Donna Howard says Texas No. 1 in uninsured residents across the board

An Austin legislator stressed the number of Texans who lack health coverage after applauding the U.S. Supreme Court for upholding federal subsidies under the Obamacare law.

On a positive note, Democratic state Rep. Donna Howard said in a June 25, 2015, press release that the share of uninsured Texans has decreased thanks to more people buying insurance, some with help from the subsidies written into Affordable Care Act of 2010. Now, she said, the Republican-led state should act to draw more federal money to insure more residents—perhaps a reference to Texas’ refusal so far to expand Medicaid to more adults with the federal government initially picking up costs.

Inaction, Howard said, "has only left Texas with the nation's highest rate and highest number of uninsured."

Whatever the reasons, does Texas lead the nation in its uninsurance rate and its count of uninsured residents?

That wasn’t so before. In 2013, we rated Mostly False a declaration by Rep. Garnet Coleman, D-Houston, that Texas had the nation’s most uninsured people, 6 million. As of 2011, then the latest year of survey data, Texas led the nation with its 24 percent share of uninsured residents. But more-populous California was home to about 1 million more uninsured residents.

Also in 2013, we found True a claim that Texas had the most uninsured children. In 2012. According to federal survey results, Texas ranked first nationally with 1.1 million uninsured children, followed by California with 891,000.

California is among states, unlike Texas, that expanded Medicaid access in accord with the Obamacare law. It stands to reason its uninsured population consequently shrunk. Another post-2013 factor: Key provisions of the Obamacare law—including the mandate that most Americans obtain coverage and the offer of subsidies for individuals to buy insurance—took effect in 2014, likely affecting who has a policy.

Texas No. 1 in rate of uninsured

Texas has evidently continued to rank No. 1 for its share of uninsured residents.

To our inquiry, Scott Daigle, Howard’s chief of staff, noted by email a June 23, 2015, Austin American-Statesman story citing a national survey by the federal Centers for Disease Control and Prevention stating Texas had a higher percentage of uninsured adults in 2014 than any other state. Nearly 26 percent of Texas adults were uninsured, the story said, down from about 28 percent in 2013.

We wondered about all residents of the states at issue. Separately, the Kaiser Family Foundation, drawing on U.S. Census Bureau survey results, keeps up with how many residents of each state have health coverage. Its latest charts indicate that per the bureau’s 2013 Current Population Survey, Texas and Nevada were tied for No. 1 that year with 20 percent of residents lacking coverage. At the time, according to the survey, 15 percent of California residents lacked coverage. In raw numbers, 5,769,600 Californians were uninsured, compared with 5,357,700 Texans, according to the survey.

We also reached out to bureau spokesman Robert Bernstein who suggested by email we consider its American Community Survey results for 2013, the latest available, indicating 22 percent of Texans and 17 percent of Californians were uninsured that year. According to this survey, Nevada had the nation’s No. 2 uninsurance rate, nearly 21 percent. In raw numbers, the survey suggested, 6.5 million Californians lacked coverage compared to more than 5.7 million Texans.

California vs. Texas in uninsured residents

In question: Whether California kept its raw-total lead in uninsured residents through 2014.

Doesn’t seem so, experts told us, because far fewer Californians continued to lack coverage through the year, causing Texas to end up No. 1 for its uninsured rate and total residents without insurance. However, we fell short of landing governmental confirmation of such a shift.

Responding to our request for backup information, Daigle in Howard’s office emailed us a link to a September 2014 Rice University press release stating Texas "has now surpassed California to become the state with the highest number of uninsured residents." But the related report, from Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation, said only that Texas has "potentially surpassed" California in its uninsured count.

According to quarterly surveys of Texans undertaken by the researchers, an additional nearly 379,000 Texans aged 18 to 64 had health coverage after the first Obamacare enrollment period, reducing uninsurance rates among such adults from 25 percent in September 2013 to 22 percent in May 2014.

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An April 2015 follow-up report by the institute and foundation said that thanks to more adults obtaining coverage, the share of uninsured Texans aged 18-64 as of March 2015 had dropped even more to 17 percent. The report said: "Despite this progress, Texas remains the state with the highest percentage of uninsured residents and, for the first time, Texas now has the largest number of uninsured residents."

