Many of the improvements in the uninsured rates are beginning to erode according to the Commonwealth Fund tracking survey released recently. Recent actions by Congress, the Administration and the Centers for Medicare and Medicaid Services (CMS) have reduced healthcare coverage. Texas continues to lead the nation in the percentage rate and number of uninsured, according to recent health statistics. Approximately 4.5 million people in Texas are uninsured, including 700,000 children.
The Commonwealth survey estimates that approximately 5 percent of insured adults will drop coverage once the repeal of the individual mandate’s penalty becomes effective next year. In recent months a series of actions, including shortening the enrollment period by half, reducing funds used in reaching people eligible for coverage and cutting dramatically the advertising budget related to enrollment in the health insurance marketplace have contributed to the increase in the uninsured in Texas. The Federal Navigator Funding for Texas in 2016 was $9.2 million and reduced to $6.1 million in 2017. We just learned last week that the 2018 available funding for the entire state will be cut to $1.2 million which represents an 86 percent decrease from 2016 funding. CMS states that the reduced funding is justified because broker services overlap with navigators in facilitating enrollment in the health insurance marketplace. While the enrollment process may overlap, the Kaiser Family Foundation Marketplace Assisted Survey found that navigators help mainly the uninsured people, participants with limited English proficiency, lacked access to the internet and offered not only assistance with the marketplace, but eligibility assessments for completing applications for Medicaid and CHIP. Brokers tend to focus mainly on insurance products, not government programs.
The increase in the uninsured population impacts the health care delivery system in many ways. First, the patient needs appropriate access and treatment so many will postpone examinations, filling prescriptions and potentially progressing to a much higher acuity level before seeking medical treatment. Second, the uninsured patient generally does not have a primary care provider and seeks treatment in an emergency department which is not the proper setting for primary care. Third, the uninsured or underinsured may not have the financial ability to pay for provider care, so the provider incurs uncompensated care or bad debt resulting in cost shifting.
Texas needs to heed this increased uninsured trend and all stakeholders need to collaboratively address coverage or access now before we slip to the uninsured levels prior to the Affordable Care Act.
W. Stephen Love
Dallas-Fort Worth Hospital Council