clinics and hospitals have traditionally served as the catch-all for the remaining uninsured population under the ACA, these institutions have been stretched to capacity in recent years due to increasing demand and limited resources.

The likelihood of an individual receiving health insurance in Texas greatly depends on their ethnic background. Persons born as United States citizens who fall in the coverage gap are mostly made up of people of color. Unfortunately, many uninsured adults in the coverage gap who are in fair or poor health put off needed services covered under health insurance in Texas due to the cost. In the long run citizens who can’t afford health insurance in Texas put an added strain on the taxpayer when they go to hospitals or clinics to receive treatment. The disproportionate effect that occurs because Texas has decided not to expand their Medicaid programs becomes more problematic as time goes on.

As a result of the state’s decision not to expand Medicaid programs, the population that falls in the coverage gap who are unable to buy health insurance in Texas under the ACA reflects the ongoing pattern of the system selectively granting Medicaid coverage to only certain categories of people. For example, the large percentage of people who fall outside these categories are mostly men and adults without dependent children. While it’s understandable that someone with dependent children would need health coverage, is it really fair for the law to make the health care needs of those without dependent children less of a priority? If the intention of the Medicaid expansion was meant to end the criteria set for someone under a certain category qualifying for Medicaid, then why are there still so many citizens going without health insurance in Texas?

While an impressive number of enrollments in private health insurance Texas plans were submitted through the federal marketplace, the percentage of the population who actually became eligible for expanded Medicaid was less noticeable. In a nutshell, more people need this form of health insurance in Texas to reduce medical financial burdens among taxpayers. More importantly, the quality and comprehensiveness of health insurance in Texas across Medicaid, marketplace plans, individual plans, and employer-provided coverage, will ultimately determine the degree in which issues with health insurance in Texas are resolved. Then and only then will the citizens of Texas truly benefit from the expanded Medicaid program.