The Uninsured Population in Texas: Understanding Coverage Needs and the Potential Impact of the Affordable Care Act

Introduction
  1. “Marketplace Enrollment as a Share of the Potential Marketplace Population” https://www.kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population/.

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  2. Kaiser Family Foundation, “The Uninsured:  A Primer” (Washington, DC: Kaiser Family Foundation, October 2013), https://www.kff.org/uninsured/report/the-uninsured-a-primer-key-facts-about-health-insurance-on-the-eve-of-coverage-expansions/.

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  3. Ibid.

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  4. See “Protections in individual insurance markets” at https://www.kff.org/state-category/health-insurance-managed-care/.

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  5. Based on data from the Centers for Medicare and Medicaid Services (CMS), State Medicaid and CHIP Income Eligibility Standards Effective April 1, 2014.

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  6. Centers for Medicare and Medicaid Services, Texas Medicaid.

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Characteristics of Uninsured Adults in Texas
  1. “2014 Poverty Guidelines” (Office of The Assistant Secretary for Planning and Evaluation) http://aspe.hhs.gov/poverty/14poverty.cfm.

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  2. Adults who qualify through a disability pathway may have higher income levels than adults who qualify through a parent pathway.

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  3. These percentages are possibly over-estimates, as the survey is unable to differentiate between undocumented immigrants and residents with refugee or asylee status.

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Patterns of Coverage Among Adults in Texas
  1. “Getting Coverage outside Open Enrollment” https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2.

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Access to Coverage Among Uninsured Adults in Texas
  1. On February 10, 2014, the Obama Administration delayed penalties associated with this Employer Responsibility Provision until 2015. U.S. Department of the Treasury, “Treasury and IRS Issue Final Regulations Implementing Employer Shared Responsibility Under the Affordable Care Act for 2015” (February 10, 2014). http://www.treasury.gov/press-center/press-releases/Pages/jl2290.aspx.

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  2. For more information, see: M. Heberlein, T. Brooks, S. Artiga, and J. Stephens, “Getting into Gear for 2014: Shifting New Medicaid Eligibility and Enrollment Policies into Drive”(Washington DC: Kaiser Family Foundation, November 2013). http://www.kff.org/medicaid/report/getting-into-gear-for-2014-shifting-new-medicaid-eligibility-and-enrollment-policies-into-drive/.

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  3. See “Protections in individual insurance markets” at https://www.kff.org/state-category/health-insurance-managed-care/.

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  4. https://www.kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population/

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  5. Excludes undocumented immigrants.

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  6. B. Aaronson, “Advocates Target Latinos in ACA Enrollment Outreach.” (The Texas Tribune, October 14, 2013). http://www.texastribune.org/2013/10/14/advocates-target-latinos-aca-enrollment-outreach/.

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Access to Health Care Services Among Uninsured Adults in Texas
  1. Institute of Medicine, Committee on the Consequences of Uninsurance, Board on Health Care Services, “Care without Coverage: Too Little, Too Late” (Washington DC: National Academy Press: Institute of Medicine, May 2002). http://www.iom.edu/~/media/Files/Report%20Files/2003/Care-Without-Coverage-Too-Little-Too-Late/Uninsured2FINAL.pdf.

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  2. Institute of Medicine, Committee on the Consequences of Uninsurance, Board on Health Care Services “Coverage Matters: Insurance and Health Care” (Washington DC: National Academy Press: Institute of Medicine, 2001).

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  3. J. Paradise and R. Garfield, “What is Medicaid’s Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on Evidence”(Washington, DC:  Kaiser Commission on Medicaid and the Uninsured, August 2, 2013). https://www.kff.org/medicaid/issue-brief/what-is-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence.

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  4. Kaiser Commission on Medicaid and the Uninsured, “Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth”(Washington, DC:  Kaiser Family Foundation, March 1, 2013). https://www.kff.org/health-reform/issue-brief/community-health-centers-in-an-era-of-health-reform-overview/.

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Methodology
  1. In capturing family size, we include all members of the respondents’ immediate family, including themselves, spouse (if married), and any dependents, as well as parents if the respondent is a dependent. These groupings mimic “health insurance units” that are used to determine eligibility for Medicaid and Marketplace coverage.

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