What is the Texas Coverage Gap?

Texas medicaid expansion, 864,000 Texans in the coverage gap, coverage gap, affordable health coverage, health insurance coverage gap.Find this blog post at bit.ly/CPPPcoveragegap or download a fact sheet here.
Between 750,000 and 1 million uninsured adult Texans are in the Coverage Gap, meaning they have no affordable health insurance options today, but they would be covered if our state accepted new federal health care funds that are available for their coverage. The Coverage Gap includes the folks who cook and serve our food, care for our seniors, build our homes, and fix our cars.

  • Do not receive health insurance from their employers.
  • Make less than $20,200 for a family three (below the federal poverty income, which varies by family size).*
  • Do not qualify for financial assistance on healthcare.gov, because the discounted premiums under Obamacare are not available for people under the poverty line.
  • Do not qualify for Texas’ Medicaid program, because it does not cover any “able-bodied” working-age adults (e.g., not fully disabled, currently pregnant, or over 65) beyond a small number of parents who earn less than $4,000 per year for a family of three.*

WHY does Texas have a Coverage Gap?

  • In Texas, most uninsured adults with incomes below 138 percent of the federal poverty level (FPL) are not eligible for Medicaid benefits.
  • The Affordable Care Act (ACA, Obamacare) expanded Medicaid to adults up to 138 percent of the Federal Poverty Income Level (FPL) (e.g., annual household income of $16,394 for one person, or $33,534 for family of four). But in 2012 the Supreme Court made expansion optional for states.
  • But the Court left in place the original ACA rule that subsidies for private insurance in the Marketplace (www.healthcare.gov) are only available to people above the poverty level (written that way when Congress assumed that all lawfully present Americans below poverty would have Medicaid coverage).
  • Key Texas elected leaders have opposed the ACA in general and have refused to create coverage for the uninsured Texans in this income group.

How could Texas close the Coverage Gap?
Texas could close the Gap for working poor adults by:

  • a traditional Medicaid Expansion for adults (25 states plus D.C. have done this); or
  • an alternative coverage plan under a federal waiver. (6 states currently do this).

Learn More about the Coverage Gap, Medicaid Expansion, and Alternative Coverage Programs under federal waivers:
Closing the Coverage Gap: What You Need to Know
The Texas Coverage Gap
Current Map of Medicaid Expansion States
Alternative Coverage Programs Under Federal Waivers
The ACA and Medicaid Expansion Waivers
How much federal money Texas has turned down to date, since 2014 (top of page, center)
Texas and County estimates of potential uninsured covered, health spending gained, and jobs created
How hospitals are doing better in states with Medicaid Expansion than in Coverage Gap states
The health system haves and have nots of ACA expansion
How to get involved in closing the Coverage Gap in Texas
*Note: edited on March 23, 2016 to reflect family size of three, as noted in the accompanying infographic.

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