Texas Puts Latinos’ Health at Risk

How Opting Out of the Medicaid Expansion Will Affect the State’s Hispanics

The state’s decision to not expand Medicaid under the Affordable Care Act will make it harder for Latinos to access quality health care, writes Jennifer Witte.

El gobernador de Texas, Rick Perry, habla durante la Convención  Republicana de Texas en Fort Worth, Texas, en junio. El gobernador Perry  ha anunciado que Texas no va a expandir el Medicaid bajo el Acta de  Salud Asequible. (AP/LM Otero)
El gobernador de Texas, Rick Perry, habla durante la Convención Republicana de Texas en Fort Worth, Texas, en junio. El gobernador Perry ha anunciado que Texas no va a expandir el Medicaid bajo el Acta de Salud Asequible. (AP/LM Otero)

On June 28 the Supreme Court upheld the individual mandate provision in the Affordable Care Act but gave states the option to reject billions in new Medicaid expansion funds included in the law. This creates uncertainty for millions of Americans but particularly for Latinos. Even though 9 million low-income Latinos would gain coverage from the expanded Medicaid eligibility, some states are turning down the funds.

Take Texas. The state has the worst overall health care, but as of this week Gov. Rick Perry proudly announced that Texas will not expand Medicaid or establish a health insurance exchange.

Texas is one of the 26 states that sued the federal government regarding the health care law and is one of the first states to officially decide to opt out of the billions of dollars in federal Medicaid support over the next six years—plus the continued support for expansion costs for 90 percent of total Medicaid program costs thereafter.

Below we review what Texas’s decision means for the state’s Latinos—many of whom lack health insurance and would have benefited from the expansion.

Texan Latinos are hit hard by not expanding Medicaid

Texas’s recent decision is concerning to all, but Latinos have been and will be affected the most. Second to California, Texas is home to the largest portion (18.7 percent) of Latinos. While Latinos represent 16.7 percent of the population nationwide, nearly 40 percent of Texans are Latino. Thirty-eight percent of the (nonelderly) Latino population in Texas is uninsured, compared to an estimated 17 percent of white Texans and 26 percent of individuals of color living in Texas.

The Center for Public Policy Priorities in Austin, Texas, estimated that federal funding under the expanded Medicaid program would mean an average of $20 billion annually in new federal money for Texas—approximately $13 billion a year for the Medicaid expansion program and another $7 billion a year to provide subsidies for low- and moderate-income Texans, who would buy private health insurance in the new health insurance exchanges. With the Medicaid expansion program alone, the federal funding for Texas would allow the approximately 2 million Texans who are currently uninsured to enroll in the program, including many Latinos.

Which health issues most affect Texan Latinos, and how would Medicaid expansion have helped?

The current state of health care in Texas is dismal at best. The Agency for Health Care Research and Quality recently published its annual state-by-state assessment of health care services, and based on scores in 12 categories, the federal agency ranked Texas in last place, with a score of 31.61 out of 100.

Not only is Texas the lowest-performing state in overall health care, but it also performs below the national average in 9 out of the 12 categories used as ranking criteria—some of which affect Latinos more than any other group. Texas performed “very weak”—the lowest categorization level—in hospital care measures and “weak” in both diabetes measures and preventive measures. Expanding Medicaid would provide more Latinos with health care coverage and allow them to access preventive care and services to manage diseases.

Preventive care

Preventive care includes well-child visits, blood pressure and cholesterol screenings, pap smears and mammograms for women, and flu shots for both children and adults. Under the Affordable Care Act, insurers are now required to cover these conditions with no cost-sharing.

Latinos are less likely to receive preventive care, making affordable access to this types of care critical. Latinos are almost two times more likely to have diabetes than non-Hispanic whites and represent nearly 20 percent of the total estimated number of HIV diagnoses among adults and adolescents. Latino women contract cervical cancer at twice the rate of non-Hispanic whites, making pap smears and regular women’s health screenings particularly important.

Expanding Medicaid would provide more Latinos with access to these services. Both children and adults covered by Medicaid are much more likely to have a usual source of care than people without insurance. Children with Medicaid are far more likely to have seen a doctor and a dentist, and adults with Medicaid are far more likely to get preventive care than the uninsured.

