Column: The Uninsured Conundrum

W. Stephen Love is President & CEO of the Dallas-Fort Worth Hospital Council and a member of the Convening Panel for the State of Reform Health Policy Conference.

Henry Ford once said, “Coming together is a beginning, staying together is progress and working together is success.” Regarding the reduction of our uninsured and underinsured population, it’s time for Texas to strive for a similar success.

The latest survey for Gallup-Sharecare Well-Being Index showed the uninsured rate in 2017 rose by significant margins in 17 states, with Texas having the highest rate for the tenth straight year at 22.1 percent. So, the increase signals a frustrating reversal in the trend previously fostered by health insurance markets.

Admittedly, the uninsured rate is still below the high-water mark of 27 percent in 2013, but the numbers are clearly moving in the wrong direction. When you walk down a street in Texas, every fifth person you meet is uninsured. This does not take into account the underinsured who struggle with coverage and access to care.

Why has the uninsured rate started to climb? The open enrollment period for 2018 suffered from reduced public marketing, an enrollment period decreased by 50 percent and navigator budgets slashed by 86 percent. Many insurers have withdrawn from the marketplace, resulting in fewer choices. The elimination of the individual mandate penalty as part of the tax reform plan in December 2017 will surely reduce many participants which could trigger premium increases.

Many argue the majority of people on the exchanges receive subsidies protecting them from premium increases, but middle-class people who do not qualify will feel the brunt. Additionally, the recent federal actions weakening coverage requirements could prohibit individuals from purchasing short-term and association plans. It does not require a crystal ball to predict that the uninsured and underinsured rates will continue to rise creating higher premiums for everyone in Texas.

In January, the 86th Texas Legislature will convene in Austin. Hopefully, they will address expanding health coverage in Texas, prohibit short-term coverage from discriminating based on health status and limit the maximum time an individual may be enrolled to less than 364 days. All stakeholders need to come together, stay together and work together for a successful solution to our healthcare insurance issues in Texas. Texans deserve medical coverage and access rather than having to choose between feeding their family or paying for medical treatment.