Texas Hospital Association

Marketplace Enrollment Growth Good for Texas

Coverage Solutions Needed to Relieve Stress on Hospital System


Lance Lunsford
Texas Hospital Association
Email: llunsford@tha.org
Twitter: @lancelunsford


THA logo

(Austin  –  Feb. 13, 2014)  –  Texas has the second highest health insurance enrollment among the 36 states relying on the federal government to administer the health insurance marketplace, according to the U.S. Department of Health and Human Services. As of Feb. 1, 2014, enrollment in Texas was 207,546, up 75 percent from the end of 2013. 

While still just a fraction of the state’s population of uninsured that exceeds six million, it is encouraging that more Texans are purchasing private coverage through the federally facilitated marketplace. Unfortunately, the positive impact for Texas hospitals is diminished because the state has rejected the federal option to expand Medicaid or to craft its own solution to reduce the number of uninsured working poor residents.

The result is more than one million Texans without access to affordable coverage options who will continue to rely on hospital emergency departments and clinics for health care ranging from primary care to critical care.

Hospitals’ financial burden of providing uncompensated care for the uninsured is compounded by ongoing and new federal funding cuts that leave Texas hospitals with significantly fewer resources with which to provide care:

  • Reductions in Medicare Disproportionate Share Hospital payments began in FFY 2012 and for FFY 2014 alone are between $16 million and $19 million.
  • Federal cuts to the Medicaid Disproportionate Share Hospital program will begin at $1.2 billion in FFY 2016 and will extend through 2023.
  • The two percent reduction in reimbursement rates for Medicare providers (including hospitals) that began with sequester is extended through 2023.
  • The recent three-month SGR or “doc fix” averts deep cuts to physician reimbursement but contains substantially lower payments for long-term care hospitals that serve patients with clinically complex conditions.

“Improved access to coverage and reduced uncompensated care costs for hospitals go hand-in-hand,” said Ted Shaw, THA president/CEO. “Ongoing and new cuts to Medicare and Medicaid are particularly significant for Texas hospitals because they will continue to see a large number of uninsured patients due to the state’s inaction on coverage for the working poor.”


About the THA
Founded in 1930, the Texas Hospital Association is the leadership organization and principal advocate for the state’s hospitals and health care systems. Based in Austin, THA enhances its members’ abilities to improve accessibility, quality and cost-effectiveness of health care for all Texans. One of the largest hospital associations in the country, THA represents more than 85 percent of the state’s acute-care hospitals and health care systems, which employ some 369,000 health care professionals statewide. Learn more about THA at www.tha.org or follow THA on Twitter @texashospitals.

Subsidiaries and Affiliates


Texas Hospital Insurance Exchange

Texas Hospital Association Foundation

Texas Healthcare Trustees


According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by John Hawkins, Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, Texas, 78701-2180.