AUSTIN — While most children don’t need expensive health care, some do — and a growing lack of insurance coverage nationally has worsened even more in Texas.

Over the past three years, the number of uninsured children under 19 in the state has increased by 32.3%, to nearly 1 million, according to a Georgetown University study to be released early Friday.

Nationwide, there are about 726,000 more uninsured kids than there were three years ago — with 243,000 of them in Texas.

“One-third of the total increase in the number of uninsured children from 2016 to 2019 live in Texas,” the report by Georgetown’s Center for Children and Families said. “The state saw by far the greatest coverage loss over the period.”

As was the case a year ago, the center found that half of the country’s 10 counties with the most children lacking health insurance are in Texas. Dallas and Tarrant counties still are among the top five U.S. counties for the number of uninsured kids — with 122,000 and 67,000, respectively.

Even though Harris County with 195,000 uninsured children has more, Dallas County’s youth uninsured rate was 17% in 2019, higher than the 16.7% of Hidalgo County in South Texas and Harris’ 15%. Tarrant’s was 11.7%.

The numbers would be even worse if they included the coronavirus outbreak’s effects, the Georgetown researchers said.

But data for 2020, capturing a recession-driven decline in employer-provided coverage to families, wasn’t available.

Lead researcher Joan Alker of Georgetown and her allies in Texas, such as the Children’s Defense Fund and Texans Care for Children, say the state could cover more kids and give them preventive care and wellness checks that would detect chronic conditions early, saving taxpayers and employers money over time.

They advocate granting 12 months of continuous coverage to children on Medicaid and removing the state’s frequent asset and income checks that bump children of seasonal workers from Medicaid and the Children’s Health Insurance Program.

Pushing to expand Medicaid

An increasingly vocal coalition that includes business leaders, health care industry executives, liberal activists and Democrats want the Legislature next year to take those steps and one that’s even more politically fraught: Expand Medicaid to low-income adults of working age, as encouraged by Obamacare.

The chambers of commerce in North Texas support expansion, and the other changes. On Thursday members of the Texas House’s Democratic Caucus released a health policy agenda that includes Medicaid expansion and other steps to expand coverage of children.

Given Texas’ hostility to the Affordable Care Act over the past decade, though, some say expansion only can happen if Texas seeks a waiver that, while freeing up the billions in federal matching money it’s been losing, also stresses personal responsibility. One way chosen by other states is to require regular job searches by many of the covered adults.

For years, state GOP leaders including Gov. Greg Abbott and Lt. Gov. Dan Patrick have criticized Medicaid, the state-federal program for low-income pregnant women and children, disabled Texans and some seniors. Washington’s one-size-fits-all rules make it inefficient, they argue.

Patrick Bresette of Children’s Defense Fund-Texas, though, said Thursday that “way too many” children in the state have lost coverage and foregone coverage they were entitled to “because of state and federal policy decisions.”

Bresette said it’s time “to ensure more Texas kids have the insurance they need so they can see their doctor, go to their check-ups, stay healthy for school and get their immunizations. Let’s roll up our sleeves and make sure that eligible kids are getting enrolled and staying enrolled in Medicaid and CHIP.”

‘Success story’ gone wrong

Georgetown’s Alker said declines in rates of coverage for kids between 2016 and last year also were the result of federal cuts to Affordable Care Act outreach and enrollment assistance, as well as confusion and fear among families with members of mixed immigration status because of the Trump administration’s so-called “public charge” rule. It factors in an immigrant’s use or potential use of certain public assistance programs when he or she applies for legal status.

“For decades, children’s health coverage had been a national success story that we could point to with pride, but the data shows the trend is now going in the wrong direction,” she said.

“What’s worse, the number of children losing coverage accelerated from 2018 to 2019 during a time when unemployment was very low. The situation is likely worse today.”

The report noted that some states — including New York, Minnesota and Maryland — increased the share of their children who were covered between 2016 and 2019, though the percentages in Texas, Florida and many other Southern states slipped.

Last year Texas continued to be home to more uninsured children under 19 than any of the 49 other states or the District of Columbia, the report found.

Texas even has regained an undesirable superlative: In 2016, Alaska had the nation’s worst uninsured rate for children — 10.3%, compared with Texas’ 9.8% that year. In 2019, Texas’ rate of 12.7% ranked 51st.