By the numbers: Texas’ failure to expand Medicaid

by | Sep 16, 2019 | Health Care, Policy

Following new U.S. Census data revealing an increase in the number of uninsured Americans, the Trump administration is blaming the Affordable Care Act, arguing that higher premiums under Obamacare have priced Americans out of having healthcare.

In reality, the Census data shows that the uninsured rate rose for the first time since the implementation of Obamacare in 2010, suggesting Trump’s continued attacks on the ACA have started taking their toll.

More concretely, according to the new Census report itself, states that experienced the most significant rise in the uninsured rate were also states that declined federal funds to expand Medicaid– a deal offered by the ACA to pay the cost of expanding Medicaid to low-income Americans. Texas is one of 14 states that has repeatedly refused the deal, passing up on more than $100 billion in federal funding to pay for the healthcare of impoverished Texans. 

To get a better understanding of how that decision continues to affect Texans, the Signal gathered five numbers that show what could have been gained– and what was lost– because of Texas’ refusal to expand Medicaid.

5 million. The number of uninsured Texans in 2018, per the new Census data released last week. Texas’ uninsured population rose to 17.7 percent, representing about 5 million Texans without health insurance. The figure, almost twice the national average, puts Texas first in the nation for uninsured population.

1.4 million. The number of Texans that would have been eligible for Medicaid under the expansion. Roughly 36 percent of Texas’ uninsured non-elderly adult population would have been eligible, representing some 1.4 million, mostly Hispanic Texans, according to the Kaiser Family Foundation.

730. The estimated number of Texans who have died annually because of the state’s refusal to expand Medicaid. Texas suffered an additional 730 disease-related deaths annually, according to a University of Michigan estimate that compared the decline in mortality rates in states that chose to expand Medicaid.

$337. The amount of medical out-of-pocket spending that Texans could have saved annually. One Harvard study comparing Texas, Kentucky (which expanded Medicaid) and Arkansas (which expanded Medicaid via the federal marketplace) found that previously uninsured individuals who benefited from the expansion saved $337 in annual, out-of-pocket spending, as well as a bump in self-reported health.

Two out of three. The share of Texans (64 percent) who support Medicaid expansion in the state, according to a Episcopal Health Foundation poll conducted in early 2019.

Photo: Getty Images | + posts

Fernando covers Texas politics and government at the Texas Signal. Before joining the Signal, Fernando spent two years at the Houston Chronicle and previously interned at Houston’s NPR station News 88.7. He is a graduate of the University of Houston, Jack J. Valenti School of Communication, and enjoys reading, highlighting things, and arguing on social media. You can follow him on Twitter at @fernramirez93 or email at

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