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New Federal Policies Help Eliminate Barriers to Medicaid and CHIP Access for Texans

The Centers for Medicare and Medicaid Services (CMS), Texas’ partner in administering Medicaid and Children’s Health Insurance Program (CHIP), released a final rule to better streamline the application, eligibility determination, enrollment, and renewal processes it regulates across states and public insurance coverage types. Overall, the goal of these policies is to reduce the “churn” of people moving on and off insurance coverage due to issues with paperwork, agency processes, and gaps in data-sharing. This rule is a collection of tweaks that will have enormous impacts on all Texans — even those who have other kinds of insurance.  

Medicaid is a cooperative state and federal program, meaning CMS and the Texas Health and Human Services Commission (HHSC) set the policies for the program while the state and federal governments fund it. Though CHIP and Medicaid are separate programs in Texas, changes to CHIP policy also require cooperation between the states and federal government. In some cases, changes to federal policy — like this final rule — create options and flexibilities for states. Other times, CMS policy requires states to make changes.  

A unique aspect of this final rule — and the basis for all of the policy changes in it — is a reminder that preserving the “integrity” of these programs does not just mean being vigilant about fraud and abuse; it means stewarding the program in a way that ensures people we know are eligible (or should know based on data we already have) are enrolled in and can keep their coverage.  

This final rule requires that changes be made to the systems and processes states use to determine whether a person is eligible or not for Medicaid and CHIP. The highly anticipated — if belated — policy changes were strongly encouraged by Every Texan and our partners, and even largely supported by HHSC as well.  

Medicaid  

The fallout of Medicaid unwinding in states like Texas clearly shows the connection between eligibility and enrollment policies and access to coverage and care. As of March of this year, 1.37 million Texans — mostly kids — have lost their access to health care without having their eligibility determined. Several policies in the new CMS rule will help people enroll in and better retain their Medicaid coverage because states will lose the ability to opt out of commonsense administrative fixes.  

States must now use a specific procedure when mail is returned and it’s clear the notice did not reach the intended person or family. This includes checking other sources, like the United States Post Office, for changes of address as well as using text messages and emails to reach Texas families. HHSC began reporting its use of emails, texts, and robocalls to reach people as they approached the end of the unwinding process, and we hope the agency continues to employ these methods to complete successful redeterminations and future enrollments.  

Federal law now requires states to use certain “ex parte” data in determining eligibility, which includes income eligibility. Ex parte data is information the state or federal agency already has access to without needing more information or evidence from the person or family applying for Medicaid coverage. In many states, there is a long list of data the state Medicaid agency can use to determine eligibility automatically so no one has to send in a paper packet or pay stubs. This, in turn, makes it less likely for applications to get denied, as there’s less manual mistake opportunity. In Texas, the list of data that can be used for ex parte renewals is comparatively short, and it’s only as long as it is now because the state is allowing some flexibility during unwinding. This is why Texas has the lowest ex parte renewal rate in the country and also why HHSC staff have to work overtime to do manually what most states handle automatically.  

The rule also sets a new minimum response time states must allow for people trying to enroll in or remain on Medicaid coverage. In cases where HHSC needs more information from a person or family trying to enroll, Texans will now have 15 days to respond to requests. Current Texas policy gives 10 days to respond. In order to ensure fewer people lose coverage we know they are likely eligible for, there is now a 30-day window for people to respond to agency information requests during an eligibility redetermination. 

Other policies in the rule are designed to enable better ex parte renewal rates by improving record and data storage, retention, and sharing. This should reduce the administrative burden on agencies as well as the likelihood that a person or family will have to provide more information as a part of their application. Ideally, state agencies will now have better information and systems to complete eligibility determinations. 

The Children’s Health Insurance Program (CHIP) 

Texas ranks last in the United States for children’s insurance coverage rates. Key pieces to closing this coverage gap are a better system for eligibility determination, easier enrollment, and ways to maintain CHIP coverage. Since CHIP covers children* from families with higher incomes versus the children covered by Medicaid, there have historically been allowances for more restrictions on access and use of CHIP coverage compared to Medicaid. These barriers to access have long been controversial because the enrollees we’re talking about are children and because many of these types of policies have previously been banned by different laws across other types of insurance. The new rule gets rid of several such restrictions, including: 

  • Arbitrary waiting periods before coverage begins after other coverage is lost (something that no other health insurance program requires). 
  • Lockouts from the program — previously, if a family did not pay their share of costs on time, the child covered by CHIP could get locked out of their health coverage.
  • Annual and lifetime limits. These are caps on what a CHIP plan would spend on a child enrolled on either an annual or lifetime basis (meaning the duration of the child’s coverage on that plan) regardless of whether a child had more health needs. A ban on these types of limits is a popular provision of the ACA, and we are glad to see this same protection applied to CHIP plans.  

Texas currently has a three-month waiting period for children who lose their coverage and want to apply for CHIP coverage that will now have to be phased out. Texas does not currently use lockouts but does have a cap on what it will spend on a child’s dental care, though a family can request these caps be waived in special circumstances. Texas also cuts kids off from CHIP coverage if their family fails to pay a fee when trying to enroll.  

