One of the most damaging ways conservative state leaders left Texas unprepared for the COVID-19 pandemic is the state’s sky-high number of people without health insurance. And that’s getting worse: many Texans who are losing their jobs are joining the already massive ranks of the uninsured. This is a public health catastrophe — one compounded by partisan opposition to helping every Texan get access to the medical care they need.
More than a million Texans could lose their health insurance because of the current crisis, according to studies from the Urban Institute and the Kaiser Family Foundation. Texas already had 5 million uninsured residents before the pandemic began. In fact, Texas has the highest rate of uninsured people of any state — nearly 1 out of every five Texans. That’s double the national average. Now that number will surge, which could mean many more Texans delay seeking care if they get sick. And that could make stopping COVID-19 in Texas even harder.
A key way to address this crisis would be to expand Medicaid under the Affordable Care Act (Obamacare) in Texas, as 36 states have already done and as progressive elected officials and candidates across the state have urged for years. But Gov. Greg Abbott, Lt. Gov. Dan Patrick and the Republican-dominated Legislature have stubbornly refused to do that. In fact, Republicans are actively trying to strip health insurance from even more Texans. Texas Attorney General Ken Paxton is leading the charge in a lawsuit, backed by the Trump administration, that asks the U.S. Supreme Court to strike down the ACA entirely. Such a court decision would send the uninsured rate soaring even higher, and protections for people with preexisting conditions would be swept away.
The state’s most vulnerable communities will suffer the most. Communities of color in Texas already have high uninsured rates, which is especially alarming in light of the fact that those communities are among the hardest hit by the COVID-19 pandemic. In fact, the COVID-19 mortality rate for African Americans is 2.4 times higher than it is for white Americans across the country. The mortality rate for Latinos and Asians in this country is also higher. And Indigenous communities, especially the Navajo Nation in Arizona and New Mexico, have been hit hard by the pandemic.
Moreover, the refusal to expand Medicaid eligibility is making access to health care harder in rural areas. According to a February report from The Chartis Center for Rural Health, states like Texas that have refused to expand Medicaid under the ACA account for the vast majority of rural hospital closures in the country. In Texas, 20 rural hospitals have closed since 2010 — more than in any other state. Of the remaining 152 rural hospitals, Chartis found that about half are vulnerable to closure. So as COVID-19 continues to spread into rural areas, Texans who live there could find it difficult to get the medical care they need to survive because Republican officials are starving their hospitals of the funding they need to stay open.
To add insult to injury, Texans already pay the taxes that would provide Medicaid coverage to those in need. But those tax dollars go to other states instead. So not only is the Republican refusal to expand Medicaid and help insure more Texans during the pandemic recklessly cruel and appallingly bad public health policy. It also punishes Texas taxpayers by forcing them to fund something Republican leaders block in their own state.
We have to change direction in Texas, and that will require new leadership. Remember this in November. Elections matter.