José E. Camacho
José E. Camacho

AUSTIN, Texas – Uninsured, low-income workers making between 100 and 400 percent of poverty can now receive subsidies to help purchase affordable health coverage in the Health Insurance Marketplace.

However, because of Texas’ decision to turn down federal funds to close the coverage gap under the Affordable Care Act (ACA), uninsured Texans earning less than poverty wages are left without affordable coverage options.

More than a million of the state’s poorest adults have been left in this coverage gap, relying on safety net providers like community health centers to provide access to primary care services. When safety net services aren’t available, or if services beyond primary care are needed, lack of health coverage and access leads to delay of care and use of emergency rooms for routine care, increasing costs in the health care system in the long term.

Texas pays anyway

Texas taxpayers are already picking up the tab for health care for low-income Texans, but we are paying for it three times: through federal taxes we pay regardless of closing the coverage gap, sales taxes that fund state indigent health care programs and property taxes that pay for hospital uncompensated care and county indigent care programs.

This patchwork of coverage is wasteful, inefficient and expensive. Alternatively, by closing the coverage gap federal taxes pay no less than 90 percent of the cost of care for the coverage gap population, freeing us state and local resources for other purposes. Texans are paying these federal taxes anyway, but they are being redistributed instead of coming back to Texas. This loss of federal funds equals a $16 billion loss for Texas taxpayers between 2014 and 2016, or almost $10 million per day in 2014.

Impact on the Existing Safety Net

Texas’ decision not to accept federal funds to close the coverage gap not only leaves our most vulnerable populations without access to coverage, ital. also threatens important safety net providers. Community health centers, also known as federally qualified health centers (FQHCs), provided high-quality, low-cost primary and preventative care to over a million low-income Texans last year.

In 2010, Congress created a temporary health center trust fund to help health centers expand sites and services to cover the newly insured under health care reform. The trust fund expires in October 2015 because Congress assumed that health centers would begin to receive more revenue through patients with coverage, and would be treating fewer uninsured patients. However, since Texas didn’t close the coverage gap, most health center patients remain uninsured today because their income is too low to qualify for assistance in the Marketplace.

Without a solution, health centers will receive about a 70 percent cut in their federal funds in 2015 when the trust expires. This would take federal health center funding levels back to where they were in 1999, placing the existing safety net in Texas at risk. Health centers may have to reduce the number of uninsured patients they treat, close satellite clinics and lay off staff. However, if Texas finds a solution to accepting federal funds to close the coverage gap, many very low-income health center patients would have access to coverage at little cost to the state, bringing in additional revenues to health centers to offset federal cuts and expand access to care in Texas.

A majority of states have already solved this problem. Texas must find a solution to accept federal funds to provide health coverage to our low-income residents that saves money in the health care system, eases local tax burdens, ensures Texas taxpayer dollars are funneled back into the Texas economy, eases burdens on the existing safety net and promotes a stronger, healthier Texas.

Learn more and get involved

Community Health Centers in Texas need your help. Coverage and access to affordable health care for thousands of our neighbors is at stake. Sign up to join a community working to make your community a healthier place for everyone.

José E. Camacho is executive director and general counsel of the Texas Association of Community Health Centers.