A Profile of Texas’s Low-Wage Uninsured Workers by Joan Alker and Alexandra Corcoran May 2021 The recently enacted American Rescue Plan Act of 2021 (ARP) includes new large financial incentives for states to extend health insurance coverage to low-wage workers and other adults earning less than $17,775 a year.1 These incentives apply to regular spending in a state’s Medicaid program and offer a five-percentage point across the board increase in the federal share for a 24-month period after the state extends coverage. The Kaiser Family Foundation estimates that Texas’s budget would see a net gain of $1.9 billion over a two- year period if the state expanded Medicaid.2 Approximately 1.4 million uninsured nonelderly The Georgetown University Center adults, or 34 percent of the state’s uninsured adult population, would gain health insurance.3 for Children and Families (CCF) is an This fact sheet examines which workers and industries would benefit from expansion of independent, nonpartisan policy and research center founded in 2005 with a Medicaid coverage.4 The top three industry sectors employing low-wage uninsured workers mission to expand and improve high- are hospitality, retail, and health care and social assistance, accounting for almost half (48.5 quality, affordable health coverage for percent) of those working without insurance (see Table 1). Businesses with a large proportion America’s children and families. CCF is of uninsured low-wage workers include restaurants, construction firms, and home health care based in the McCourt School of Public agencies. The most common jobs for low-wage, uninsured workers in Texas are cashiers, Policy’s Health Policy Institute. cooks, waiters and waitresses, retail sales, and personal care aides (see Table 2). Table 1. Top Industry Sectors in Texas For Low-Wage Workers For Low-Wage, Uninsured Workers Retail trade 16.5% Accommodation and food services 17.8% Accommodation and food services 15.5% Retail trade 16.5% Health care and social assistance 14.1% Health care and social assistance 14.2% Educational services 7.2% Construction 9.9% Construction 6.9% Administrative, support, and waste management 8.7% Administrative, support, and waste management 6.9% Other services 6.7% Other services 6.0% Manufacturing 4.7% Manufacturing 4.9% Educational services 3.8% Transportation and warehousing 4.2% Transportation and warehousing 3.7% Professional, scientific, and technical 3.2% Professional, scientific, and technical 2.5% Table 2. Top Occupations in Texas For Low-Wage Workers For Low-Wage, Uninsured Workers Cashiers 5.9% Cashiers 6.5% Retail salespersons 3.5% Cooks 4.2% Waiters and waitresses 3.4% Waiters and waitresses 3.8% Cooks 3.3% Retail salespersons 3.4% Customer service representatives 3.0% Personal care aides 3.3% Personal care aides 2.7% Construction laborers 3.0% Laborers and freight, stock, and material movers 2.4% Customer service representatives 2.7% Driver/sales workers and truck drivers 2.4% Driver/sales workers and truck drivers 2.6% Maids and housekeeping cleaners 2.1% Laborers and freight, stock, and material movers 2.5% Janitors and building cleaners 2.0% Maids and housekeeping cleaners 2.5% Note: Workers with no occupation are not listed. Other services category includes industries such as repair and maintenance, barber shops and beauty salons, and laundry services. Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS). Contact authors for more information on the methodology. Demographics of uninsured low-income adults Our analysis finds that women make up a disproportionate share of low-income, nonelderly citizens in Texas (58 percent) and 55 percent of those who are uninsured. Women dominate the top three industries where large numbers of low-wage uninsured workers are employed (see Figure 1). In Texas, as Figure 2 illustrates, ethnicity varies somewhat by industry.5 In the top three industries with the largest shares of low- wage uninsured workers (i.e., hospitality, retail, health care and social assistance), non-Hispanic/Latino individuals comprise a slim majority of low-wage, uninsured citizen workers. Figure 1. Gender of Low-Wage, Figure 2. Ethnicity of Low-Wage, Uninsured Workers in Top Industry