The rule also requires states to create and bolster the process for transitioning children between Medicaid and CHIP when there are changes to income in order to prevent coverage termination. These new processes include a single notice delivered to a household letting the members know who is or could be eligible for what kinds of coverage, including ACA Marketplace coverage and tax credits. Kids shouldn’t lose health coverage just because a rise or decline in family income makes them ineligible for Medicaid or CHIP when Texas has data to show they are eligible for the other program. Coverage loss is fairly common, and it has become a larger issue in many states during the unwinding because there has been no federal requirement for states to create a good, predictable process for transitioning kids between coverage types.   

*CHIP also covers some non-minors under certain circumstances, such as some pregnant adults.  

People Eligible for Both Medicare and Medicaid  

Though Medicare is a federal program, some state eligibility and enrollment processes can impact eligibility and ease of access to Medicare benefits for many Texans with lower incomes and/or disabilities, as a person can be “dually-eligible” for both Medicaid and Medicare (there is no way to qualify for Medicaid based on Medicare eligibility, however). The new rule ensures barriers to enrollment, such as an interview requirements, multiple eligibility checks in a year, and waiting periods, are not applied to programs that do not factor the income and assets limits of an enrollee into the eligibility determination.  

In the same way CHIP, with its higher income eligibility limits, has made enrollees jump through more hoops to enroll and stay enrolled, other groups whose incomes are not a factor in applying for coverage have also faced a daunting process to sign up. These groups are low-income seniors, people with disabilities, and people with medically complex care needs. In these cases, higher income eligibility or the absence of an income check has led to more requirements, such as in-person interviews, designed to make people prove they qualify for coverage the state already knows they should have. Unsurprisingly, these extra steps often translate to barriers to coverage and access. Elimination of these barriers in the final rule is especially important for these populations, as Medicaid and Medicare sometimes pay for different types of care in specific settings. In these cases, losing Medicaid eligibility can have a major impact on a person and their family. Removing these barriers to Medicaid coverage is a vital step to ensuring all Texans have access to all of the types of coverage they need. 

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Blog

What Makes ‘El Paso Strong’?

Having been born and raised in El Paso, it’s clear to me that inclusion – regardless of race, income, or nationality – lives at the heart of our city’s culture. Following a tragic mass shooting in 2019 when a white supremacist murdered 23 people and injured another 24, the phrase “El Paso Strong” emerged as a demonstration of our community’s ability to unite against adversity. Now, our city is facing another challenge: deadly, anti-immigrant policy spearheaded by Greg Abbott and other extremist Republicans. 

While El Paso’s local government, religious centers, and community groups are working diligently to implement a humanitarian process for migrants, extremists in our state’s government continue to impede that progress by perpetuating the false ‘invasion’ rhetoric seen in Operation Lone Star and bills like SB 4. As bad actors continue to implement harmful legislation across the state, it is more important now than ever to recognize the power that exists in community. “El Paso Strong” is not just a phrase; the community’s bond can act as a catalyst for change to bring about proactive policies in the state government. 

A large part of what makes “El Paso Strong” is the city’s ability to accept people regardless of where they come from. Nearly 25% of El Paso residents were born in a different country. Countless residents have banded together to feed, clothe, and shelter migrants who are crossing through the southern border. The organizers spearheading these efforts are not asking for harsher policies or to further militarize the border. On the contrary, these advocates want state investments in education, infrastructure, and housing.

Ivonne Diaz, the Regional Program Coordinator for the nonprofit Texas Rising, has spent the last few years volunteering to help process asylum seekers in El Paso. She has also made numerous trips to Austin to testify that instead of investing in health care, a new electric grid, or better pay for teachers, state legislators “focus on things that don’t advance our community, like spending money on barbed wire and law enforcement and more prisons.” Unfortunately, it’s fallen on deaf ears, as Texas is now spending more than $5.5 billion this biennium on failed border security measures.   

Instead of implementing a proactive agenda, extremist Texas Republicans have opted to score cheap political points at the expense of migrant families and border residents including an attempt to run the Annunciation House that provides basic housing to migrants out of business. This political game has a significant, tangible cost to Texas families. Over the last decade, state spending on border militarization has reached $6 billion. Meanwhile, state spending on education has remained roughly stagnant over the same period of time. 

It’s not just that these extremist policies fail to benefit border communities, they actively hurt them.

“Legislation like SB 4 is the definition of counterproductive policy,” said advocate Manuel Guzman, who was raised in both El Paso and neighboring Ciudad Juárez. “Those who are most impacted by these bad bills aren’t asking for them in the first place. People who live on the border don’t want to live in a place that is over-militarized and overpoliced. They want access to health care and funding for quality education, and they want migrants to be treated with dignity and respect. Texas has failed to provide any of these things.” 

Extremist legislation, like those proposed, serves to propagate an out-of-touch agenda that wrongfully villainizes migrants while ignoring the critical issues border communities are actually facing. For instance, even though a quarter of nonelderly Texas border residents are uninsured, the Texas government fails to expand Medicaid, which would pay for itself. Every dollar spent on deterrence policies without evidence of effectiveness is a dollar lost on education, health care, and other underfunded public services. 

Though the state government is failing to adequately address the needs of migrants at the border, people can still take action. Diaz notes that El Paso’s residents hold extreme power in the effort to ease conditions for asylum seekers and migrants: “It’s important [for people] to connect to organizations that are doing the work and to educate ourselves, not just believe what’s shown on TV.” 

