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20% 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 (Community met current target. New target to be set for 2016 Dashboard report)

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. Medical debt often becomes 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.

what the data tell us

All Texas regions displayed on the graph below have higher rates of uninsured people than the nation. The percentage of people who are uninsured has been declining in Texas and local jurisdictions over the past few years, and in 2013, the Travis County uninsured rate met CAN’s target of 20%. According to analysis by Travis County Research and Planning, Travis County’s uninsured rate for the population as a whole is slightly lower than Texas’s other major urban counties. The impact of the Affordable Care Act on this indicator will not be fully known until the 2014 American Community Survey data are released, as ACA enrollment had just begun in October 2013. Therefore, CAN has not yet set a new target for this indicator.

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

The Texas Regional Health Partnership Seven reports that 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 extend eligibility to nearly all low-income children. Even so, just less than one out of ten children in Travis County are uninsured. While seniors typically have access to Medicare, access to public insurance programs for low-income adults under the age of 65 is limited. Currently, about one out of four adults 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 initial ACA enrollment period from October 2013 to April 2014, Central Health estimated that approximately 42,601 people in Travis County selected healthcare plans in the marketplace. According to the U.S. Department of Health and Human Services, about 8 million people nationally and 733,757 Texans selected plans in the healthcare marketplace. Central Health estimates that just over 101,000 people selected healthcare plans during the second year of enrollment, which began in November 2014.

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 about 64,000 Travis County residents could have gained coverage with Medicaid expansion.

some local efforts to improve this indicator

  • EnrollATX, a partnership between Central Health and 211 Texas, provides information and assistance related to health insurance enrollment for Central Texans, including over-the-phone enrollment assistance. 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. Central Health reports that during Fiscal Year 2014, an average of 22,635 people were enrolled in the Medical Assistance Program, a locally funded program that provides health coverage for uninsured people. Over the fiscal year, total unduplicated enrollment in the program was 96,600.

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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 will be 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. 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 Community Care Collaborative and Ending Community Homelessness Coalition are working together on a Street Health Care project 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 Health Care project will create teams to meet people experiencing homelessness where they gather, build relationships, and develop health care plans that work for each person.

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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 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, 2013

In 2013, 33% of Travis County’s low-income residents (incomes below 200% of federal poverty thresholds) were uninsured, whereas 13% of Travis County residents who were not low-income lacked insurance. This disparity is true across geographic areas. All Texas jurisdictions below have higher rates of both low-income and non-low-income uninsured 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, 2013

In 2013, 9% of Travis County residents under the age of 18 and 23% 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, Travis County, 2013

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. Other racial/ethnic groups are roughly equally-likely to lack health insurance.

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, 2013

Foreign-born individuals who are not citizens are substantially more likely to lack health insurance than U.S. citizens. In 2013, 51% of non-citizens in Travis County lacked health insurance, compared to 13% 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. 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.

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.

selected populations