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Fact-check: How many Texans can’t access health insurance coverage during the pandemic?

Austin American-Statesman - 7/30/2020

MJ Hegar: Says 1 in 5 Texans did not have health insurance coverage before the pandemic, and now "nearly 1 in 3 Texans under the age of 65 don't have access to health care insurance."

PolitiFact's ruling: True

Here's why: After a primary campaign extended by the coronavirus, MJ Hegar was selected by Democratic voters in Texas to challenge Republican U.S. Sen. John Cornyn in November.

Hegar celebrated her primary election win with a virtual victory party hosted on Facebook, with appearances from state officials and members of the Texas Democratic Party.

During the event, Hegar talked about the coronavirus and its impact in Texas, stating that "we had a health care crisis in this state before COVID-19."

"Before the pandemic, nearly 1 in every 5 was without access to health care coverage," Hegar said. "And now: 1 in 3. Nearly 1 in 3 Texans under the age of 65 don't have access to health care insurance because of the record unemployment and because of our health care model that is failing Texas."

Texas consistently ranks as the state with the highest uninsured rates, but is Hegar right about the number of people without insurance coverage during the coronavirus pandemic?

Pre-pandemic insurance levels

Hegar's campaign shared multiple news articles about Texans without health insurance published before and during the pandemic, including recent reporting from the Houston Chronicle highlighting how job losses are leading to a growing population of uninsured Texans.

Let's start with the rate of uninsured Texans before the onset of the coronavirus pandemic.

The Kaiser Health Foundation, a nonprofit health policy research organization, publishes state health facts using detailed data from the Census Bureau, including the insurance status of people under 65 in Texas.

More than 4.8 million people under 65 are uninsured -- about 19.9% of the population that age, or about 1 in 5 people, according to the latest Census Bureau data published in 2019.

Of those Texans who are insured, about 66% are covered through their employer and 21.6% are covered by Medicaid.

Texas is one of 13 states that has not expanded Medicaid coverage under the Affordable Care Act, which allows people between 100% and 400% of the federal poverty level (considered middle class) to receive tax credits to offset the cost of insurance plans purchased through an online marketplace.

The act also grants free coverage under Medicaid to anyone earning less than 138% of the federal poverty level (which this year is $26,200 for a family of four) in states that have opted to expand the program.

Since Texas has not expanded the program, eligibility requirements for the program are more strict and are not based solely on income. In order to qualify, a person must have an annual income below a certain threshold ($51,876 for a family of four) and be pregnant, be a parent or caretaker of children, have a disability or a family member with a disability or be 65 years or older.

Pandemic insurance levels

Since Texas first shut down segments of the economy to stop the spread of the coronavirus, the unemployment rate has fluctuated, spiking to a record 13.5% in April before falling to 8.6% in June.

For comparison, in June of 2019 the unemployment rate in Texas was 3.4%.

As people lost their jobs, many also lost their health insurance coverage. The actual calculation of the number of people without coverage is a moving target, as people find new jobs or secure coverage elsewhere after becoming unemployed.

But two national studies show that between 650,000 and 1.6 million Texans could have lost coverage since the onset of the coronavirus pandemic.

In May, the Kaiser Health Foundation released a report estimating the number of people losing job-based health insurance coverage during the pandemic and how many of those individuals are eligible for coverage through Medicaid or through the Affordable Care Act's marketplace tax credits.

Nationally, the report estimates that as many as 26.8 million people will become uninsured, including workers, adult dependents and children. Of those, the report estimates that half are eligible for coverage through Medicaid and others through tax credits.

In Texas, that report estimates that 1.6 million people will lose insurance coverage, which would bring the state's uninsured rate to about 26.5% for people under 65 -- or about 1 in 4 people without health insurance coverage.

But these figures don't speak exactly to Hegar's claim, which is about the number of people who "don't have access to insurance."

Even though Texas has opted not to expand Medicaid coverage to people with incomes below the poverty line, the report states that unemployment benefits and the temporary $600 weekly payments approved by Congress are likely to push annual income for many of these unemployed workers to levels that would make them eligible for Medicaid coverage in Texas.

This means they will be able to access Medicaid coverage and marketplace tax credits for the remainder of the calendar year.

Other people who lose coverage could switch to insurance offered through a spouse's or parents' employer and others may qualify for coverage but opt not to enroll, according to the report.

So even though an estimated 1 in 4 Texans will now be without health insurance coverage, the actual number of people who are uninsured and "don't have access to healthcare insurance" is likely even lower.

A July report from Families USA, a research and advocacy non-profit that supports policies that make healthcare more accessible, offers a closer estimate.

The report tried to pin down the number of uninsured adults who would be unable to obtain new health insurance coverage after losing employment during the coronavirus pandemic.

The report estimates that about 5.4 million people across the country became uninsured after losing their jobs between February and May of this year and could not find new coverage.

In Texas, an estimated 659,000 adult workers lost insurance coverage after losing jobs and could not find coverage elsewhere, bringing the rate of uninsured adults in the state at the end of May to 29%, or about 1 in 3 adults, the report found.

But these figures are just about workers, and don't account for children and other dependents who may have been covered by another adult's health insurance plan through an employer, which means the total number of people who are uninsured is likely higher than this estimate.

Our ruling

Hegar said 1 in 5 Texans did not have health insurance coverage before the pandemic, and now "nearly 1 in 3 Texans under the age of 65 don't have access to health care insurance."

Hegar is right about how many Texans under 65 were previously uninsured. The number of Texans without health insurance during the pandemic is harder to pin down, but her "nearly 1 in 3" remark reflects the latest figures available from reports on the rate of uninsured people.

We rate this claim True.

PolitiFact Texas is a partnership of the Austin American-Statesman, Houston Chronicle and the San Antonio Express-News to help you find the truth in Texas politics.

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