As migrants come to seek refuge in the United States, Texas should follow El Paso’s lead. The city continuously demonstrates that inclusion makes communities stronger. Instead of hampering El Paso’s progress with divisive, unhelpful legislation, Texas leadership must bolster funding for the humanitarian programs that the city’s community centers have implemented. Border residents know best and have made their position loud and clear: less barriers, more resources.

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Comments Testimony

Comments on the Healthy Texas Women Section 1115 Medicaid Demonstration

View these comments as a PDF.

Every Texan appreciates the opportunity to comment on the Texas Health and Human Services Commission’s (HHSC) application to the Centers for Medicare & Medicaid Services (CMS) to extend the Healthy Texas Women (HTW) demonstration under Section 1115 of the Social Security Act. 

Every Texan is a nonpartisan, nonprofit 501(c)(3) public policy organization that uses data analysis to advocate for solutions that enable Texans of all backgrounds to reach their full potential. Improving access to health care for Texans has been at the core of our mission and activities since our founding more than 30 years ago. Every Texan is a vocal advocate for improving access to publicly funded, quality family planning services because making sure that all Texans have access to the tools they need to plan the timing and size of their families is a critical piece of the puzzle in building equal economic opportunity for Texans. 

We urge HHSC to amend its waiver application, as outlined below, before submitting it to CMS, to ensure that the program can maximize access to quality family planning services for Texas enrollees. 

We echo comments made by the Texas Women’s Healthcare Coalition, including requesting the use of a short form family planning only application, opting-in to presumptive eligibility, and ensuring network adequacy and expedited provider credentialing when moving HTW into Managed Care. 

While we are supportive of the HTW program and the coverage it offers to enrollees in Texas, we are concerned that the extension application would continue to exclude access to certain well-qualified family planning providers, which will continue to needlessly harm access to health care. We recommend that HHSC remove the request to waive federal freedom of choice protections in Section1902(a)(23) with respect to providers that do not adhere to Texas Human Resources Code 32.024(c-1) or any similar consideration of services provided (or by affiliates), before submitting the waiver extension application to CMS. 

The current extension application seeks to continue to waive Medicaid’s freedom of choice of provider protection – excluding qualified providers who provide clients with the full spectrum of reproductive health services or affiliate with providers who do so from participating in the HTW demonstration. Continuing this authority holds no experimental purpose and its negative consequences directly conflict with the purpose of 1115(a) waivers in Medicaid. Excluding providers for reasons unrelated to their qualifications does not further the objectives of the Medicaid program because it severely reduces low-income women’s access to family planning and other preventive services. 

Based on current Texas state law, there is no longer a basis for waiving freedom of choice based on services providers are now largely prohibited from legally providing in Texas. Following the Dobbs v. Jackson Women’s Health decision in June 2022, abortions became inaccessible in almost every case in Texas beginning in August 2022. There is no demonstration value, if there ever was one, to waiving freedom of choice to exclude certain providers now in Texas. It is only restricting access to care, including preconception services that can help promote healthy pregnancies. 

At this time, we do not oppose a waiver of freedom of choice that is solely intended to implement managed care networks and does not restrict access to providers based on the range of services they (or their affiliates) provide. We would not support any freedom of choice waiver if the state uses its managed care contracts to limit or impede access to providers (or those with affiliates) that offer the full range of reproductive health services. We also urge the state, in its managed care contracts and contracting process, to set strong requirements ensuring that contractors have robust provider networks that include the community-based providers that have the most experience providing reproductive health services to low-income populations. 

In conclusion, we urge HHSC to restore freedom of choice in the HTW demonstration waiver with respect to providers that provide a full range of services. We appreciate Texas’s recognition of the need to support access to women’s health care services. However, the current waiver extension application continues to exclude well-qualified providers which will limit eligible women’s ability to receive important services. Restoring Medicaid’s freedom of choice protection for providers that offer the full range of services is critical to ensure access to needed care. 

View these comments as a PDF.

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Blog

Reflections on Race-Class Narrative

This blog was authored by Every Texan’s Southern Education Leadership Initiative (SELI) Fellow Jack Kiggins.

Race Class Narrative (RCN) and its messaging strategy potential is an encouraging step forward in the fight for education equity. As a Southern Education Leadership Initiative (SELI) Fellow new to the fight for fair education, comprehending the extent of ongoing neglect impacting students from historically underrepresented groups can be overwhelming. To maximize support for change, informing the public about dog whistle diversion is necessary to achieve equitable education and a more just government. 

As a white male entering the field of education equity, learning about racist dog-whistling greatly shaped my understanding of inclusive messaging. Discriminatory policies are often used to strategically preserve the class structure and limit progress – a groundbreaking realization in my perception of policymaking in the United States. The targeted suppression of historically  underrepresented groups limits everyone’s progress. For generations, powerful figures have constrained economic prosperity and access to public resources for entire groups.

My language choice has also evolved with RCN. Experts explain how some seemingly harmless phrases can be off-putting to readers, encouraging me to be mindful of potentially divisive language in my writing. I also try to remain conscious of the RCN messaging architecture, which recommends specifying the opposition and using direct language to maximize support. Dog-whistle tactics are intentionally subtle, and my investigation into RCN helped me understand how entrenched stereotypes harm good policy in the United States. Representatives on both sides of the aisle use dog-whistle concepts like “government handouts” to elicit stereotypes of lazy welfare recipients, but even messages without malicious intent can stir tension between communities.

