Gain in insurance coverage and residual uninsurance under the affordable care act: Texas, 2013-2016

Objectives.To examine the effects of the Affordable Care Act's (ACA's) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least. Methods. We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016. Results. Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74.7% to 80.6%; P= .012) after implementation of the major insurance provisions of the ACA.The 4 subgroupswith the largest increases in adjusted insurance coverage between 2013 and 2016were persons aged 50to64 years (12.1percentage points; P = .002), Hispanics (10.9 percentage points;P = .002),persons reportingfair orpoor health status (10.2 percentage points; P = .038), and those with a high school diploma as their highest educational attainment (9.2 percentage points; P = .023). Conclusions. Many population subgroups have benefited from the ACA's Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA's Medicaid expansion is ameansto address the lack of coverage.