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The Uninsured Face Many Challenges in Texas

Recently, the passage of the federal Affordable Health Care Act sparked widespread national debate. Commentators describe aspects of the new legislation which they believe prove beneficial, or damaging. The law remains controversial in the sense that it still arouses vehement discussion from proponents and critics. Texas lies in the crucible of this ideological firestorm.

Texas: A Big State With Massive Insurance Coverage Issues

What makes Texas a focal point for insurance issues? For one thing, the state’s significant size and economic importance mean that it will necessarily generate considerable attention during any insurance discussion. Health insurance in Texas attracts widespread interest from the media today.

And unfortunately, a second factor may place Texas in a bellwether position on this issue, too. Texas possesses a very large number of uninsured. Prior to the passage of the Affordable Care Act, fully 25% of the Lone Star State’s population lacked any health coverage. Health insurance in Texas has reportedly risen since the federal provisions took effect, but significant numbers of uninsured remain.

The situation with respect to automobile insurance coverage also gives cause for dismay in Texas. It is one place where, in large numbers, uninsured drivers impose a huge risk on others. Some 14% of Texas drivers possess no liability insurance. Large numbers lack any insurance at all. Although some insurance companies reportedly sell policies providing coverage for uninsured drivers in the state, many uninsured do not carry the legally required liability insurance.

The Future of Health Insurance in Texas

Some critics of the federal Affordable Care Act note that in some states, such as Nebraska, private health insurance policy premiums have risen, even as more citizens obtain lower cost coverage through federal programs such as Medicaid. In fact, despite cooperatives, high premiums still prevent many Americans from obtaining health insurance. Health insurance in Texas reflects these concerns.

Unless they are willing to sign up for Medicaid, a federal health program for low income people, in large numbers impoverished families cannot afford the premiums required to obtain health insurance in Texas. And insurance continues to take a significant portion of many family incomes. For example, one recent study indicated that the typical Texas household receives $41,284 a year; of this amount, some $5,649 goes towards the payment of insurance premiums, i.e. roughly 13.7% of income.

Following the passage of the Affordable Care Act, Texas accepted generous federal subsidies to pay for uncompensated health care. However, the state declined to expand the Medicaid program for health insurance in Texas. Potentially, low income Texans who do obtain health insurance in Texas face the uncomfortable prospect of enjoying Medicaid coverage without a sufficient number of private physicians willing to accept new Medicaid patients.

An Analogy with Automobile Insurance

Health insurance in Texas for the uninsured may pose some analogies with the lack of automobile insurance. Just as federal regulation of health insurance in Texas seeks to compel families to sign up for low cost health insurance coverage under the threat of paying fines for non-compliance, authorities have endeavored to encourage compliance with laws mandating automobile liability coverage.

In 2009, Texas implemented a creative program called TexasSure. It established a massive database. Every person registering a vehicle expends $1 to support the initiative, which matches vehicle ID and license plate numbers with lists of insured drivers. Some 25,000 letters issue every week directing the uninsured to verify their insurance coverage and warning them of fines in the event of failure to abide by the liability insurance requirement.

Municipal ordinances in Dallas, and more recently, Texarkana, authorize police to have vehicles towed if an owner stopped for a traffic violation or an accident possesses no insurance.

Yet even as health insurance in Texas does not attract universal compliance, neither does automobile liability insurance. Automobile liability coverage costs only $35 to $40 a month in most cases.

Critics of the enforcement programs point out many insurance companies penalize drivers with poor credit scores or those in other “high risk” groups by charging higher premiums. Robert Hunter, who previously served as a Texas Insurance Commissioner, explained: “Legislators and insurance regulators need to recognize that the uninsured motorist problem is much more about affordability than about irresponsibility.”

Health Insurance in Texas: The Future

Health insurance in Texas continues to generate debate. Dianna Wray wrote an article about health insurance in Texas and Houston’s charitable Memorial Hermann facility. She noted that Time reported M.D. Anderson recently made a profit of $531 million. That renowned facility earned criticism for trying to deny services to an acute leukemia patient with limited insurance coverage until she paid an outstanding $100,000 on her bill.


Health insurance in Texas matters to many people. What changes will occur to health insurance in Texas? Only time will tell.

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