Texas is the hardest place in the nation to obtain health care and ranks among the most expensive places if you don’t have coverage, according to the latest federal data collated by the Commonwealth Fund, a nonprofit, nonpartisan research group.
After decades of competing with Mississippi and West Virginia for the worst ranking in health care access and affordability, Texas ranked 51st out of the 50 states and the District of Columbia in the latest data from 2021, released last week.
Texas hit rock bottom even before Republican leaders stripped cities and counties of authority to mandate health care benefits. The state has the highest uninsured rate at 24.3 percent, double the national average, and catastrophic compared to top-performer Massachusetts at 3.4 percent.
The Legislature’s refusal to expand Medicaid coverage to the working poor is the culprit. Texas is one of only 10 states that does not provide a health care program for all low-income people. Our lawmakers are determined to maintain their short-circuit of the Affordable Care Act despite dozens of economic studies showing state revenues would rise with Medicaid expansion.
About 16 percent of Texans said they put off treatment for an injury or illness because they can’t afford care. Instead of requiring employers to provide coverage or expanding the joint federal-state Medicaid program, we force people to wait until a minor problem becomes severe and they end up in an emergency department.
Hospitals are only required to stabilize patients, not treat chronic problems. The patient ends up with a referral and a bill they cannot afford. Hospitals and doctors rely on other state and federal charity programs or overcharge insured patients to recoup losses.
Every two years, activists try to end this false economy, and every two years, Gov. Greg Abbott and Lt. Gov. Dan Patrick squash the idea. They would rather spend taxpayer money on a pound of cure than an ounce of prevention.
Access and affordability were only two out of dozens of aspects of data points the fund studied. Others included premature deaths, women’s health and reproductive care.
Texas ranked 48th in the nation across all categories.
Premature deaths have risen everywhere since the COVID-19 pandemic began, but more so in Texas. We averaged 252 deaths per 100,000 people in 2018-19 from preventable and treatable causes, but that number rose to 348 in 2020-21.
The rise in preventable deaths was highest among Blacks and Hispanics, who also have the highest uninsured and poverty rates.
For proof that access to health care makes a difference, in Massachusetts, preventable deaths rose from 196 per 100,000 people to only 222 in the same period.
When it comes to reproductive health, Texas ranked 49th in the country, with 29 percent of pregnant people failing to receive early prenatal care, which put us in a tie with Florida. But in this case, the Legislature made a change for the better this year.
Almost half of all births in Texas are paid for by Medicaid, reflecting the state’s extraordinary poverty rate among young people. Until now, Texas Medicaid only paid for two months of post-natal care for low-income mothers. Under a law passed last month, coverage will last a year.
After all, a child’s health depends on a healthy mother.
These dismal statistics may surprise Texans who receive employer-funded health benefits or enjoy Medicare, the program for those over 65. If you are covered, you can typically find a doctor, and while premiums are high, they are not bankrupting as long as you don’t get sick.
Our health care system works very well for healthy people with means. But try to access our world-class specialists without insurance or stacks of hundred-dollar bills, and you’ll find doors slammed in your face.
Even if you are covered, developing a severe illness can impoverish you. About 19 percent of Texans have medical debts in collections, and health care bills are the leading cause of personal bankruptcies, even among the insured.
Poor public health, misspent resources and premature deaths drag down the state’s economy. Worse yet, none of these problems are new. Texas has ranked at or near the bottom of health care statistics for decades. Our elected officials have done nothing that has improved Texas’ rankings.
Chris Tomlinson, named 2021 columnist of the year by the Texas Managing Editors, writes commentary about money, politics and life in Texas. Sign up for his “Tomlinson’s Take” newsletter at HoustonChronicle.com/TomlinsonNewsletter or Expressnews.com/TomlinsonNewsletter.
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