This commentary was originally featured in The Hill on March 3, 2018.
Texas is frequently criticized in the media for having the highest uninsured rate in the nation. The presumption is that uninsured Texans and uninsured residents in other states aren’t getting health care because they lack health insurance, particularly government supported insurance. But, is this true? Does the insured rate really reflect people being harmed for lack of health insurance?
A look at the actual data in the four most populous U.S. states–number of insured individuals, Medicaid coverage, and access to care–suggests that states with high uninsured rates like Texas are receiving undeserved blame.
New York has the lowest uninsured rate at 5.4 percent and the highest enrollment in Medicaid or Children’s Health Insurance Program (CHIP): 32 percent. By contrast, Texas has the highest uninsured rate in the U.S., 17.1 percent, which is triple the number in New York. Having not expanded Medicaid, the Lone Star State has the lowest Medicaid/CHIP enrollment of just16 percent, half of New York’s rate.
Two useful indicators of access to care are wait times to see a primary care physician and how well a state meets the needs of its residents for primary care. A large national survey performed in January 2017 by Merritt Hawkins provided good data. The surveyors chose to subdivide cities into large metropolitan sites such as Dallas and New York City, as well as mid-sized cities like Albany, N.Y.
Wait times in both large cities and mid-sized ones in all four states were not statistically different, with averages ranging from 22 days to 28 days. Dallas, Texas, was the exception: In the state with the highest rate of uninsured, the average wait time there was 16.5 days, the lowest found anywhere.
The state with the lowest uninsured rate, New York, satisfied the primary care needs of its population only 45 percent of the time. The state with the highest uninsured rate and the lowest Medicaid enrollment, Texas, did the best: Lone Star doctors met primary care needs of Texans 71 percent of the time.
What do all these numbers mean for the average American, policymakers, and in particular for 29 million Texans? It tells us something important for the U.S. public, something that is glaringly absent from media coverage. Being uninsured does NOT mean that Americans die for lack of needed medical care.
In fact, an internal VA audit suggested that more than 300,000 U.S. veterans died while waiting for care, despite being eligible for government provided insurance.
The media constantly focus on two minor considerations: cost of insurance and praising the ACA for giving insurance, mostly through Medicaid expansion, to 19.2 million Americans. The pundits ignore the most important factor–why we have a healthcare system in the first place. It is neither to insure people nor even to save money. We have a healthcare system in order to assure timely access to care and thus make Americans as healthy as possible.
When national data are considered for the effect on public health, Medicaid expansion actually decreased access to care, in some cases allowing people newly insured by Medicaid to die while waiting in line for care.
Instead of getting the credit Texas deserves for providing timely care to the most people, it gets a bad rap for its high uninsured rate. No good deed goes unpunished.
There is another, larger takeaway message from this data. Contrary to what is called popular wisdom, having health insurance, especially government-provided no-charge coverage, does not get you in to the doctor’s office.