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18% of those under age 65 in Travis County have no health insurance

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

Goal: Decrease the percentage of Travis County residents under the age of 65 who are uninsured

Target: 15% by 2020

Key Trends: Over 13,000 more residents were insured in 2014 than 2013 in Travis County, thanks in large part to the Affordable Care Act (ACA). In 2014, 18% of Travis County residents under the age of 65 were uninsured, a considerable decline from 20% in 2013. According to the Center for Public Policy Priorities, the main source of 2013-to-2014 coverage gains in the U.S. and Texas was direct purchase of insurance, which includes the ACA marketplace that launched in 2014. Despite gains, Hispanics are still less likely to have health insurance than other races or ethnicities. According to the Migration Policy Institute, an estimated 6.7% of the population in Travis County are undocumented immigrants, and 71% of those undocumented immigrants do not have health insurance. The Affordable Care Act intended for states to expand Medicaid eligibility to include lawfully-present adults with incomes under 138% of the federal poverty threshold (FPT). Those earning more than that amount qualify for subsidies. Many poor Texans fall in the “coverage gap,” earning too little to qualify for subsidies. Additionally, Medicaid was not expanded in Texas leaving many with incomes below 138% FPT few options for insurance.

what the data tell us

The percentage of people who are uninsured has been declining in Texas and local jurisdictions over the past few years, and in 2014, the Travis County uninsured rate fell to 18%. Despite this decline, all Texas regions displayed on the graph below had higher rates of uninsured people than the nation in 2014. Texas regions also experienced a less significant decline in the uninsured population than the rest of the nation despite ACA enrollment numbers.

Definition: Percent 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

Many local residents depend on public insurance and benefit programs to access care. Children are more likely than adults to be insured due to the impact of the Medicaid and Children’s Health Insurance Program (CHIP), which extends eligibility to nearly all low-income children. Even so, just less than one out of sixteen (6%) children in Travis County is uninsured. While seniors typically have access to Medicare, access to public insurance programs for low-income adults younger than 65 is limited. Currently, about one out of six adults (17%) ages 18-64 in Travis County is uninsured.

The Affordable Care Act (ACA) attempts to decrease the number of uninsured individuals in the United States. During the latest Enrollment Period, November 15, 2014 through February 22, 2015, Central Health estimates that approximately 65,524 people in Travis County and 102,094 people in the Austin-Round Rock Metro Area selected healthcare plans in the marketplace, an increase of 54% and 57% respectively from the previous year. Preliminary estimates from the U.S. Department of Health and Human Services show an increase in Marketplace healthcare plan selections during the 2014-2015 open enrollment period for the State of Texas too, with 1,189,316 Texans selecting healthcare plans.

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 thus far decided not to undertake the expansion. Central Health estimates that an additional 64,000 Travis County residents could have gained coverage with Medicaid expansion.

Significance of Indicator: Health insurance improves a person’s health and their 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. Medical debt can become a financial and emotional burden for people without health insurance. Taxpayers and people with insurance also bear the costs of caring for uninsured residents. According to a report by Travis County Research & Planning, when uninsured patients utilize hospital services, many of the uncompensated costs of care are shifted to taxpayers and insurers. In 2012, these costs amounted to more than $1 billion in Travis County.

some local efforts to improve this indicator

  • Since the inception of the Health Insurance Marketplace, Central Health has invested in the education and enrollment of Travis County residents into quality, affordable health coverage.  Central Health has led local efforts resulting in the formation of the EnrollATX Enrollment Coalition.  EnrollATX is a partnership between Central Health and United Way’s 211 Texas that provides information and assistance related to health insurance enrollment for Central Texans, including in-person and over-the-phone enrollment assistance that is easily accessible. Additionally, Central Health and United Way’s 211 implemented a community wide scheduling tool for local groups providing Marketplace information and referrals.  This initiative has allowed residents to call one number to obtain an appointment for in person assistance with EnrollATX enrollment groups across Central Texas. To ensure residents are aware of these local resources Central Health has funded a robust Public Information Campaign which has reached millions of Central Texans over the past three years.  As a result of Central Health’s dedicated support, local efforts have been recognized as a national best practice and more importantly, over 73,000 Travis County residents now have quality, affordable health coverage and expanded access to care.

