What Happens to Texans Insurance Coverage When Medicaid and Marketplace Pandemic-Era Policies End? Institutional Repository Document uri icon


  • The COVID-19 related public health emergency (PHE) led to federal legislation that changed the landscape of Medicaid and Marketplace insurance coverage. Beginning in 2020, policy responses led to increasing Medicaid enrollment due to federal rules preventing Medicaid disenrollment, and increased Marketplace participation through generous subsidies extended to the majority of the working age population without access to employer provided coverage. In this brief, we describe and summarize the implications of the federally declared PHE and federal legislation for health insurance coverage during the 2020-2022 period in Texas at the state and county level, estimate the implications for insurance coverage once the PHE ends, and provide estimated aggregate fiscal impacts. Texas had the nations highest uninsurance rate at 18.4% in 2019, but since January 2020, total Texas Medicaid caseload has increased by 41% or 1.6 million people (as of June 2022), and about 750,000 individuals have newly enrolled in Marketplace coverage, likely substantially decreasing the number uninsured. The Medicaid policies have provided a net financial windfall to the state of $3.5 billion since January 2020. With the eventual end of the PHE, our conservative estimates expect that 550,000 to 700,000 individuals will lose Medicaid coverage, increasing the uninsurance rate by at least 2 percentage points or about 10%. Attention to policies and administrative actions that support ongoing insurance enrollment can help ensure that the large gains to insurance coverage achieved during the PHE can be sustained. Policies and administrative actions that would help ensure the historic gains in coverage are maintained include reducing red-tape costs of processing renewals and redeterminations by streamlining eligibility systems (including the use of information already available to the state), using the capacity of managed care and health insurance navigator organizations for outreach and processing, and taking advantage of increased federal matches for Medicaid expansion.

author list (cited authors)

  • Dague, L., & Ukert, B.

complete list of authors

  • Dague, Laura||Ukert, Benjamin

publication date

  • December 2022