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Uninsured

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21% of those under age 65 in Travis County have no health insurance

Indicator: % under age 65 in Travis County with no health insurance

Goal: Hold constant the number of Travis County residents under the age of 65 who are uninsured

Target: 20% by 2014

Significance of Indicator: Health insurance improves a person’s health and his/her ability to get an education and achieve and maintain productive employment reports the Kaiser Commission on Medicaid and the Uninsured. Many uninsured individuals forgo needed care– avoiding preventative care and failing to manage chronic conditions. Currently, the U.S. Government and taxpayers spend billions of dollars caring for the uninsured. For the uninsured themselves, medical debt often becomes a financial and emotional burden.

what the data tell us

All Texas regions displayed on the graph below have higher rates of uninsured persons than the nation. The percentage of people who are uninsured has been declining in the City of Austin, Travis County and the Austin-Round Rock-San Marcos MSA over the past few years. Travis County seems to be on track for meeting the target of 20% uninsured by 2014.

Definition: Under 65 years with no private or public health insurance coverage for the civilian non-institutionalized population

Data Source: American Community Survey, 1 Year Estimates

Data Considerations: The American Community Survey samples 3% of the Nation’s population. Due to small sample sizes, margins of error are increased and hard to reach populations may not be accurately represented in the data.

the story behind the indicator

The Texas Regional Health Partnership Seven reports that many local residents depend on public insurance and benefit programs to access care. Due to Medicaid and the Children’s Health Insurance Program, children (persons under the age of 18) are more likely than adults to be insured. Even so, more than one out of ten children in Travis County are uninsured. While seniors typically have access to Medicare, access to government coverage programs for adults under the age of 65 is limited. Currently, about one in four adults ages 18-64 in Travis County are uninsured. The Affordable Care Act (ACA) attempts to decrease the number of uninsured individuals in the United States. The ACA provides for the expansion of Medicaid to all legal residents living at or below 138% of the federal poverty level, but Texas leaders have refused to undertake the expansion. The Kaiser Family Foundation estimates that 42% of uninsured Texans are eligible for assistance obtaining health coverage, and another 21% have access to unsubsidized coverage through the Marketplace. They estimate that 37% of uninsured Texans will lack access to affordable health insurance under the current policy framework. The U.S. Department of Health and Human Services estimated that just over 4.2 million Americans and 295,000 Texans selected a plan as of March 1, 2014.

some local efforts to improve this indicator

  • Central Health Healthcare Navigation is a partnership with United Way for Greater Austin that connects people who call 2-1-1 with health insurance enrollment assistance. Other local organizations, including Foundation Communities, and the Latino Healthcare Forum have worked to increase health insurance enrollment. Through the Affordable Care Act, many more individuals will gain access to health insurance. Unfortunately, many groups, particularly people with incomes below 100% of the federal poverty threshold, will continue to face barriers to obtaining health insurance.

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  • Central Health provides access to health care for uninsured and under-served residents. Central Health reports that enrollment in the Medical Assistance Program, a locally funded program that provides health coverage for uninsured people, has increased 176% since 2005. Central Health is the lead agency for a six county Regional Healthcare Partnership Plan, a 5-year demonstration project that will work to transform healthcare delivery as part of a state-wide 1115 Medicaid Waiver. Through their efforts, Central Health is working to transform the healthcare delivery system in order to provide service that is person-centered, coordinated, and better quality at a lower cost. Local funds for the projects will be used to draw down additional funding from the federal government. In the second year of the project, all regional partners together received $129 million in federal funds.

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  • Austin Travis County Integral Care, a key partner in this effort, plans to expand and enhance community-based services through integration of physical and behavioral health with chronic disease prevention programs, mobile outreach, tele-medicine, peer support services, and community outreach and education. Travis County voters approved a tax increase in 2012 for Central Health that will result in expanded access to health care for uninsured and underinsured people and will support collaborative efforts with UT Austin and the Seton Healthcare Family to create a medical school and teaching hospital.

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  • The Central Texas Regional Healthcare Coverage Coalition engages partners across multiple counties to help people access public healthcare assistance. 

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  • Health care providers in Central Texas are working together, through the Integrated Care Collaboration (ICC), to collect and analyze clinical data in a Health Information Exchange called the ICare system. Through this analysis of regional data, ICare will help providers identify needs in the Central Texas health care system and create programs to improve health outcomes for vulnerable populations.

