Sources of Health Insurance in Texas State - Essay Sample

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University of California, Santa Barbara
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Research paper
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Health insurance coverage in the USA is a major concern for the health care reform. Since the introduction of Patient Protection and Affordable Care Act, commonly known as Obamacare in 2012, surveys show that the number of the uninsured individuals has dropped (Smith and Medalia, 2014). This is because PPACA expanded eligibility for Medicaid as well as health insurance exchanges. Sources for health insurance coverage vary depending on the age group of the holder, their occupation, eligibility, and their ability to afford the cover. A 2016 survey indicates that 79.7% of Americans rely on traditional sources for their coverage. These include employers and government programs such as Medicare and Medicaid which cover mostly children and their parents in low-income households. Despite all the insurance programs that have been put in place, there is still a population constituting 9% that do not yet have the cover. Some of these are victims of politics where some states refused to embrace Medicaid despite the fact that almost the entire funding came from the federal government. This discussion will analyze sources of insurance coverage in the State of Texas.

Texas is one of the states that are affected by a high number of uninsured individuals (DeNavas-Walt, 2010). As at 2014, 19.1% of Texans had no health insurance. 11% of this population composed of children below 18 years of age. At this time, the national rate for uninsured children stood at 6%. Sources for insurance coverage for Texans range from Medicaid, Medicare, private health insurance, other public sources, and out-of-pocket covers. For most adults aged 65 years and older, they automatically qualify for Medicare Part A, which is insurance for inpatient hospital services. This is for those individuals who have a work history that involved deductions from their payroll. In fact, a study in that year 2014 indicated that only 1% of this age group was uninsured. For those who do not qualify, they are free to purchase the hospital coverage from their own pockets. Children 18 years of age and below are covered under Medicaid or Texas Childrens Health Insurance Program (CHIP).

The low-income earners and those whose income level fall below the percentage drawn by the Federal Poverty Level are also beneficiaries of Medicaid (Holahan, Carroll, and Buettgens, 2011). For the low-income earners, these are the ones who are employed but the employer does not offer coverage, or the deductions are too high. To be considered eligible for Medicaid for this group, one must be caretakers of at least one child eligible for the cover, are pregnant or disabled. These conditions make such individuals qualify for Supplemental Security Income. A survey conducted in the state showed that in 2014, 4.5 million people, who make up 17.2% of the total population, lived below the poverty line. Of this number, 38% were children of 18 years and below. The unemployed people are also beneficiaries of Medicaid due to their level of income. Texas had a 4.5% rate of unemployment in June 2016 with the rates varying among regions in the state. The federal government, therefore, covers for their insurance through Medicaid.

Self-employed individuals are required to have health coverage by law or else face a tax penalty. These individuals have to purchase insurance programs of their choice from the insurance marketplaces in Texas (Smitha and Medalia, 2014). The Obamacare act brought with it some reforms meant to make the process of acquiring a cover easier. There are provisions for subsidies to lower monthly premiums or the costs for health care for this group of people. For the part-time, seasonal and temporary employees, they can be covered by either their employers or Medicaid depending on their level of income. They can also purchase private cover if their income allows them. In some cases, employers provide workers compensation for the period the employee is at the work station. If they fail to qualify in these two covers, they can purchase a plan from an agent or an insurance company through the federal health insurance marketplace.

Employees of large companies are covered by their employers. Businesses with employees exceeding two hundred must automatically enroll them in an insurance plan (Smitha and Medalia, 2014). The employees are free to opt out of this kind of plan by the employer, but they must possess another cover. Such individuals do not qualify for subsidies offered to people who purchase their covers. Employers can also choose to pay for the costs of medical care for their employees under self-funded plans, instead of buying a plan from an insurance company. However, these plans may require the employee to make contributions to the costs of the plan. For small businesses, it is not mandatory for the employer to offer a plan for the employees. Therefore, the employer gets to decide whether to offer insurance covers for his employees or not. If they are not covered, they will be required to purchase any cover of their choice at an individual level.

College students in Texas have different options for their health insurance coverage (Monheit, Cantor, DeLia, and Belloff, 2011). One, a student can stay on the parents plan. Full-time students are eligible for this kind of plan. However, the rates may not be the same if one is schooling out of the state. The second option is a school sponsored program. This is offered in some colleges but may not cover services offered outside the college. Others may not cover part-time students. Third is student health plan which typically covers full-time students of between 17 and 29 years of age. Lastly, one can purchase an individual and family plan which offers a variety of benefits based on the actual plan selected.

Health insurance policies require that certain amount of money is contributed to the insurance providers which will be used to cover the medical costs when the beneficiaries need the health services. For the different groups listed above, there are different requirements on whether they contribute premiums or not (Young and DeVoe, 2012). Persons eligible for government sponsored programs like Medicaid do not contribute premiums for their covers. Medicare beneficiaries, that is, seniors who are 65 years and above, had their premiums and deductions done during their employment years. Premiums will, however, be paid if one is changing from one phase of Medicare to the next. Employer-sponsored plans require that the employee is deducted a certain amount of money from their salary. Premiums are either paid annually or monthly depending on the type of cover selected. Individuals who purchase covers on their own are responsible for paying up the premiums as required by their insurance companies.

In summary, Texas, as in many other states embraces health insurance coverage. Sources for the funding come from different sources ranging from government, employer, private, and out-of-pocket.


DeNavas-Walt, C. (2010). Income, poverty, and health insurance coverage in the United States (2005). Diane Publishing.

Holahan, J., Carroll, C., & Buettgens, M. (2011). Health reform across the states: increased insurance coverage and federal spending on the exchanges and Medicaid.

Kenney, G. M., Lynch, V., Cook, A., & Phong, S. (2010). Who and Where Are the Children Yet to Enroll in Medicaid and the Childrens Health Insurance Program?. Health Affairs, 10-1377.

Monheit, A. C., Cantor, J. C., DeLia, D., & Belloff, D. (2011). How have state policies to expand dependent coverage affected the health insurance status of young adults?. Health services research, 46(1p2), 251-267.

Smith, J. C., & Medalia, C. (2014). Health insurance coverage in the United States: 2013. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census.

Young, R. A., & DeVoe, J. E. (2012). Who will have health insurance in the future? An updated projection. The Annals of Family Medicine, 10(2), 156-162.

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