RCN is more effective than other messaging strategies because it appeals to a broader audience. Approaches that solely call out racist tactics or highlight class issues have the tendency to alienate, preventing the formation of a multiracial unity capable of deposing powerful politicians. Unlike these communication strategies, RCN explains how government figures rely on long-held stereotypes to avoid resolving the social and economic issues that impact all of us. The RCN approach garners a more positive response from listeners, particularly with messages that express shared values. 

A wide and diverse voting body has the power to create change, and RCN helps form this union by combining interests in racial justice and economic financial fairness. Multiple states have seen success after implementing RCN messaging into campaigns; Minnesota’s recent landmark decisions on renewable energy and school meal provisions defined a remarkable legislative session for the state, and through the integration of RCN communication techniques,  it’s possible for Texas to do the same. The pessimism caused by ineffective government fuels the fire of dog-whistling and continues the cycle of negativity spurred by many politicians seeking reelection.

Before change can happen, however, we need to debunk the social resentment created by dog-whistle racism. These divisive narratives often rely on the zero-sum fallacy, the mistaken belief that advancing one social group requires a setback for another. As noted by RCN advocate Heather McGhee, the zero-sum fallacy emerged as a way to eradicate support for racial equity by claiming policies that benefit historically underrepresented groups infringe upon the welfare of white communities. However, research reveals the exact opposite; the zero-sum doctrine harms everyone, an irony frequently displayed during periods of desegregation. As McGhee explains, integration mandates were often met with  Southern opposition as several neighborhoods opted to close public facilities to avoid interaction with Black families. This anti-integration mindset not only limited resources for communities but also damaged economic welfare because of objections to multiracial unionization. 

Even recent efforts, such as the  Mississippi Nissan plant uprising in 2017, disintegrated due to workers’ apprehension of siding against white management. The assumption that racism only affects certain groups reinforces the scheme of dog-whistling, as politicians and elites are able to maintain control, while communities across the country divide on long-standing stereotypes. RCN provides an incredibly valuable opportunity to destroy the cycle of vicious economic resentment and government distrust sown by strategies of covert racism. 

There will be inevitable opposition to a new, progressive messaging strategy from the roughly 25% of the population that’s ideologically averse to race-class ideals. Regardless of these holdouts, however, the messaging techniques embedded in RCN have proven to elicit largely favorable reactions from supporters and on-the-fence voters, who constitute a national majority. With an effective communication strategy, swaying the voting bulk becomes far more feasible.

RCN has the ability to change perspectives, more so than other narrative strategies. If politicians in the United States continue to prioritize personal gains, patterns of racial discrimination and unfair treatment will remain widespread. There is a special opportunity with RCN to attack the root of these issues and oust divisive figures in favor of the government leaders who are fighting against inequity.

This blog was authored by Every Texan’s Southern Education Leadership Initiative (SELI) Fellow Jack Kiggins.

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Blog

Data Brief: The State of Mental & Behavioral Health in Young Texans

View the full data brief here.

All Texans are worthy of mental health support, yet Texas adolescents and teens are particularly vulnerable to the life-threatening effects of depression and suicidal ideation. Our youth are in a state of emergency, facing stress from the COVID-19 pandemic, widespread school closures, extreme financial strain, and inflation. Not to mention, millions of Texas families are without insurance with the end of Medicaid eligibility expansion. The National Institute for Mental Health estimates that half of all mental health conditions manifest by age 14, yet youth typically wait 8-10 years before accessing care. In Texas, two-thirds of children living with major depression receive no treatment whatsoever. Early identification and intervention are critical to reducing the prevalence and severity of mental illness in young Texans.

Many Texas youth identify as having a mental, emotional, behavioral, or developmental (MEDB) problem.  

Of the more than 7 million Texans ages 17 and younger, more than 1.2 million report having a mental, emotional, behavioral, or developmental (MEDB) problem. That’s 20% of all Texas youth. The definition used by the Census Bureau for its National Survey of Children’s Health includes behavioral problems, conduct problems, anxiety problems, and depression.

Texas students are increasingly at risk of depression and suicidal ideation.

The Center for Disease Control and Prevention’s (CDC) Annual Youth Risk Behavior Survey assesses students on various mental and emotional distress levels. Texas student responses show:

  • 31% of students say their mental health is not good ‘most of the time’ or ‘always.’ Around 60% of these students identify as LGBTQ+.
  • 47% of students reported feeling sad or hopeless almost every day for two or more weeks in a row and stopped their usual activity. The highest prevalence was among Asian (40%) and Hispanic students (31%).
  • 22% of students seriously considered attempting suicide within the past year.
  • 20% of students say they made a plan on how they would commit suicide in the previous year. The highest prevalence (21%) was among Black and Hispanic students.
  • Only 13% of students reported reaching out to someone for help prior to a suicide attempt, whether it be a doctor, counselor, parent, or another support. Black students are the least likely to reach out for help.
  • 12% of Texas students attempted suicide at least once within the last year. Black (14%) and Hispanic students (13%) are the most likely to report attempting suicide, while LGBTQ+ youth are three times more likely to report suicide attempts than heterosexual students.

