King v. Burwell: Measuring the Potential Harm to Texas

The U.S. Supreme Court is preparing to issue a ruling in King v. Burwell, the case challenging Affordable Care Act (ACA) insurance subsidies for residents of states — such as Texas — that did not set up their own Health Insurance Marketplaces. Texas and Texans will suffer significant harm if subsidies are eliminated by the court’s ruling.
In many respects, Texas has the most to lose if the Supreme Court eliminates subsidies in the Health Insurance Marketplace.
Texas has the highest uninsured rate in the nation. Texas has the most people who are eligible for Marketplace subsidies, at just over 2 million people. Of the states where subsidies are at risk, Texas has the highest number of people potentially eligible for Marketplace coverage at over 3 million for 2015. Texas also has the highest number of people who would become uninsured – 1.4 million by the end of 2016 – if subsidies are eliminated.
Texas has not closed its coverage gap, so even more low-income individuals (specifically, people with income between 100 percent and 133 percent of the Federal Poverty Level) are dependent on Marketplace subsidies to keep their healthcare costs affordable.
Texas kids will be harmed if subsidies are eliminated.
According to the U.S. Department of Health and Human Services, about 10 percent of Texans who gained coverage through the Marketplace are children, meaning coverage for about 100,000 Texas kids could be placed in jeopardy. Even more children would put at risk if their parents lose health coverage as that impacts the health and financial security of the whole family.
Texans across the state will lose coverage.
The table below shows the number of Texans enrolled in Marketplace coverage with subsidies as of March 2015 for the seventeen largest counties in Texas. You can find the full table of Marketplace enrollment and related health coverage data by Texas county here.
[ultimatetables 7 /]
Texas will lose billions in federal spending for health care.
A decision to end the Marketplace subsidies in King v. Burwell would mean a loss of approximately $4.4 billion in federal spending to Texas in 2016.  The loss of this funding will be felt by health care providers and communities, which will struggle with added uncompensated care costs. Texas is already losing $8-$10 billon a year because state leaders have not accepted federal Medicaid dollars to expand coverage, which has already contributed to Texas hospitals closing and cutting back medical services.

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