A Tale of Two States: Children’s Uninsurance Rates in Texas and California

This week, we released our sixth annual report on children’s health coverage rates across the country. Overall, we found that the country is making incredible progress in reducing rates of uninsurance with the vast majority of states (41 states) experiencing a significant decline in uninsurance rates.

The two states with the largest population of uninsured children – California and Texas – have had different levels of success in improving uninsured rates for children. The contrast is stark. California embraced the Affordable Care Act and took additional steps with state funding while Texas resisted the ACA, didn’t establish a state-based marketplace, and rejected federal funds for Medicaid expansion.

Mayra Alvarez, President of the Children’s Partnership in California, attributes California’s success to the establishment of a state-based marketplace and expanding Medicaid coverage to low-income parents and adults (stay tuned for Mayra’s blog!). In addition, California also extended coverage to kids in the state regardless of their immigration status, and although these newly covered children are not yet reflected in the data that we analyzed, it speaks to the state’s commitment to signing up children for coverage.

Texas, in contrast, has yet to accept federal funding to expand Medicaid. Anne Dunkelberg, Associate Director and Health and Wellness Program Director of the Center for Public Policy Priorities in Texas, also notes that the state could lower their uninsurance rates by improving outreach and enrollment for children, particularly those living in rural areas.

About 28 percent (984,000 uninsured children) of all uninsured children live in these two states alone. Texas has one of the highest uninsurance rates in the country while California’s rate is now below the national average. California also saw a much larger decline in the number of uninsured children between 2013 and 2015 compared to Texas, despite the fact that California started out with fewer uninsured children to begin with.

The percent of uninsured children in California declined by 4 percentage points, going from 7.4 percent in 2013 to just 3.3 percent in 2015. California started above the national average prior to the passage of the Affordable Care Act to below the national average, jumping from the 36th lowest rate of child uninsurance in the nation to the 14th lowest rate. Texas also experienced a large decline in uninsurance rates, going from 12.6 percent in 2013 to 9.5 percent in 2015 – a 3.2 percentage point decline. However, Texas ranked 50th in both 2013 and 2015.

Alisa Chester
Alisa Chester is a Research Associate at the Center for Children and Families