The Impact of Affordable Care Act on Health Insurance in Texas

According to popular opinions, health insurance is generally expensive no matter the location of an individual in the US. However, Texas stands among the most costly states in the realm of the affordability of health covers, especially for people living below 133% of the federal poverty level. Evidently, data demonstrates that this trend is replicated among other states that declined the expansion of the Medicaid programme through the Obama championed Affordable Care Act after the first Supreme Court case (Soni et al. 220). Nevertheless, other factors have contributed to the high cost of care in this and other states with similar predicaments. In this report, research and poll opinions across Texas and other affected states are presented to demonstrate the ramifications faced by poor citizens as a result of expensive healthcare. Furthermore, the history, developments, and underlying factors leading to the high cost of Medicare are evaluated in comparison to other states to ascertain the best course of action in the environment of the prevailing political ill will and the citizenry uprising through protests in the state of Texas. Finally, a considered course of action is given to contribute to the way forward in the unfolding healthcare crisis which may escalate if left unattended.


The number of medically uninsured Texans currently stands at more than one million citizens across its major cities which is among the highest rates per state in the US (Green 23).

According to the 2016 census bureau's rankings on the rates of uninsured residents among America's largest cities, Houston, Dallas, and Antonio occupied the first, second, and fourth positions respectively. This statistic can be attributed to the increased cost of health insurance which has been estimated at an average of 12 per cent of the annual income across many American low-income households (Kominski et al. 490). In Texas, the citizens earning between 100% to 133% of the federal poverty level are at disadvantage due to the high cost of private insurance, lack of subsidies, and absence of expanded Medicaid (Gong et al.). In this way, workers such as teachers have been poised to lose close to half of their annual pay to health insurance. Consequently, many prefer not to be insured and to delay care so as to save on the increased costs.

Historically, the Medicaid programme has assisted American households living under the federal poverty line to access Medicare. With the enactment of Obamacare's Affordable Care Act (ACA), states were required by law to expand the coverage to Americans living below 133% of the previous cap or forfeit the previous federal funding (Obama 526). However, red states petitioned the Government in the Supreme Court and won a case requiring dissenting states to retain their former Medicaid assistance. Henceforth, red states such as Texas chose not to expand the scheme since it was Democrat-sponsored and as per the leaders, not suitable for their people. This has to date spiralled into a widespread outcry, especially among poor Texans who are considerately overcharged as compared to other states. This issue is important since it directly influences the capability of millions of Americans to receive affordable care as well as to secure their overall well-being as people chose to delay or forfeit medical attention (Pickett et al. 121). The Texan and the federal government should, therefore, chart a way forward due to the imminent need of poor people to fundamentally access quality care.


Both, the federal and state governments have addressed this matter in various ways over the last few years. The measures taken include the push to improve mass understanding of health insurance and outreach, facilitatation of enrollments and legal repeals as well as push for the abolishment of the ACA. According to a report by Rice University's Baker Institute and Houston's Episcopal Health Foundation, a gross drop in uninsured rates to 18.5% in 2015 from 23.5% in 2013 can be attributed to state government's outreach, education, and enrollments (Sommers et al. 1013). Accordingly, the state agencies have endeavoured to educate Texans on the options and relevance of medical insurance which has decreased the proportions of the uninsured. At the national level, efforts have been made from the ruling Republican government to amend the ACA so as to provide a better remedy to Medicare, especially to the red states which have declined to expand Medicaid. Furthermore, there have been threats to completely abolish the ACA from unsatisfied politicians.

Currently, proponent factions are campaigning for the expansion of Medicaid in the state of Texas, while the opponents in the ruling class seek for a complete overhaul of the act. Whereas this is seen as a contention between the republicans and the democrats, recent mass protests and independent surveys have expressed a need for Government to expand Medicaid funding, although Texan leaders such as Rick Perry have proposed the formulation of a better program. The Government is also reviewing agency reports and statistics from the census bureau among others to ascertain the prevailing disparities in Texas so as to sponsor remedial regulations to that effect (Soni et al. 218).


It is, therefore, considerably certain that the high cost of health insurance in Texas is as a result of two reasons. First, the absence of expanded medical coverage to the poor leaves a 'gap' between the families covered under the ancient Medicaid and the others under government subsidies (Gong et al.). This portion of the population constitutes the largest percentage of uncovered Texans, according to extensive research in the state (Su Dejun et al. 860). Consequently, the state forfeits millions of dollars annually in foregone funding from the federal government. In this perspective, the absence of benefits from ACA is a major contributing factor in the issue.

On the other hand, there has been a general rise in the cost of medical insurance across the US which can be attributed to the situation in Texas. With increased claim settlements among insurance companies over the years, the cost has steadily risen, thus sidelining low-income earners. In Texas, this is coupled with greater social and legal hurdles to enrollment which has occasioned low rates of inclusion in Medicaid insurance (Sommers et al. 1011). In essence, the cost of enrollment has increased in both, financial and logistical manners which have kept many Texans uninsured.

Moreover, it is my considered opinion that state leaders have done little to promote Medicare in Texas. With widespread protests and glaring study reports, they have continued to oppose proven remedies such as the ACA to date. In this way, the problem has persisted and compromised the health of millions of people not only in Texas but across other similar states in the country.


In conclusion, the cost of health insurance in Texas is an issue that requires an urgent resolution from both, the state and the federal government. Its unaffordability to low-income earners, especially teachers is of critical concern in the realization of universal healthcare in the country. In my prospective action plan, the political and party differences should be shed and a common negotiated resolution agreed upon for the benefit of the residents. Such includes the consultation with state leaders, the business community, private stakeholders, and the public to endorse solutions that promote the health of Texans through reduced costs of Medicare. Such would ensure that residents of the state rank favourably among their counterparts across the country regarding the health outcomes of the poor.

Works Cited

Gong, Gordon, et al. "The Health Insurance Gap After Implementation of the Affordable Care Act in Texas Texas Medicine March 2017." The Journal (2017).

Green, Michelle A. Understanding health insurance: A guide to billing and reimbursement. Cengage Learning, 2018.

Kominski, Gerald F., Narissa J. Nonzee, and Andrea Sorensen. "The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations." Annual review of public health 38 (2017): 489-505.

Obama, Barack. "United States health care reform: progress to date and next steps." Jama 316.5 (2016): 525-532.

Pickett, Stephen, Elena Marks, and Vivian Ho. "Gain in Insurance Coverage and Residual Uninsurance Under the Affordable Care Act: Texas, 2013–2016." American journal of public health 107.1 (2017): 120-126.

Sommers, Benjamin D., et al. "The impact of state policies on ACA applications and enrollment among low-income adults in Arkansas, Kentucky, and Texas." Health affairs 34.6 (2015): 1010-1018.

Soni, Aparna, Michael Hendryx, and Kosali Simon. "Medicaid expansion under the Affordable Care Act and insurance coverage in rural and urban areas." The Journal of Rural Health 33.2 (2017): 217-226.

Su, Dejun, et al. "Cross‐border utilization of health care: evidence from a population‐based study in south Texas." Health services research 46.3 (2011): 859-876.

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