💡 What’s Happening?
In the next couple of days, thousands of Texas children under age 6 will walk into a classroom for the first time. More than 73,000 of them have lost their health insurance since 2022. Today, Texas’ uninsured rate for this age group is more than double the national average – 10.8% vs 5.3%. In 2024, almost 1.1 million children under 18 in Texas were uninsured, comprising nearly a quarter of the country’s uninsured children’s population.
The consequences extend beyond skipping a check-up. Without accessible healthcare, children risk being exposed to preventable factors for chronic illnesses, miss widely available treatments or have their lives endangered from acute conditions – health challenges that can follow them into adulthood.
The alarming jump in numbers can be traced back to the process of reversing COVID-19 era policies which reestablished Medicaid eligibility and eliminated automatic extensions known as Medicaid unwinding. The surprising fact? Most of these children are still eligible for federal assistance. It comes down to faulty processes; about two million Texans lost Medicaid coverage during the unwinding, and 1.7 million lost coverage due to procedural issues such as missing or incomplete paperwork rather than a determination that they no longer qualified.
“Cathy Hope, a representative for Georgetown CCF, said the new report indicated that states like Texas should investigate whether their health coverage systems are functioning as they should. ‘What we’re saying is the check engine light is on — somebody needs to check what’s going on in these states, because kids shouldn’t be losing health coverage,’ Hope said. ‘The eligibility levels didn’t change, and their parents aren’t suddenly making too much money to qualify.’“
Houston Public Media: More of Texas’ youngest kids are becoming uninsured, new research shows
“The American Academy of Pediatrics recommends 13 well-child visits before the age of six because this schedule is associated with fewer hospitalizations and lower emergency department use. Unfortunately, on average, children miss 30% to 50% of these recommended checkups. …. Missing well-child visits contributes to higher rates of emergency department visits, hospitalizations, and delays in diagnosing developmental disorders.”
Equality Health: The High Costs Associated with Missed Well-Child Visits
💸 Unwinding and Washington
The sharp increase in uninsured children following Medicaid unwinding offers an early look at what can happen when administrative hurdles outpace families’ ability to navigate them and several recent federal policy changes could amplify those same challenges.
The expiration of Enhanced Premium Tax Credits has already made Marketplace coverage less affordable for working families, with projections estimating roughly one million Texans could lose Marketplace coverage by 2034. At the same time, the budget reconciliation package passed last July reduces federal Medicaid funding by $911 billion over the next decade while also bringing significant changes to eligibility, verification and enrollment requirements that states must implement over the coming years.
Taken together, these policies shift greater administrative responsibility to states at the same time families are being asked to navigate a more complex coverage system. For Texas – which experienced one of the nation’s highest rates of procedural Medicaid disenrollments during unwinding – the lesson is clear: when enrollment becomes more difficult, eligible children are often the ones who lose coverage, and more people begin to rely on hospitals as a last resort for their medical care.
“‘You can’t disinsure this many people and not have, in many communities, just a collapse of the health care system,’ said Sara Rosenbaum, founding chair of the Department of Health Policy and Management at George Washington University’s Milken Institute School of Public Health. ‘The future is South Texas,’ she said.
…Margo, the family physician, said because so many people lack insurance and there are so few places to seek care, many residents treat the ER as their first stop when they’re sick. … ‘They come in with chest pain or they stop breathing. They collapse. They’ve never seen a doctor,’ Margo said. ‘They’re literally dying.’”
KFF Health News: Projected Surge in Uninsured Will Strain Local Health Systems
“‘If all states had done as poorly as Texas did with the unwinding,’ Alker said, ‘we would have seen a much higher jump in the uninsured rate of children nationally.’ …‘In what universe is it beneficial to anybody for a child not to have health insurance?’ [said Dr. Ben Hoffman].”
Public Health Watch: A Closer Look at What’s Driving the Rising Rate of Uninsured Children
🌱 Supporting Strong Futures
More than five million Texans lack health insurance, and many more are effectively underinsured; patients covered on paper but unable to afford deductibles, premiums, copays or other out-of-pocket costs. Preventive care and health management are neglected, and many only seek urgent care for serious illnesses and injuries. For families, hospitals often become the healthcare safety net, providing financial assistance and essential services regardless of a patient’s ability to pay.
That role has never been more important – or more financially demanding.
Hospitals rely on reimbursement from Medicare, Medicaid, supplemental payment programs and commercial insurance to help sustain the services their communities depend on. But many of those revenue sources are under increasing pressure. Public programs frequently reimburse below the cost of care, while proposed and enacted funding reductions and continued cost growth further strain hospitals’ ability to absorb uncompensated care.
🤝 What Can We Do?
Texas prides itself on independence, but recent research shows just how dependent its families can be on a health coverage system that works.
Protecting children’s health requires more than eligibility – it requires ensuring families can successfully enroll and stay enrolled. Hospitals, physicians, health plans, community organizations and policymakers all have a role to play in reconnecting eligible youth in Texas with coverage before missed checkups become missed diagnoses.
THA recommends the following to secure health coverage for this vulnerable population:
- Modernize Medicaid and CHIP renewal processes to reduce procedural coverage losses.
- Strengthen outreach and enrollment assistance so eligible families receive timely reminders and hands-on help completing renewals.
- Maintain affordable coverage pathways as federal Marketplace changes take effect.
- Support hospitals and community enrollment partners that connect eligible families with Medicaid, CHIP and Marketplace coverage.
⭐ As federal policy evolves, ensuring eligible children stay enrolled may be one of Texas’ most important opportunities to improve health outcomes.
📖 Learn More
Proposed Medicaid Cuts Would Have Catastrophic Impact On Texas
How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State?
