By: TAHP | Wednesday, December 8, 2021

December 8, 2021

By: Alicia Pierce, Jamie Dudensing

For many of the five million uninsured Texans, our state’s health care safety net is their routine source of health care and final lifeline. Although critically important for these Texans, it’s worth asking, “why is a safety net the first and only option for so many Texans?” Proponents of safety net only policies fail to realize that safety net care should be a last resort, not a plan for a healthy Texas.

What will create a happier, healthier Texas is investing in strategies for ongoing care that keep patients from having to use the safety net care of last resort in the first place. The best way to achieve that: get more Texans health coverage.

Currently under debate in Washington is a proposal to help uninsured Texans who fall into the medicaid coverage gap purchase private health insurance through healthcare.gov. This private market solution would dramatically improve access to care for these Texans.

According to a Kaiser Family Foundation analysis, one in five uninsured adults went without needed care for a year because of cost compared to just 3% of adults with private coverage and 8% of adults with public coverage. And that access is reflected in the outcomes. Uninsured patients have a higher mortality rate than the insured. Not only are mortality rates higher amongst the uninsured, they also report lower quality of life and wellness.

Take cancer for example. Researchers found that having insurance affects outcomes more than age. For the uninsured, diagnosis unfortunately too often occurs in the emergency room and patients are left discharged with nowhere to go for treatment. Without coverage, reliable, affordable care is out of reach and too expensive for uninsured Texans.

Additionally, health care coverage increases access to mental health services and allows for a coordination that treats the whole person and makes treatment more effective. Health coverage providers care for every health need, from mental health to physical health, emergency care to chronic health conditions, and addressing health inequities and social barriers that get in the way of better health.

Maybe that’s why Americans’ satisfaction with the value of health care coverage is at an all-time high and there is increased demand for coverage. Last year, 1.4 million Texans enrolled and paid for insurance through the individual marketplace, an increase of about 40% more Texans since 2019.

The Texas health insurance market is among the most competitive in the nation and 86% of Texans have three or more options for coverage when buying it on their own. Texas is set to add four more insurers to the individual marketplace; that’s after adding two new carriers in 2020.

The debate about supporting safety net programs versus increasing the number of insured is a false choice. We need our critical safety net providers and applaud the access to care created by community health centers and others that reach deep into communities that need care the most. Increased health coverage takes pressure off these safety net heroes and creates more financial stability for Texas providers and taxpayers who foot the bill for uncompensated care.

A USC-Brookings study of the Build Back Better Act, which could provide coverage options for more than 770,000 Texans, showed that hospital profit margins would improve by $11.9 billion in states like Texas with large coverage gaps. Safety net providers, including federally qualified health centers, benefit more from Medicaid, Medicare, and private insurance payments as a primary source of funding.

So in the debate of safety net versus health coverage, there isn’t actually a debate. Focusing on increased coverage is a win for everyone — patients, taxpayers, health care providers, and our overburdened safety net system.