Diabetes care and other disease management

Latinos are more likely to have chronic diseases such as diabetes, cancer, and HIV/AIDS compared to other Americans. Uninsured adults with diabetes who could gain Medicaid coverage under the expansion would likely experience both improved access and increased use of health care. This is crucial for people with diabetes, as they require a high level of care and have a high prevalence of comorbidities, or secondary conditions.

Racial and ethnic minorities including Latinos already often receive lower-quality care and face more barriers accessing care and chronic disease management than non-Hispanic whites. A research brief from the Department of Health and Human Services reported that Latinos receive poorer-quality care and worse access to care than non-Hispanic whites for approximately 60 percent of core quality measures—which relate to safe, timely, effective, efficient, equitable, and patient-centered care—and 83 percent of core access measures, meaning accessibility to needed primary care, health care specialists, and emergency treatment. Importantly, these measures include availability of diabetes treatment.

When patients don’t have access or can’t afford treatment that is necessary to properly manage their chronic conditions, they often acquire secondary conditions, and their overall health declines even further. Latinos with diabetes, for example, are more likely to incur kidney disease and foot amputations than their non-Latino counterparts.

A study published in Health Affairs, a leading academic journal of health policy and research, concluded that Medicaid plays an important role for low-income, nonelderly adults with diabetes. Compared to their Medicaid-covered counterparts, low-income, nonelderly adults with diabetes who are uninsured such as many Texan Latinos are less likely to use services, to report problems obtaining needed prescriptions, and to report access barriers such as not having a usual source of care, putting this population at risk of not adhering to recommended guidelines for diabetes care.

Medicaid coverage is thus crucial because it ensures that the relatively high and complex care needs of lower-income, nonelderly adults with diabetes are met, while keeping out-of-pocket expenses at relatively modest levels.

Economic implications of Medicaid expansion

The Texas Health and Human Services Commission projected that even with a large enrollment increase in Medicaid for poor adults, the state’s Medicaid costs would only increase by $5.8 billion from 2014 to 2019. But because the federal matching funds would provide the state with $76.3 billion, the result would be a net gain of a little more than $70 billion for Texas.

Importantly, there will also be key savings for state and local governments that offset some, if not all, of those costs, while still addressing the health care needs of so many Americans. A recent report by the Urban Institute estimated that without Medicaid expansion, Texas would pay $21.3 billion from 2014 to 2019 for uncompensated care costs, but that rate would drop to $9.6 billion under the Medicaid reforms, when the amount of uncompensated care in Texas would decline by 55 percent.

Anne Dunkelberg, associate director of The Center for Public Policy Priorities, explains that expanding Medicaid has other benefits as well: “Expanding Medicaid will save Texas money in other ways, especially by reducing the money it spends providing health care in emergency rooms and health clinics to people without insurance. Texas could even end up saving more on these costs than it spends on the expansion, easing the strain on property taxes.”

Health care could affect Latino voters

With the presidential election only four months away, states’ choices on Medicaid expansion may play a large role in voting decisions. When Gallup asked about the importance of six national policy issues this past month, 21 percent of Latinos registered to vote ranked health care as more important than any other issue. This is not surprising, as Latinos are the most uninsured or underinsured group in the country—recent figures have shown that half of Latinos do not even have a regular doctor.

Candidates should take note. As the United States shifts to a majority-minority nation, Latinos will soon make up the majority of new voters and comprise significant portions of the electorate in key swing states such as Texas. In fact, Latino Decisions estimated that Latinos will make up 28 percent of eligible voters in Texas in the 2012 election.


By opting to not expand Medicaid or implement provisions in the new health care law, states such as Texas are choosing to ignore the urgent health care issues faced by millions of American citizens, many of whom are Latinos. Governors such as Rick Perry are undermining the portions of the law that would have served the most vulnerable Americans, which consequently diminishes the benefits for the rest of the country. In a state where one of every four citizens is uninsured, Texas has a lot to gain from this reform.

The Affordable Care Act is a real solution to meet the health needs of all Americans, but across the country, Latinos and non-Latinos alike are waiting to see if their states will decide to take advantage of health insurance reform and the billions of dollars in federal support. These millions of Americans are left wondering how much they will actually get to benefit from the Affordable Care Act.

Jennifer Witte is an Intern with the Ethnic Media team at the Center for American Progress.

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