The Affordable Care Act and its Impact on the Uninsured Children in Texas

Jenny A Mathai, The University of Texas School of Public Health


Texas is the uninsured capital of the United States and has the largest number of children and adults who are uninsured. Lack of healthcare access can be detrimental to a child’s health. Compared to children who are insured, uninsured children are 20% less likely to be in good or excellent health. The two main federal polices addressing the coverage of low-income uninsured children are the Children Health Insurance Program and Children’s Medicaid. The Children’s Health Insurance Program Reauthorization Act (CHIPRA) was passed in 2009 as a part of the Affordable Care Act. With the enactment of CHIPRA funding for CHIP was extended and enrollment and retention provisions for both CHIP and Medicaid were implemented. This dissertation evaluated whether the CHIPRA expansion worked to get more children covered under health insurance coverage in Texas. An IPUMS extract of the Current Population Survey from 2006 to 2008 and the American Community Survey from 2009 to 2015 was utilized for the analysis. Children were stratified into eligibility and coverage subgroups (e.g., private, public and uninsured) from each year’s extract. Through further stratification of the IPUMS extract, Medicaid and CHIP enrollment numbers were calculated based on eligibility criteria of federal poverty level, household size, citizenship/permanent resident status. The presence of crowd-out was determined using a proportion strategy. An interrupted time series analysis was conducted of the changes in portion of children covered by insurance Pre-and Post-CHIPRA for each coverage subgroup. Based on the raw numbers CHIP and Medicaid were successful in covering more uninsured children with health insurance in Texas. Moreover, since the results were not statistically significant, it cannot be concluded the CHIPRA outreach, enrollment and retention strategies were successful in decreasing the number of uninsured children and increasing the number of children in public insurance and CHIP. Despite, not expanding income eligibility levels and removing the citizenship/permanent resident requirement like other states that chose to expand, Texas was still able to decrease the number of uninsured children with their public insurance programs, Medicaid and CHIP.

Subject Area

Public health|Public policy|Health care management

Recommended Citation

Mathai, Jenny A, "The Affordable Care Act and its Impact on the Uninsured Children in Texas" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10686175.