Sectors Uninsured Workers in Top Industry Sectors Accommodation Accommodation 42.9% 57.1% 53.1% 46.9% and food services and food services Retail trade 43.6% 56.4% Retail trade 50.6% 49.4% Health care and Health care and social assistance 10.2% 89.8% social assistance 52.7% 47.3% Construction 88.3% 11.7% Construction 43.6% 56.4% Administrative, Administrative, support, and waste 55.8% 44.2% support, and waste 54.0% 46.0% management management MenWomen Not Hispanic/Latino Hispanic/Latino Source: Georgetown University Center for Children and Families analysis of Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2019 Public Use U.S. Census Bureau American Community Survey (ACS) 2019 Public Use Microdata Sample (PUMS). Contact authors for more information on the Microdata Sample (PUMS). Contact authors for more information on the methodology. methodology. Which parts of the state have higher proportions of uninsured workers? The map on the right shows the range of uninsured Uninsured Rate for rates for all nonelderly adult workers across the Nonelderly Workers Above 20% state of Texas. Only Williamson County has fewer Between 10-20% than 10 percent of its workers uninsured (9.9 Lower than 10% percent). Table 3 lists 19 counties with reliable data Estimate suppressed where more than one-third of workers of all incomes due to unreliable data and citizenship status are uninsured. Most of these counties are rural except for Hidalgo, Cameron, Note: Includes all workers ages 19-64 Webb, and Hudspeth County. regardless of income or citizenship status. Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2015-2019 Table DP03. Contact authors for more information on the methodology Table 3. Texas Counties with More County Uninsured Rate County Uninsured Rate than a Third of All Working Adults United States Texas 11.0% 20.5% Maverick 37.5% Willacy 37.2% Uninsured Real 55.0% Duval 36.9% Menard 46.8% Bailey 36.2% Figure includes all workers ages 19-64 regardless of income or Starr 46.6% Briscoe 35.6% citizenship status. Zapata 41.5% Webb 34.9% Source: Georgetown University Center for Children and Motley 41.3% Hudspeth 34.4% Families analysis of U.S. Census Bureau American Community Hidalgo 41.1% Haskell 34.2% Survey (ACS) 2015-2019 Table DP03. Out of Texas’s 254 Hall 40.2% Kimble 33.5% counties, 18 county estimates were suppressed due to high Brooks 40.1% Coleman 33.4% margins of error and low-reliability. Cameron 37.6% May 2021 CCF.GEORGETOWN.EDU Texas’S low-wage, uninsured workers 2 Endnotes 1 For more information on the provisions of the law, see E. Park and S. Corlette, “American Rescue Plan Act: Health Coverage Provisions Explained” (Washington DC: Georgetown University Center for Children and Families and Center on Health Insurance Reform, March 2021), available at https://ccf.georgetown.edu/2021/03/11/american-rescue-plan- act-health-coverage-provisions-explained/. Low-income individuals defined as those earning less than 138 percent of the Federal Poverty Line—approximately $17,775 for an individual or $30,305 for a family of three. Workers defined as those who report industry and occupation information on the American Community Survey. Contact authors for more information on sources of data and methods. 2 R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending” (Washington DC: Kaiser Family Foundation, March 2021), available at https://www.kff.org/medicaid/ issue-brief/new-incentive-for-states-to-adopt-the-aca-medicaid-expansion-implications-for-state-spending/. 3 Kaiser Family Foundation, “Who Could Medicaid Reach with Expansion in Texas?” (Washington DC: Kaiser Family Foundation, February 2021), available at https://files.kff.org/attachment/fact-sheet-medicaid-expansion-TX. 4 Contact authors for more information on sources of data and methods. All data are derived from the American Community Survey (2019) most from the Public Use Microdata Sample; county data calculated from American Community Survey five-year (2015-2019) prepared tables. 5 The American Community Survey measures race and ethnicity as two separate facets of an individual’s identity. Hispanic/Latino individuals can be of any race. May 2021 CCF.GEORGETOWN.EDU Texas’s low-wage, uninsured workers 3