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  • A coalition of partners including the Texas Hunger Initiative, Texas Impact, and the Texas Association of Community Health Centers secured a Texas Health and Human Services Commission contract to implement a Community Partners Program. The “Community Partners” will use Texas’s online application at www.YourTexasBenefits.com to help eligible families apply and enroll in public programs such as Medicaid and SNAP.

a closer look at the story behind the indicator:

Click on one of the titles below for more information.

» Health Insurance Coverage in Travis County

% of individuals with no health insurance coverage by economic status, 2012

In 2012, 33% of Travis County’s low-income residents were uninsured. This compares to 11% of Travis County residents who were not low-income. The percentage of low-income individuals who were uninsured dropped for every jurisdiction on this graph from 2010 to 2012.

Definition: Individuals with no private or public health insurance coverage for the civilian non-institutionalized population by economic status

Data Source: American Community Survey, 1 Year Estimates

Data Considerations: The American Community Survey samples 3% of the Nation’s population. Due to small sample sizes, margins of error are increased and hard to reach populations may not be accurately represented in the data.

% of People Under the Age of 65 who are Uninsured by Age Group, 2012

In 2012, 10% of Travis County residents under the age of 18 and 24% of Travis County residents aged 18-64 were uninsured. Both Travis County and the City of Austin have seen a steady decline in the uninsured rates of both age groups since 2009.

Definition: Under 65 years with no private or public health insurance coverage for the civilian non-institutionalized population by age

Data Source: American Community Survey, 1 Year Estimates

Data Considerations: The American Community Survey samples 3% of the Nation’s population. Due to small sample sizes, margins of error are increased and hard to reach populations may not be accurately represented in the data.

% of people who are uninsured by race and ethnicity

One third of Hispanics report being uninsured. Non-Hispanic Whites report being uninsured at the lowest rate in Travis County (12%). The percentage of Asians (17%) and Blacks (16%) who report lacking insurance is roughly equal.

Definition: Individuals with no private or public health insurance coverage for the civilian non-institutionalized population by race and ethnicity. “Hispanic” is classified by the U.S. Census Bureau as an “ethnicity” and not as a “race.” As a result, the following categories may include some people who also identify as Hispanic: African American, Asian, American Indian/Alaskan Native, Some Other Race Alone, and Two or More Races.

Data Source: American Community Survey, 1 Year Estimates

Data Considerations: The American Community Survey samples 3% of the Nation’s population. Due to small sample sizes, margins of error are increased and hard to reach populations may not be accurately represented in the data.

» % uninsured by citizenship status, 2012

Foreign-born individuals who are not citizens are substantially more likely to lack health insurance than U.S. citizens. In 2012, 55% of non-citizens in Travis County lacked health insurance, compared to 14% of native born citizens and 18% of foreign born citizens who have naturalized. The ‘non-citizen’ category includes both lawfully present and unauthorized non-citizen immigrants.

image of Map Showing percentages of Uninsured residents in 5-County Region Click on the map to view a data table with this information.

Definition: Percent of individuals who lack health insurance by citizenship status

Data Source: American Community Survey, 1 Year Estimates.

Data Considerations: The American Community Survey samples 3% of the Nation’s population. Due to small sample sizes, margins of error are increased and hard to reach populations may not be accurately represented in the data. The ‘non-citizen’ category includes both lawful and unauthorized immigrants.

» Percent Uninsured by ZIP Code, Austin-Round Rock-San Marcos Metropolitan Statistical Area, 2008-2012

 

Uninsured individuals live throughout the region, though the heaviest concentration of individuals without insurance live in Central Eastern Travis County. High concentrations of residents without insurance are also found in Northern and Eastern Williamson County, Western Bastrop County, Eastern Hays County, and much of Caldwell County.

image of Map Showing percentages of Uninsured residents in the Austin-Round Rock-San Marcos Metropolitan Statistical Area

Definition: Under 65 years with no private or public health insurance coverage for the civilian non-institutionalized population

Data Source: American Community Survey, 5 Year Estimates. Shapefiles from CAPCOG and U.S. Census Bureau.

Data Considerations: The American Community Survey samples 3% of the Nation’s population. Due to small sample sizes, margins of error are increased and hard to reach populations may not be accurately represented in the data. This issue is particularly acute when considering small geographic areas, such as Census Tracts and ZIP Codes.

vulnerable populations

turning the curve

The CAPCOG Area Agency on Aging Plan, Central Health's Strategic Plan, the Community Advancement Network's Frequently Asked Questions documents on Child and Youth Mental Health and on Childhood Poverty, and the Imagine Austin Comprehensive Plan all advocate for increasing access to healthcare through strategies such as expanding eligibility for public health insurance programs or by increasing efforts to enroll eligible persons in public health insurance programs.