These data not only spotlight a mental health crisis developing among our state’s youth but also defend the need for urgent expansion of education and health care so mental health screenings and treatments can become a priority.

Texas underperforms in providing adequate access to mental health care and coverage.

The quick-and-fast termination of expanded Medicaid eligibility during the pandemic left millions of Texans uninsured and unable to afford coverage alternatives. While state leaders fail to expand eligibility, our youth continue to suffer. Texas youth are more than twice as likely to be uninsured compared to other American children. Medicaid is one of few programs that includes mental health coverage for its recipients, many of whom are poor women and children. Yet, the fundamental right to health care remains a privilege only for those who can afford it.

The evidence-based Collaborative Care Model is gaining support as a way to expand mental health care and early identification for youth. This model combines mental and physical care under primary care, which means families can access mental health care through primary care providers, rather than seek help elsewhere at an additional expense. With Texas already facing a shortage of mental health professionals and psychiatrists, this model could alleviate long waitlists and rejections.

Texans, call for change!

Texas youth often have to deal with unfamiliar and overwhelming thoughts, feelings, and experiences without the proper tools or support. Life-saving, quality mental health treatment and access can only be achieved through public policy. 

Policy solutions that improve the mental health of Texas youth increase the likelihood of early detection and intervention and also work to normalize the different feelings and experiences adolescence brings. Panelists at Beyond ABC, an annual conference focused on improving the quality of health and life for children, say most suicides are the result of someone who does not have the coping or problem-solving skills to deal with emotional trauma. They say schools are facilitating “open, honest conversations” with kids to show that negative experiences are normal. 

We urge all Texans to make their needs the main priority of Texas policymakers by keeping in regular contact with local government representatives and actively voicing the importance of data collection efforts. Survey instruments, like the CDC’s Youth Risk Behavior Survey we used to inform this brief, promote new conversations on isolating topics. They have the power to reveal that one person’s trouble may reflect an entire population’s dilemma. 

During the special legislative session, some legislators added language to a school voucher bill that would significantly impact participation in the Youth Risk Behavior Survey (YRBS), among other surveys. Should this bill pass, important health and wellness data about Texas youth will be lost. We urge you to contact your representative and ask them to protect this important data. Just as the Texas students surveyed in this brief were given an opportunity to voice their struggles, protecting quality survey instruments ensures that every Texan has a chance to bring their concerns to the forefront of policy.

View the full data brief here.

Unsure of who represents you? Find out at this link to join us in taking action and promoting change for every Texan: Who Represents Me? (texas.gov)

For more information on the state of Texas children and overall well-being, view Annie E. Casey Foundation’s 2023 Kids Count Interactive Data Book and explore the other areas in which you can take action to improve the lives of Texas youth.

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Blog

Proposition 3 Will Maintain Texas’ Extreme Wealth Inequality

Proposition 3 Will Maintain Texas’ Extreme Wealth Inequality

We all benefit when everyday Texans, regardless of where we live or what we look like, have a fair opportunity to prosper. Contrarily, a state tax system designed to favor the ultra-wealthy undermines all of us. In Texas, the wealth gap is so extreme that 66 billionaires living in the state own more wealth than 70% of Texans combined. And this November, Texas voters face Proposition 3 – a critical ballot decision that could prohibit future lawmakers from establishing a wealth tax, a key policy to reshape our unfair tax system and make the rich pay what they truly owe. 

This November, Texas voters should vote in their own interest. Proposition 3, a constitutional ban on a wealth tax supported by self-serving state leaders, freezes future Texas lawmakers’ options to make investments in our state’s most valuable asset, our people. A constitutional prohibition on a state wealth tax would also limit Texas’ ability to diversify state revenue sources and adapt to evolving economic challenges. A key step for shared prosperity through fair and equitable taxation starts with voting no on Proposition 3.

The state’s appalling wealth inequality is a result of an upside-down tax system. Texas’ tax system ranks as the second most regressive in the nation. This means that working residents pay a larger share of their income in taxes compared to the state’s wealthiest residents. Texas residents with the lowest incomes pay an average of 17% of their earnings in state and local taxes, three times more than what the wealthiest pay (4.75%). The broken tax system stems from a heavy dependence on sales, excise, and property taxes to generate the government revenue required for preK-12 and higher education, health care, infrastructure, and other essential services. 

A more progressive tax system would ensure that the people who benefit the most from the upside-down system contribute in proportion to their wealth. Taxing the wealthiest Texans’ colossal $4.9 trillion fortune would be a powerful mechanism to rectify Texas’ regressive tax system. According to the Institute on Taxation and Economic Policy, a 2% tax on wealth over $30 million would generate an extra $33 billion in yearly tax revenue, a tenth of the 2024-2025 state budget. This revenue would provide much needed funds that support our communities, improving outcomes in education and health care.  

This report relies on wealth estimates for Texas provided by the Institute on Taxation and Economic Policy (ITEP), which compiles data from the Internal Revenue Service (IRS), the Survey of Consumer Finances (SCF), and Forbes’ estimates of U.S. billionaire wealth from 2019. ITEP‘s analysis was performed using their Microsimulation Tax Model.   

