Texas continues to report the highest uninsured rate in the United States, with 16.6% of the state’s population lacking health insurance coverage as of 2023. According to the U.S. Census Bureau’s American Community Survey, this figure significantly exceeds the national uninsured rate of 8.0%, highlighting a persistent disparity in healthcare access across the state.
Why does Texas have the highest uninsured rate?
The elevated uninsured rate in Texas is largely attributed to the state’s decision not to expand Medicaid under the Affordable Care Act (ACA). According to the Kaiser Family Foundation (KFF), this policy choice leaves a "coverage gap" for thousands of low-income adults who earn too much to qualify for traditional Medicaid but not enough to afford private marketplace plans with federal subsidies.
While the national uninsured rate reached a historic low of 8.0% in 2023, Texas remains an outlier. The U.S. Census Bureau data indicates that approximately 5.1 million Texans lacked health insurance throughout the 2023 calendar year.
How do regional uninsured rates compare?
The contrast between Texas and states that opted for Medicaid expansion is stark. Data from the U.S. Census Bureau shows that states like Massachusetts, which expanded Medicaid and implemented state-level mandates, maintain uninsured rates as low as 2.3%.
| State | Uninsured Rate (2023) | Medicaid Expansion Status |
|---|---|---|
| Texas | 16.6% | No |
| California | 6.7% | Yes |
| New York | 5.2% | Yes |
| National Average | 8.0% | N/A |
Source: U.S. Census Bureau, American Community Survey 1-Year Estimates.
What are the consequences of high uninsured rates?
A lack of health insurance frequently delays preventative care and early diagnosis of chronic conditions. According to the American Medical Association (AMA), uninsured patients are less likely to receive timely screenings for diseases such as hypertension, diabetes, and cancer.
When uninsured residents do seek medical attention, they are more likely to rely on emergency departments for non-urgent care. This shift increases the financial burden on public health systems and individual hospitals, which must often absorb the cost of uncompensated care.
What is the outlook for coverage in Texas?
Despite the high uninsured rate, the federal government has continued to promote enrollment through the Health Insurance Marketplace. According to the Centers for Medicare & Medicaid Services (CMS), record numbers of Texans signed up for ACA marketplace plans during the most recent open enrollment period.
However, policy analysts at the Georgetown University Center for Children and Families note that the end of continuous Medicaid enrollment—a policy implemented during the COVID-19 pandemic—has led to a rise in uninsured children across the state. As states complete the redetermination process for Medicaid eligibility, many families are finding themselves without coverage, further complicating efforts to lower the state’s overall uninsured percentage.