Nationwide, the ACS found districts with higher uninsured rates also tended to have lower incomes and be in states where government officials chose against expanding Medicaid coverage under the Affordable Care Act, the 2010 health care overhaul signed into law by President Barack Obama.
ACA expanded Medicaid eligibility to people up to 138 percent of the federal poverty level, but Texas was one of the states that did not elect to broaden eligibility. A 2012 Supreme Court decision, NFIB v. Sebelius, tossed provisions of the law that made the expansion mandatory.
Texas also had the top 10 congressional districts in the country with the highest uninsured rate among people making less than that 138 percent threshold. All but two of the state’s congressional districts were among the top 10 percent of that category.
A 2020 report by the state’s comptroller estimated that more than 650,000 people in the state lost their employer-related insurance during the coronavirus pandemic.
Since the implementation of the Affordable Care Act, the nation’s overall uninsured rate fell from nearly 15 percent in 2013 to 8.7 percent in 2020. According to ACS data that looked at a five-year period ending in 2020, only 12 states had an uninsured rate of higher than 10 percent: Alaska, Arizona, Florida, Georgia, Idaho, Mississippi, Nevada, North Carolina, Oklahoma, South Carolina, Texas and Wyoming.