The Health Insurance Gap After Implementation of the Affordable Care Act in Texas

Households with incomes between 18% and 99% of the federal poverty level (FPL) are ineligible for Medicaid or enrollment in the health insurance exchange marketplace in Texas, resulting in the health insurance gap. We sought to determine the number of non-elderly adult Texans (NEATs) aged between 18 and 64 years in the insurance gap in rural vs urban areas in East Texas, West Texas, and South Texas. Data were obtained from the US Census Bureau website. In 2014, there were 1,101,000 NEATs in the insurance gap, accounting for 24.5% of all uninsured persons in Texas. The gap was significantly higher in rural vs urban areas in East and South Texas and in Texas as a whole. Large coverage gaps in states like Texas not expanding Medicaid under the Affordable Care Act pose major hurdles to reducing the number of uninsured individuals in these states.