EDINBURG, November 29 - The potential “welcoming effect” of Obamacare will add hundreds of thousands of pre-eligible children in Texas to Medicaid within three years, a healthcare experts has predicted.

The state’s so-called “Welcome Mat” for children refers to those who were eligible for services all along, and are just beginning to feel encouraged enough to enroll, according to Anne Dunkelberg, associate director for the Center of Public Policy Priorities, quoting figures by the Texas Health and Human Services Commission.

Dunkelberg is one of the state’s leading experts in policy and budget issues relating to healthcare access. She was the keynote speaker during the lunch segment of the UT System’s third UT Vista Summit, which was held at UT-Pan American on Wednesday. It brought together state and national leaders to discuss opportunities in education, healthcare and economic development in the Valley.

Texas can expect at least 400,000 newly enrolled children who were eligible for services all along, Dunkelberg said in her presentation.

“History has shown that whenever states have undergone an expansion of healthcare coverage, anywhere from 50 to75 percent of the people who sign up in the first years turn out to be people who were eligible all along,” Dunkelberg said. “In Texas, 100 percent of the so-called Welcome Mat effect is children. We don’t have a big working population out there for adults, but we do have probably close to 600,000 uninsured kids in Texas who can qualify for Medicaid or CHIP but are not enrolled and uninsured today.”

Karen Fossom, associate director of the Children's Defense Fund in the Rio Grande Valley, could not attend Wednesday's UT Vista Summit. However, she told the Guardian she agreed with Dunkelberg's analysis of the impact Obamacare will have on eligible children.

"We know there are many Texas children that qualify for Children’s Medicaid or CHIP but that are not currently enrolled. It is anticipated that as families explore their options for health coverage through the health insurance exchanges, they will discover that their children qualify for these programs. This could result in hundreds of thousands of Texas children being linked to the preventive health care they need to avoid costly emergency room visits, miss less school, and lead healthier, happier lives," Fossum said.

The focus of Dunkelberg’s presentation included talking about some of the most pressing issues facing healthcare when the Texas Legislature convenes in 2013. She also offered her perspective on the looming impact of the Affordable Care Act, otherwise known as Obamacare,  that will enable a vast majority of uninsured Texans to have some kind of access to healthcare in 2014, however with a couple of big “ifs” rolled into that, Dunkelberg said.

As of 2011, there were 6.1 million uninsured people in Texas, with 656,000 out of that 6.1 million on incomes four times above the poverty level, Dunkelberg said. Under the Affordable Care Act, everybody with an income up to four times the poverty level will qualify for some kind of help with their health insurance costs if they don’t already have affordable coverage through an employer, according to Dunkelberg.

“One of those big “ifs”… out of our 6.1 million uninsured, the Census data shows that about 1.7 million of those are not U.S. citizens,” she said in her presentation. “Some of those are people who lawfully present, about one-third but about two-thirds are undocumented. Undocumented folks are not qualifying for any of the new benefits under the Affordable Care Act, just as they’re excluded from Medicaid and CHIP today.

“So, we do have probably about 1.1 million out of our uninsured population in Texas who are not looking for any solutions to come with the ACA,” Dunkelberg said.

Citing more recent numbers, Dunkelberg said that in August there were almost 2.6 million children on Texas Medicaid, and another 580,000 in the state’s CHIP program. The biggest category of adults, with respect to Texas Medicaid, is reserved for people with serious disabilities, as well as seniors who are below poverty. A small fraction of Medicaid is comprised of poor parents, about 226,000 as of August.
This means you have 2.6 million children, and only about 226,000 of their parents who qualify for Medicaid, Dunkelberg said.

“The issue of not covering parents in Texas Medicaid is one of the reasons that the question of whether or not we expand Medicaid is such a big issue for Texas,” she said.

Notable experts, including former state demographer and former director of the U.S. Census Dr. Steve Murdock have estimated that even with moderate enrollment of the Affordable Care Act, Texas will cut its uninsured rate by at least half. About three million Texans in the near term would gain coverage, Dunkelberg said. The catch however, according to Dunkelberg, is that half of that half (1.5 million) will depend on the Medicaid portion of the ACA. 

“Medicaid would be responsible for about half the coverage gains that Texas stands to get from health reform. Conversely, if we don’t do it we will only have half the gains that we would otherwise,” Dunkelberg said. 

“I should point out that when those like Dr. Murdock look at this, they estimate that if we have really strong enrollment in the Affordable Care Act, we could reduce the uninsured rate by three-fourths, covering more like 4.4 million people,” she said.