The Uninsured: A Hidden Burden on Texas Employers and Communities

Transmittal Letter

Fellow Texans:

In 2004, Senator Elliot Shapleigh asked my office to develop information on the percentage of Texans without health insurance in the state’s metropolitan areas. This report has been prepared in response to his request.

According to the U. S. Census Bureau, Texas has the highest share of uninsured persons of any state. Based on the most recent data available, about one in four Texans lacked health insurance at some point. The U.S. average for the same period was more than one in six Americans.

I was aware of that unfortunate pattern. Until this study was completed, however, I didn’t know that every major metropolitan area in Texas exceeded the U.S. average.

The Laredo and El Paso metropolitan statistical areas had the state’s highest shares of uninsured residents, at 36 percent and 33 percent, respectively—about one in three. Brownsville-Harlingen-San Benito had 32 percent uninsured; Corpus Christi, 28 percent; and McAllen-Edinburgh-Mission, 28 percent.

Among the largest metropolitan areas, Houston led with almost 28 percent of its residents lacking health insurance. In Dallas, the uninsured rate was 25 percent; in San Antonio, 24 percent; and in Fort Worth-Arlington, 24 percent. Austin had the lowest share among the largest cities, at 18 percent, but that still exceeded the national average.

The sheer number of uninsured Texans ultimately makes health care less affordable for Texas employers and individuals alike. Much of the costs involved in providing health care to the uninsured ultimately are shifted to those who have health insurance—and to Texas taxpayers.

I have previously suggested ways in which the federal and state governments could help more Texans afford health insurance. Some of these have been enacted, such as a program that allows small businesses to form cooperatives to purchase affordable employee health insurance. Yet more remains to be achieved by federal, state and local governments, working in cooperation with the private sector and community groups. I have outlined several ways to proceed.

I firmly believe that the first place to start is to fully restore the cuts made in 2003 to the Children’s Health Insurance Program (CHIP). Nearly 179,000 Texas children have lost health insurance coverage since September 2003. That represents over 35 percent of the previous CHIP caseload. Similarly, the ending of the Medicaid Medically Needy program in Texas will cost the state’s hospitals an estimated $517.7 million in state and federal funds in fiscal 2006 and 2007. This program paid hospitals to care for individuals with excessive medical bills and should be restored to prevent further growth in the numbers of uninsured Texans.

Tackling the health insurance problem will require innovative ideas and actions. As always, my office stands ready to help in this effort.

Sincerely,

Carole Keeton Strayhorn,
Texas Comptroller