"One in four Texans lacks health insurance, the highest proportion in the nation."

Paul Krugman on Monday, August 15th, 2011 in a column in the "New York Times"

One in four Texans lack health insurance

Texas Gov. Rick Perry declared over the weekend that he was running for the Republican nomination for president. In his announcement speech, he said that if elected, he would rein in the federal government just as he's pursued policies of lower taxes, less spending and less regulation in the state of Texas.

Those policies, he said, have resulted in strong job growth.

No, they didn't, replied Paul Krugman, the liberal New York Times columnist. Krugman wrote in his column that simple population growth, among other things, has fueled new jobs in Texas. Meanwhile, Krugman said, unemployment has risen in Texas just like it has in other states.

"In June 2011, the Texas unemployment rate was 8.2 percent. That was less than unemployment in collapsed-bubble states like California and Florida, but it was slightly higher than the unemployment rate in New York, and significantly higher than the rate in Massachusetts. By the way, one in four Texans lacks health insurance, the highest proportion in the nation, thanks largely to the state’s small-government approach. Meanwhile, Massachusetts has near-universal coverage thanks to health reform very similar to the 'job-killing' Affordable Care Act."

Krugman was right on his unemployment numbers -- we checked them with the U.S. Department of Labor's Bureau of Labor Statistics.

But we were interested in checking his claim about health insurance, that "one in four Texans lacks health insurance, the highest proportion in the nation, thanks largely to the state’s small-government approach."

To check this, we turned first to the U.S. Census Bureau, which conducts a regular survey on health insurance status, the Current Population Survey. According to the latest numbers, 26.1 percent of Texans had no insurance in 2009 -- just about equal to the one-in-four number Krugman cited and the highest number among the 50 states. The Census Bureau also averaged its data for the years 2007, 2008 and 2009. In that analysis, Texas also ranked first, with 25.5 percent uninsured.

Gallup also conducts polls on whether people have insurance or not, and most recently polled during 2010. For that year, it concluded that 27.8 percent of Texans lack health insurance, which comes to nearly 3 in 10. That too made it the state with the highest uninsured rate in the country.

Krugman adds the kicker that these numbers are "thanks largely to the state’s small-government approach," suggesting that the conservative philosophies of Perry and other state leaders result in less health coverage.

We asked Anne Dunkelberg, associate director of the Center for Public Policy Priorities, a left-leaning group that advocates for low- and middle-income Texans, about the uninsured in Texas. She noted several relevant trends.

• Employment-sponsored health insurance is declining, as it is across the nation. But Texas is 8 to 10 percentage points below average when it comes to workers covered by their employers.
• Enrollment in government plans that insure the poor such as Medicaid, is about the average in Texas, even though poverty rates in Texas are higher.
• Texas generally takes a hands-off approach when it comes to regulating health insurance.
• The income limits for parents to qualify for Medicaid are set extremely low -- $188 per month for a family of three, for example, which excludes many working poor families. (As in most states, healthy adults without children can't qualify for Medicaid at all.)

"We have not done things that other states have done to make health care more affordable and accessible," Dunkelberg said.

On the other side of the political spectrum, John C. Goodman of the Texas-based National Center for Policy Analysis, which advocates free market approaches, said Texas uninsurance rates are explained by ethnicity and poverty. "The state’s population is disproportionately Hispanic and Hispanics tend to have twice the uninsured rate. Also, we have a lot of low-income people in the state," he said.

In ruling on Krugman's statement, we're looking at his statement, "One in four Texans lacks health insurance, the highest proportion in the nation." He got his numbers right, so we rate his statement True.