Texas’ Wealth Skewed to the Wealthiest 1%, Who Hold a Colossal $4.9 Trillion Fortune

Wealth, or net worth, is determined by assessing the total value of an individual’s or a family’s assets, including real estate, financial investments, bank deposits, and business equity. The total value of assets is subtracted by the individual’s or family’s outstanding liabilities, including mortgage debt, credit card debts, and loans on vehicles or education.

Given that wealth accumulates over years and generations, it serves as a significant gauge of financial stability in the Lone Star State. Wealth provides financial security against ups and downs in the economy, offering a stable foundation for improved educational attainment, health outcomes, and outsized political influence. This in turn generates more wealth, and the cycle reinforces itself. Meanwhile, families at the bottom experience fragile economic circumstances and are constantly at risk of experiencing a significant financial crisis due to an unforeseen expense, such as a medical or car repair bill. 

In 2022, the total wealth of Texas’ 14.1 million tax filers totaled $10 trillion. Eight percent of the nation’s total wealth exceeding $30 million per household is held by households in Texas, the fourth highest state behind Florida, California, and New York. The wealth held by these four states accounts for more than half of the nation’s extreme wealth. 

Texas’ astonishing wealth is concentrated in the hands of the wealthiest residents. The wealthiest 1%, approximately 140,400 tax filers, own a colossal $4.9 trillion in fortune, representing nearly half (49%) of the state’s total wealth. The 95-99%, around 563,000 tax filers, hold $2.5 trillion, about 25% of the state’s total wealth. In total, the top 5% hold 74% of the state’s wealth. The middle class, the 2.8 million tax filers in the 40th-60th percentile, own $246.8 billion, which is about 2.5% of the state’s total. 

In stark contrast, the bottom 20% find themselves in dire financial strains, collectively carrying a negative net wealth of -$54.1 billion. The bottom 10% sits at an average wealth of -$35,000, and the 10th-20th percentile at -$3,000. These disparities illustrate the troubling wealth divide between the affluent few and the multitude of Texans grappling with economic insecurity. 

The collective fortune of 66 billionaires in Texas exceeds the total wealth of 70% of Texans. The wealth of these 66 billionaire Texans, nearly 0.0005% of all state tax filers, adds up to a staggering $578.6 billion. In clear comparison, the bottom 70%, about 9.9 million tax filers, collectively own $463.8 billion. The wealth inequality in 2023 could be much larger, since ITEP relied on Forbes’ 2019 billionaire list. 

  • According to the Forbes’ 2023 billionaire list, Texas’ wealthiest billionaire is Elon Musk, founder of Tesla and SpaceX, whose wealth alone totals $251 billion. That is 300,000 times the average wealth held by all tax filers in Texas. 
  • Second to Musk is Michael Dell, CEO of Dell Technologies, with a total wealth of $71.5 billion, followed by Alice Walton, heiress to the fortune of Walmart, with a wealth of $66.5 billion. 

Intersection of Wealth and Race Reveals Deep Inequalities in the United States

Racial wealth disparities in the United States, particularly between Black and Hispanic households, are deeply rooted in historical injustice and persist due to ongoing, systemic racism. Addressing the wealth gap requires recognition that discrimination in our public policies has systematically denied marginalized households access to wealth and maintains the state’s modern wealth inequality. Throughout generations, the institution of slavery and colonization, political disenfranchisement, redlining practices, and exclusion for G.I. Bill benefits prevented Black and Hispanic residents from building wealth.

While the ITEP analysis does not specifically disaggregate wealth by race, an analysis of the 2019 Survey of Consumer Finances (SCF) by the Board of Governors of the Federal Reserve System revealed that deep wealth inequalities exist across and within each race and ethnic group in the United States. In each race and ethnic group, the mean household wealth is consistently higher than the median wealth, meaning that wealth is strikingly concentrated at the top. 

  • The 2019 SCF national survey found that white households have the highest levels of median and mean wealth, $188,200 and $983,400, respectively. 
  • In contrast, Black and Hispanic households experienced significantly lower levels of wealth compared to white households. 
  • Notably, Black households owned close to 13% of the median wealth of white households, with a median wealth of $24,100 and a mean of $142,500. 
  • Meanwhile, Hispanic households reported median and mean wealth of $36,100 and $165,500. 
  • “Other” households, which represent households of diverse racial and ethnic identities, had higher wealth than Hispanic and Black households but less than white households. 

Wealth Proxies Illustrate Disparities Across Race Groups in Texas Similar to the Nation

Because of limitations in data to uncover wealth held by race and ethnic groups in Texas, home values, along with household income and poverty rates, offer an additional measure to understand economic inequality. Mirroring the larger wealth disparities across the country, Black and Hispanic households in Texas experience lower home values, income levels, and higher poverty rates compared to their Asian and white peers. Longstanding exclusionary practices have limited the ability of Black and Hispanic Texans to access well-paying jobs and loans for higher-value homes, creating barriers to building substantial wealth. Furthermore, evidence suggests that racial inequality in home appraisals has increased in recent years.

Home values play a significant role  in the assets of around 90% of American households. In Texas, the median home value stands at $275,400. Asian households lead with the highest median home value at $407,200, followed by white households at $322,100. However, the contrast is striking for Hispanic and Black households, as their median home values are notably lower, at $201,500 and $258,800 respectively. Homes owned by Black residents are valued about half the price of homes owned by Asian residents. This significant disparity reflects the broader wealth disparities among racial and ethnic groups at the national level. 

