The Uninsured in Texas

Who are the Uninsured  |  Medical Impact  |  Financial Impact  |  Children  |  Special Populations  |  Geographic Breakdown  |  Sources  |

Texas is the uninsured capital of the United States. More than 4.3 million Texans - including 623,000 children - lack health insurance. Texas' uninsurance rates, 1.75 times the national average, create significant problems in the financing and delivery of health care to all Texans. Those who lack insurance coverage typically enjoy far-worse health status than their insured counterparts. 

Health Insurance Coverage of Adults 19-64, 2015, U.S. and four largest states (numbers in thousands)

United States 
Population: 197,250 
Uninsured: 24,594
% Uninsured 12.5%  

Population: 24,879
Uninsured: 2,573
% Uninsured: 10.3%
Rank: 3 

Population: 16,855 
Uninsured: 3,636
% Uninsured: 21.6% 
Rank: 1  

Population: 12,111
Uninsured: 2,200
% Uninsured: 18.2%
Rank: 2 

New York: 
Population: 12,303
Uninsured: 1,090
% Uninsured: 8.9%
Rank: 4 

 Health Insurance Coverage of Children 0-18, 2015, U.S. and Four Largest States (numbers in thousands) 

United States
Population: 74,062
Uninsured: 3,866
% Uninsured: 5.2% 

Population: 7,234
Uninsured: 623
% Uninsured: 8.6%
Rank: 1 

Population: 9,159    
Uninsured: 336
% Uninsured: 3.7% 
Rank: 4

Population: 4,217
Uninsured: 288
% Uninsured: 6.8%
Rank: 2

New York
Population: 4,246
Uninsured: 161
% Uninsured: 3.8%
Rank: 3 

Health Insurance Coverage of Total Population, 2015, U.S. and Four Largest States (numbers in thousands)

United States
Population: 318,868
Uninsured: 28,966
% Uninsured: 9.1% 

Population:  39,114
Uninsured: 2,981
% Uninsured: 7.6%
Rank: 3 

Population: 27,434
Uninsured: 4,334
% Uninsured: 15.8% 
Rank: 1

Population: 20,085
Uninsured: 2,545
% Uninsured: 12.7%
Rank: 2

New York
Population: 19,695
Uninsured: 1,264
% Uninsured: 6.4%
Rank: 4

Who Are the Uninsured in Texas?

The uninsured are a diverse group that includes people who cannot afford private health insurance; who work in small businesses that do not offer insurance; who simply choose not to purchase health insurance, even though they can afford it; who are eligible-but not enrolled-in government sponsored programs such as Medicaid or the Children's Health Insurance Plan (CHIP); and recent immigrants.

According to a summary of national data by the Congressional Budget Office (CBO), groups with a high likelihood of lacking health insurance include:

  • People in families with income below 200 percent of the poverty level;
  • Hispanics;
  • Young adults, age 19 to 34;
  • People in families in which the adults worked either part-time or only part of the year; or
  • Individuals in fair or poor health status who are significantly more likely than others to be uninsured for longer periods.

Texas workers are less likely to have employment-based health insurance coverage than those in other states. 50 percent of all companies in the US offer health coverage for their employees.  In 2014, Texas ranked 49th in the nation, with only 47 percent of Texans having employment-based health insurance coverage. The Kaiser Family Foundation reports 84 percent of the uninsured have at least one family member who works either full-time or part-time in 2014.

The average annual premiums for employer-sponsored health insurance in 2015 was $5,963 for single coverage and $17,322 for family coverage.  The average annual worker contribution in 2015 was $1,255 for single coverage and $4,710 for family coverage.  For family coverage, the worker contribution increased 163%  ($1,787 to $4,710) from 2001 to 2015. Workers in small firms (3–199 workers) have lower average contributions for family coverage than workers in larger firms ($16,625 vs. $17,938) The average single premium did not differ significantly based on firm size.

People making moderate and low wages are much less likely to have job-based health insurance coverage than those earning more. In Texas, an average of 33 percent of the uninsured population had incomes below 100 percent of the federal poverty in 2014. 

Medical Impact of Lacking Health Insurance

The uninsured are up to four times less likely to have a regular source of health care and are more likely to die from health-related problems. They are much less likely to receive needed medical care, even for symptoms that can have serious health consequences if not treated. About one in six Texans lives at or below the poverty level; for children, it's nearly one in five. Extending health coverage to the uninsured could improve their overall health by 7 to 8 percent. Lack of insurance increases their dependence on Medicaid. 

