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Impacting Long-Term Health Equity by Empowering the Uninsured

Learn More About the Affordable Care Act

By Amy Einhorn, MPP, Senior Program Officer at St. David’s Foundation

Published November 1, 2021

In January of 2019, the Texas Alliance for Health Care predicted more than six million Texans would be without health insurance by 2040. Despite some progress in addressing this challenge, Texas was facing an uphill battle, already leading the country in the number of uninsured.

Then the pandemic hit.

Now, just two years later, we could be on the verge of reaching that dire milestone much earlier. According to research from the Kaiser Family Foundation, as many as 1.6 million Texans may have lost employer-sponsored health insurance during the pandemic. While some of this loss may have been short term (we’ll know the longer-term impact with the U.S. Census Bureau’s American Community Survey data release in November), for Texans already facing systemic racism and inequalities in health care, a loss of health insurance can snowball into even more detrimental barriers to health equity.

Many Central Texans facing this predicament will often skip medical care because they cannot afford it or are forced to take on crippling medical debt that can impact families for generations. The stark reality is many families are forced to reckon with difficult decisions: the choice between buying groceries or investing in health insurance.

Health insurance coverage is one of 10 critical factors that determine whether a community can rebound from significant and traumatic societal events like a pandemic. According to the U.S. Census Bureau, it only takes two or three of these factors to be at-risk or highly at risk of not recovering. Nearly 60% of Central Texans live in communities that fall within this category, through no fault of their own.

The Opportunity to Turn the Tide is Now

On November 1, 2021, as many as 1.1 million Texans will be eligible for health insurance under the Affordable Care Act. While there are still more than 700,000 low-income people who don’t qualify under Texas’ current laws, we can build a better future for those who are eligible during this year’s open enrollment period—especially for those who are impacted unfairly by inequitable systems.

Did you know? Texas is one of 12 states that has not expanded Medicaid coverage under the Affordable Care Act, leaving an additional 770,000 Texans ineligible for Medicaid coverage. To qualify for Medicaid coverage in Texas, a single parent with one child cannot make more than $196 per month before taxes. Many Texans have already made the choice to improve their health care options—more than two million signed up on the federal exchange during the 2017 and 2018 open enrollment periods. This positive trend has continued over the last two years, with Texas’ percentage gain in enrollment more than double the average increase nationwide. It’s clear that Texans are eager to get covered.

With more than 226,000 Central Texans on the poverty line, our efforts must be multifaceted. The most influential drivers of health outcomes are factors that exist outside of the healthcare system, including poverty, unemployment, housing status, and education level—factors that are often influenced by systemic racism. Leading up to and during Open Enrollment, we have an opportunity to identify and break down the barriers that are separating those who have not yet enrolled for access to equitable, quality health care.

Tackling inequity simply cannot be a tangential “add on” to our ongoing focus and goals—it must be at the root of both the solutions we support and, even more, how we understand the context in which we work. St. David’s Foundation is committed to connecting Central Texans with accessible and affordable health insurance coverage that will help open the door for a brighter future for these individuals, their families, and their communities.

For more information on the federal health insurance marketplace, open enrollment, and eligibility, check out this quick guide from, where you can also enroll in a plan.