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  • Other local organizations, including United Way for Greater Austin, Foundation Communities, and the Latino Healthcare Forum have worked to increase health insurance enrollment. United Way for Greater Austin and Foundation Communities, have partnered through the Consumer Health Insurance Marketplace Enrollment Services (CHIMES) Consortium to provide in-person health insurance enrollment assistance in the ten-county South Central Texas region. Through the partnership, Foundation Communities, through its Insure Central Texas program, will provide assistance in Travis and Williamson Counties, and United Way will provide assistance in rural counties in the Greater Austin area. 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. Individuals and families in Travis County with incomes under 100% of the federal poverty threshold may qualify for comprehensive medical coverage through the Medical Access Program (MAP). Central Health reports that during Fiscal Year 2015, 29,050 people received care through MAP.. In addition, Central Health also provided access to medical care for 42,224 residents with incomes up to 200% of the federal poverty threshold on a discounted sliding fee scale basis.

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

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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.

Several other local initiatives increase access to healthcare by improving healthcare delivery methods:

  • 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 are used to draw down additional funding from the federal government. A full list of funded projects is available on the website of the Region 7 Regional Healthcare Partnership . 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.

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  • Travis County voters approved a tax increase in 2012 for Central Health resulting in expanded access to health care for uninsured and underinsured people and support of collaborative efforts with UT Austin and the Seton Healthcare Family to create a medical school and teaching hospital.

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  • The Community Care Collaborative, through CommUnityCare, ATCIC, the City of Austin paramedic team and Ending Community Homelessness Coalition are working together on a Street Medicine Pilot to better meet the health needs of individuals experiencing homelessness. After analyses showing that people experiencing homelessness were utilizing emergency departments at a high rate for conditions that could be prevented with primary care, local health providers undertook steps to change the way health care services are provided for this population. The Street Medicine Pilot created teams to meet people experiencing homelessness where they gather, build relationships, provide health care and develop health care plans that work for each person.

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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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data and reports

  • Texans who earn more than the federal poverty threshold can purchase private insurance on the Marketplace and may qualify for tax subsidies. However, the poorest Texans cannot. The ACA was designed with the intention that Medicaid would cover the low-income population who are ineligible for subsidies. For states like Texas, without expanded Medicaid coverage, a "coverage gap" exists for folks that earn too much to qualify for Medicaid but not enough to qualify for subsidies. In 2015, the Center for Public Policy Priorities (CPPP) released fact sheets for every county in Texas detailing the benefits of closing the health care coverage gap. For Travis County alone, CPPP estimates the creation of 15,441 jobs, taxpayer savings of $269.5 million currently paying for uninsured health care, and coverage for 50,200 Travis county residents who fall within the coverage gap.

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  • The City of Austin and Travis County Health and Human Services Department released a report in 2015 highlighting health inequities in our community. The Department worked with the Alliance for African American Health in Central Texas, Austin Immigrant Rights Coalition, and Mama Sana/Vibrant Woman to assess racial and ethnic health disparities. The report specifically examines issues of maternal and infant health, access to health insurance, African American Health disparities, disparities in LGBTQ people of color, and mental health for immigrant families and the elderly. The report summarizes best practices and provides recommendation to better serve these communities.

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  • A new data portal, Healthy Austin Travis County (or Healthy ATC), was released to promote health equity in Austin and Travis County. Healthy ATC is a collaboration between Central Health, the City of Austin Health and Human Services Department, and Travis County Health and Human Services & Veterans Services Department. The Healthy ATC website empowers Travis County residents with data, tools and resources about the health of the community.

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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, 2014

In 2014, about 32% of Travis County’s low-income residents (incomes below 200% of federal poverty thresholds) under age 65 were uninsured, whereas 11% of Travis County residents under age 65 who were not low-income lacked insurance. This disparity is true across geographic areas. All Texas jurisdictions below have higher uninsured rates of both low-income and non-low-income residents than the United States as a whole.