Financial Impact of Texas' Uninsured Crisis

Lacking a medical home, uninsured people tend to look for health care in the emergency room, the most expensive setting they could possibly choose. Nationally, patients made over 136 million emergency room visits in 2011. The U.S. Centers for Disease Control and Prevention says that about 7 percent (9.1 million) of ER visits are for non-urgent issues that could be treated in a doctor's office or clinic. 

Health Insurance Coverage Among Children and Young Adults in Texas  

Texas' share of uninsured children is higher than the U.S. average. In 2015, almost 9 percent of Texas children were uninsured, compared to 5 percent nationally.

CHIP Re-enrollment Requirement in Texas

More than half of the uninsured children are eligible for public programs, but are not enrolled. In Texas, this could be a result of the SCHIP program requirement to re-enroll every six months or the lack of parent coverage in the program.

Health Insurance Coverage Among Special Populations in Texas  

Health Insurance Coverage in Relation to Race and Ethnicity 

Disparities based on race and ethnicity also exist. People of racial and ethnic minorities are more likely to go without health insurance than whites. In Texas, 59 percent of Hispanics/Latinos were uninsured, compared to 27 percent of whites

Uninsured Among Non-Citizens in Texas  

In Texas, non-citizens are almost three times as likely to be uninsured as native U.S. citizens. Immigrants, many of whom are Hispanics, often work in economic sectors less likely to offer health insurance than others, such as construction.

Foreign Born Residents and Non Citizens in Relation to Uninsured Population

Non-citizens are almost three times as likely to be uninsured as are native US citizens. Over 63 percent of non-citizens went without insurance in 2015, compared to 10 percent of US native citizens and 26.2 percent of naturalized citizens. In Texas, 38 percent of the uninsured are non-citizens.

Health Insurance Coverage in Relation to Level of Educational Attainment

Another factor that increases the likelihood of being uninsured is the level of educational attainment. Texas has lower rates of high school and college graduates than the national average (Murdoch, 2003). There is a strong correlation between education and income as well as between income and insurance.

Those who have more education on average earn more money and have insurance coverage.

  • Among uninsured adults born in the US, 34.7 percent have a high school diploma as their highest level of education; 28.3 percent have not completed high school and 37 percent have a post high school education.
  • Among uninsured adults born outside the US, 28.1 percent have at most a high school diploma; 48.1 percent have not completed high school and 23.8 percent have a post high school education. (ERIU, 2005)

In 2015 estimates from the America Community Survey, Texas had a lower percentage of high school (82.4 percent vs. 87.1 percent) and college graduates (28.4 percent vs. 30.6 percent) in the 25-and-older-population compared to the national average. In addition, over half of all Hispanics in Texas over the age of 25 did not have a high school diploma (Murdock et al., 2003). This is significantly higher than other ethnic populations in the state.

Health Insurance Coverage By Geographic Areas in Texas  

Estimates of the Uninsured for Counties in Texas, Adults 18-64, 2015

# Uninsured: 212,990
% Uninsured: 45.9%

# Uninsured: 95,580
% Uninsured: 40.7%

# Uninsured: 59,234
% Uninsured: 38.7%

# Uninsured: 21,429
% Uninsured: 31.3%

# Uninsured: 45,627
% Uninsured: 31.1% 

El Paso 
# Uninsured: 142,379
% Uninsured: 29.7%

# Uninsured: 13,914
% Uninsured: 27.8%

# Uninsured: 439,689
% Uninsured: 27.4%

# Uninsured: 19,780
% Uninsured: 27.1% 

# Uninsured: 19,250
% Uninsured: 26.2%

# Uninsured: 739,850
% Uninsured: 25.8%

# Uninsured: 9,924
% Uninsured: 25.7%

San Patricio 
# Uninsured: 10,005
% Uninsured: 25.7%

# Uninsured: 10,872
% Uninsured: 25.4%

# Uninsured: 24,269
% Uninsured: 25.3% 

# Uninsured: 11,959
% Uninsured: 23.9%

# Uninsured: 51,796
% Uninsured: 23.7%

# Uninsured: 12,109
% Uninsured: 23.5%

Tom Green
# Uninsured: 15,602
% Uninsured: 22.6%

# Uninsured: 10,095
% Uninsured: 22.4%

# Uninsured: 15,476
% Uninsured: 22.4%

*See the list of the top 50 uninsured counties.

Counties in Texas with Highest Uninsured Rates

In Texas, 35 of the state's 254 counties account for 70 percent of the uninsured. A common misconception is that the uninsured are concentrated in the counties along the Texas - Mexico border. Texas’ 28 largest cities, including Houston, Dallas, San Antonio, Austin, Ft. Worth and El Paso, had a greater percentage of their population without insurance than the collective United States.