That report did not say how the researchers decided California no longer had the most uninsured. By email to our inquiry, co-author Elena Marks told us an undated web post on Wallethub.com, a personal finance website, fueled the conclusion. After the Obamacare law took effect, she noted, WalletHub projected that 14.26 percent of Californians and 24.81 percent of Texans lacked coverage. WalletHub also said its estimates were limited to beneficiaries under 64 years of age.

Those state-by-state percentages, according to WalletHub’s post, were calculated in part from a June 2014 Kaiser Family Foundation look into insurance sign-ups during the first Obamacare enrollment period, which WalletHub described as "the best estimate to date of the proportion of private health plan enrollees under Obamacare who previously lacked health insurance and therefore would be gaining coverage under the new law."

Marks told us the Texas researchers multiplied the WalletHub projections by each state’s population to estimate that more than 6.8 million Texans and 5.5 million Californians were uninsured once the Obamacare law had rolled into place.

Other analysts

Seeking other perspectives, we queried experts including Paul Fronstin of the Washington, D.C.-based Employee Benefit Research Institute, which says its mission is to enhance the development of public policy through objective research and education.

In 2012, Fronstin wrote that the year  before, California had the largest number of people under age 65 without health insurance of any state, at 7.1 million. But he also wrote that with Obamacare taking effect, the western state’s share of uninsured adults would likely drop. As it was, Fronstin told us at the time, his analysis of bureau research released in March 2012 showed more Californians than Texans were lacking coverage.

That also held in Fronstin’s latest analysis, published in 2013, which said that nationally in 2010-12, Texas and California were among 14 states with 20 percent or more of residents lacking insurance. California had an average of 7 million uninsured non-elderly residents, according to a chart in the report, outpacing other states including No. 2 Texas, which averaged 6.1 million uninsured non-elderly.

Still, those counts reflected conditions before the Obamacare law took fuller effect. By email, Fronstin told us this month that he believes California no longer leads the nation in uninsured residents, likely due to more people there taking advantage of coverage options thanks to the state expanding Medicaid and residents otherwise buying insurance with the subsidies offered thanks to the Obamacare law.

Fronstin pointed out Gallup polls taken through 2014 indicating Texas that year had the nation’s greatest share of uninsured adults (24.4 percent) for the seventh straight year. That was a slight improvement from the 27 percent rate Gallup gauged in 2013. From 2013 to 2014, per Gallup’s results, California’s adult uninsurance rate fell from 21.6 percent to 15.3 percent.

We considered multiplying the 2014 Gallup percentages by federal population estimates to approximate the number of uninsured adults in each state.

But Howard referred to all uninsured residents. We sought the same broad focus.

On this front, Anne Dunkelberg of the Austin-based Center for Public Policy Priorities, which advocates for programs serving low-income Texans, guided us to a June 23, 2015, report from the Centers for Disease Control and Prevention stating that according to its surveys undertaken through 2014, 11.5 percent of all Americans were uninsured.

Also, a chart in the report indicates 19.4 percent of all Texans were uninsured at the time they were interviewed while 12 percent of Californians reported no coverage. We multiplied these percentages over July 2014 Census Bureau population estimates for each state, reaching estimates of 5.23 million uninsured Texans in 2014 and 4.66 million uninsured Californians.

Next, we reached Gerald "Jerry" Kominski, director of UCLA’s Center for Health Policy Research, who said by phone that results of its 2014 survey indicating the number of uninsured Californians at that time were to be released later this summer. Kominski otherwise said our calculation using the CDC study and federal population estimates seemed reasonable. "California has been very successful in reducing the number of uninsured," Kominski said, "because of its aggressive promotion of the Affordable Care Act."

We also ran our calculation by the Kaiser foundation. Researcher Rachel Garfield cautioned by phone against reaching conclusions by making calculations using figures from different sources. Generally, she said, data is not yet available to assess how many people were uninsured in each state in 2014 though the census bureau is expected to release relevant survey results in September 2015.

Our ruling

Howard said Texas is No. 1 in its uninsurance rate and its total uninsured residents.

Texas leads the nation in its percentage of uninsured. Also, it newly looks like Texas has the greatest raw number of uninsured residents, though that’s evidently backed up only by rough calculations like our own, a clarification missing from this claim.

We rate Howard’s claim Mostly True.

MOSTLY TRUE – The statement is accurate but needs clarification or additional information.

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