Disparities in household income have a direct impact on a family’s ability to save and invest, ultimately affecting their prospects for wealth accumulation. In 2022, Asian households had the highest median income of $107,673, about 1.5 times higher than the state median income of $72,284. White households have the second highest household income of $86,229. In contrast, Black and Hispanic households experienced lower median incomes, with figures of $55,759 and $60,504 respectively. 

Individuals living below the poverty line have limited financial resources, ultimately leading to a multi-generational challenge in building wealth. In Texas, white (8.4%) and Asian (9.2%) individuals experience a poverty rate lower than the state rate of 14%. Black individuals face the highest rate at 19.7%, with Hispanic individuals following at 18.6%. For both, the rates are higher than the state’s and twice as high compared to their Asian and white peers.

A Wealth Tax on the 1% is Key to a More Prosperous Future for All Texans

Texas voters should not continue to allow the wealthiest few to use their power and money to influence the tax system in their favor. A key step for shared prosperity through fair and equitable taxation starts with voting no on Proposition 3.

The wealth gap in the Lone Star State is so extreme that 66 billionaires living in the state own more than 70% of Texans combined. Texans deserve a tax system that shares prosperity to all residents through fair and equitable taxation, regardless of their background or zip code. The existing tax system creates an upside-down tax burden that benefits the ultra-wealthy, all while widening economic inequality for Black and Hispanic households. 

A wealth tax could address these disparities by targeting the $4.9 trillion held by the wealthiest 1%, potentially generating an extra $33 billion annually in state revenue. Banning future lawmakers from establishing a wealth tax threatens the state’s ability to invest in our people and prevents the legislative body from competently responding to evolving economic challenges through diverse tax revenue streams.

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Blog

College Food Access Toolkit: The Push for Equitable Higher Education

Explore our College Food Access Toolkit

College students across the country struggle to afford and secure consistent access to quality food, though food insecurity on college campuses is often underreported and overlooked. Beyond existing hardships, the COVID-19 pandemic left a devastating effect on college students by disrupting their access to food. One third of college students  at four-year institutions and 38% of students at two-year institutions face food insecurity, even with tuition aid. Addressing food access on college campuses through collective advocacy and interventions is critical, so that every student has an equal opportunity to succeed.

Whether you are a higher education administrator or a passionate student advocate, Every Texan created this toolkit with best practices to implement at your college or university to address student population needs. Food insecurity is widely felt but rarely discussed as a barrier to attaining higher education:

  • Food insecurity has been noted as a predictor of academic performance.
  • A lack of adequate nutrition has been linked to negative academic outcomes, like lower retention rates and grade point averages. 

As a college student living in my university’s off-campus neighborhood – an area classified by the USDA as being a “low-income and low-access census tract” food desert – my access to food is marred with obstacles. Whether it’s the cost of groceries, course materials, tuition, housing or unreliable transportation, universities must account for the intersection of food and other social drivers of health when assessing campus food access.

Explore our College Food Access Toolkit



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Blog

The Inflation Reduction Act Makes Progress Toward Health Justice

This blog was co-authored by Senior Policy Analyst Stacey Pogue and Policy Analyst Karla Martinez.

The Inflation Reduction Act, signed into law on August 16, progresses toward health justice by making health coverage and prescription drugs more affordable for many Texans. 

The Act extends enhanced subsidies for Health Insurance Marketplace (HealthCare.Gov) coverage through 2025 that have saved Texans in the Marketplace an average of $560 per year. These subsidies, first available in 2021, have made coverage more affordable for many Texans and driven record enrollment in the Texas Marketplace. In 2022, Texas saw the largest percentage increase in Marketplace enrollment in the nation — a stunning 42% to reach 1.8 million Texans. The enhanced subsidies were slated to expire at the end of 2022. By continuing them through the Inflation Reduction Act (IRA), Congress prevented 370,000 Texans from becoming uninsured and maintained affordable coverage for another 1.4 million who would have seen their premiums spike. 

Enhanced Marketplace subsidies are not available to Texans caught in the Medicaid coverage gap, i.e. working but poor adults — primarily Texans of color — who earn too little to qualify for Marketplace subsidies, but too much to be eligible for Medicaid. These Texans have no affordable coverage options today because Texas leaders have refused to expand Medicaid, an action taken in 38 other states and Washington, D.C. 

The Inflation Reduction Act also makes prescription drugs more affordable for seniors and individuals with disabilities who have Medicare prescription drug coverage. It caps total out-of-pocket costs for prescriptions at $2,000 a year, caps out-of-pocket costs for insulin at $35 a month, makes vaccines available with no out-of-pocket costs, and expands eligibility for Medicare’s low-income drug subsidy. On top of that, the bill lowers drug costs for both Medicare enrollees and the federal government by 1) requiring the federal government to negotiate with drug companies to lower prices on some high-cost drugs, and 2) requiring drug companies to pay rebates if they raise prices at a higher rate compared to inflation. 