Definition: Individuals with no private or public health insurance coverage for the civilian non-institutionalized population by economic status; low-income refers to incomes beneath 200% of federal poverty thresholds

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 Age Group, 2014

In 2014, 11% of Travis County residents under the age of 18 and 21% of residents aged 18 to 64 were uninsured. A much larger percentage of Texas kids (89 percent) than adults (74 percent) have health insurance thanks to Medicaid-CHIP coverage available to many low-income children. Still, the Texas children's uninsured rate (at 11 percent for those under age 18) is statistically tied with Alaska and Arizona for the worst uninsured rate for children and teens in the country.

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, Travis County, 2014

In Travis County, Hispanics are much more likely than other racial/ethnic groups to be uninsured, with one third of Hispanics reporting that they lack health insurance. According to the Migration Policy Institute, about 90% of undocumented immigrants are Hispanic and the large majority (71%) of undocumented immigrants do not have health insurance, often because they are ineligible.

Definition: Percent of individuals under 65 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, 2014

Foreign-born individuals who are not citizens are substantially more likely to lack health insurance than U.S. citizens. In 2014, 45% of non-citizens in Travis County lacked health insurance, compared to 12% of native born citizens and 14% of foreign born citizens who have naturalized. The ‘non-citizen’ category includes both lawfully present and unauthorized non-citizen immigrants.

Click on this graph for expanded information 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. American Community Survey data on insurance coverage by citizenship status by age were unavailable. Therefore, these data include people of all ages, in contrast to other graphs on this page, which include only people under 65.

» % uninsured - major Texas urban counties

Travis County had a lower uninsured rate than five of the six major Texas Urban Counties, falling second only to Bexar County—San Antonio. While this is a positive trend for our community, from 2013 to 2014, Travis County actually saw the smallest decline in the percent of uninsured residents under the age of 65 (-2%), compared to Bexar—San Antonio (-3%), Dallas (-4%), El Paso (-6%), Harris—Ft. Worth (-3%) and Tarrant—Houston (-3%) counties.

Click on this graph for expanded information Click on the graph for expanded information.

Definition: Percent of individuals who lack health insurance

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. American Community Survey data on insurance coverage by citizenship status by age were unavailable. Therefore, these data include people of all ages, in contrast to other graphs on this page, which include only people under 65.

» Percent under 65 years old with no health insurance by census tract, Austin MSA, 2009-2013, ACS, 5-year data

Uninsured individuals live throughout the region, though the heaviest concentration of individuals without insurance live in central eastern and southeastern Travis County. High concentrations of residents without insurance are also found in northern and eastern Williamson County and eastern Hays County, as well as much of Caldwell and Bastrop Counties.

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

Definition: Percent 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.

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.

» Affordable Care Act plan selections by ZIP Code, Austin-Round Rock-San Marcos msAinitial open enrollment period: october 1, 2013 to march 31, 2014 with supplemental perios ending April 19, 2014

 

During the initial enrollment period for the Affordable Care Act, about 64,963 people in the 5-County Austin-Round Metro Area* selected health insurance plans in the federally-facilitated marketplace, based on an Enroll America analysis of U.S. Department of Health and Human Services data. The highest number of enrollees were found in Eastern Hays County, South Austin, Northern (particularly Northeastern) Travis County, and Southwestern Williamson County. These figures include anyone who chose an insurance plan in the health care marketplace. Some of these individuals may have failed to pay their premiums, and therefore did not gain health coverage during the year.

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

Definition: The number of healthcare plans selected , by ZIP code, during the initial Affordable Care Act enrollment period from October 1, 2013 to April 19, 2014

Data Source: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

Data Considerations: The U.S. Department of Health and Human Services provides data for unique individuals who were eligible to enroll in, and selected, a marketplace plan. Some of these individuals may have failed to pay their premium and were not enrolled in health insurance coverage. Data are masked for ZIP codes with less than 50 plan selections. Zip codes cross county lines. The map above is based on the total enrollees in a ZIP code, regardless of the County in which they reside. Therefore, some enrollees may reside just outside of the 5-county area shown above.

*Data were masked for ZIP codes with less than 50 enrollees. In Enroll America's analysis, these ZIP codes were assumed to have zero enrollees. In ZIP codes that cross county lines, shares of enrollees were assigned to a county based on the proportion of ZIP code residential addresses located in that county. Click here for more information on Enroll America’s methodology.

vulnerable populations