Every Texan celebrates the progress of the Inflation Reduction Act, which makes health coverage and prescription drugs more affordable for many Texans, but more work remains. We will continue to advocate for the Texas Legislature to close the coverage gap and reduce our state’s worst-in-the-nation uninsured rate. Regardless of race, background, gender, or zip code, every Texan deserves access to quality, affordable health coverage.  

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Blog

Join the Policy Leaders of Texas Fellowship Program!

2021-2022 Policy Leaders of Texas Fellows Isabel Agbassi and Braelynn Barborka share their experiences with the program and why eligible students should apply today.  

Braelynn Barborka

My name is Braelynn Barborka. I am a senior at the University of Texas at Austin, double-majoring in Government and Women’s & Gender Studies. I had the privilege to be a part of the 2021-2022 cohort for the Policy Leaders of Texas Fellowship Program. I am currently a legislative and policy intern for Every Texan. During the summer going into my junior year, I wasn’t sure what I wanted to do with my time. I knew I wanted to be in a program where I would continue to gain and apply knowledge. I came across Every Texan and really loved the message that “social justice requires public policy.” The Policy Leaders of Texas Fellowship program gave me a platform to not only learn but also talk about my experiences within higher education. 

I learned about many subjects and tools during my time as a fellow, but one of the most valuable things I learned is that policy work can and must be done in collaboration with those who are currently being affected by the issue. It was great to work on something like higher education as a current student. I was also able to speak with Every Texan staff members from other departments about policy areas beyond higher education. I loved that I was given an opportunity to learn about the state budget, food insecurity, and other issues that heavily affect policy reform and are connected to higher education. I was able to take that knowledge and create ideas that will be used for the structure of future legislation. 

The PLT Fellowship program also helped me develop a bird’s-eye view of the higher education system and understand the intricacies of the problems it faces. I was able to hear from other students to get a better understanding of the struggles we all have to endure and how we can come together to fight them. Throughout my time in the program, it truly felt like Every Texan was interested in hearing from current students, and I was given many opportunities to voice my concerns about policy issues and what I wanted to get out of my time as a fellow. If you are someone who is interested in joining a program that gives you not only opportunities to learn about an array of issues, but also spaces to create ideas and to be heard, then the Policy Leaders of Texas Fellowship Program is for you.

Isabel Agbassi

I went into this fellowship as a sophomore eager to learn about how to better advocate for other college students, and I left as the student body vice president of my college institution.

I’m Isabel Agbassi, and I’m a junior at the University of Texas at Austin majoring in Public Health with a minor in Health Care Reform and Innovation. I was a part of the 2021-2022 cohort of the Policy Leaders of Texas Fellowship and am now a health and food justice intern.

As a pre-health student, the root of my policy interests has been equity in the health care sphere, whether it be about addressing social determinants of health, tackling health disparities, or understanding the ethics of health care policy. But as I navigated my journey to graduation, I noticed universal higher education issues that had the potential to hinder my success and the success of so many others. These issues — which include the lack of diversity and inclusion in STEM and research, food insecurity, the financial barriers to pursuing graduate education, and inadequate mental health care — consistently interfere with academic retention. In the face of such issues, one can either accept them as the norm and try and make due in spite of them or take action to make positive change and empower others to do the same. I chose the latter because I am a firm believer in helping improve your community. And it was one of the best decisions I’ve ever made.

The fellowship introduced me to passionate and inspiring college students who I constantly learned from throughout the year. Together, we grew as advocates under the amazing mentorship of Simona Gabriela Harry, the Policy Leaders of Texas Program coordinator, Skyler Korgel, the higher education policy analyst, and Chandra Villanueva, the economic opportunity team program director. From the beginning, they centered our personal learning styles, optimal working conditions, and aspirations. We always started meetings with mental health check-ins before diving into a wide variety of topics such as the Texas budget and legislative process. We were always in a comfortable environment where questions were welcomed and encouraged. Some of the highlights of my time as a fellow include doing a team exercise where we made our own Texas budget, creating my first theory of change, and hearing from the various experts at Every Texan who joined meetings as guest speakers. 

My major takeaways from this fellowship include a more comprehensive view of the current state of higher education and actionable steps to fixing issues, empowerment to advocate for myself and others, and an understanding of how much goes into making positive change come to fruition.

In these formative years in college, it’s important that we students remember the power each and every one of us has to create a better and more equitable environment for everyone. I truly recommend participating in the PLT Fellowship Program to learn and become a better advocate for your community.

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Testimony

Testimony to the House Select Committee on Health Reform on Reducing the Texas Uninsured Population

This week, the new Texas House Select Committee on Health Reform begins hearings on its ambitious and important list of interim charges, from tackling health care cost growth to increasing health care coverage. In creating the committee, Speaker of the House Dade Phelan has put a much-needed focus on health care policy.

Every Texan’s Anne Dunkelberg and Stacey Pogue shared with the committee the three top ways Texas can reduce its worst-in-the-nation uninsured rate:

  • Use federal funds to provide Medicaid to “working but poor” adults — both parents and adults without any dependent kids at home.
  • Remove barriers to enrollment/renewal of currently eligible individuals in Texas Medicaid.
  • Maintain record-breaking enrollment at HealthCare.Gov. Texas is already poised to do so.

View the full testimony from Associate Director and Health & Food Justice Team Director Anne Dunkelberg, and Senior Policy Analyst Stacey Pogue here.