Health Insurance
Nearly 1 in 5 Americans Without Health Insurance Live in Texas
Everything is bigger in Texas — including uninsured rates. In fact, 18.1% of Americans without health insurance live in the Lone Star State.
Here’s a closer look at the demographics and metros with the highest uninsured rates in Texas.
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Key findings
- Texas has the highest rate of residents without health insurance. 5.1 million Texans — 17.4% of its population — don’t have health insurance. That’s about double the national uninsured rate of 8.6%. Overall, 18.1% of uninsured Americans live in Texas.
- In every age group, Texas has higher uninsured rates than the national average. 11.8% of children 18 or younger are uninsured — more than twice the national rate of 5.4% for this age range. Among adults 19 to 64, 23.2% of Texans don’t have health insurance, compared with 12.0% nationwide.
- Low-income and immigrant Texans face steep insurance gaps. More than 1 in 4 (26.1%) Texans in households earning $25,000 to $49,999 are uninsured, compared with 10.1% in those earning $100,000-plus. And 34.5% of the foreign-born population doesn’t have insurance, well above the 13.8% among native-born Americans in Texas.
- By metro, McAllen has the highest uninsured rate. Its uninsured rate is 29.7%, ahead of Laredo (28.4%) and Brownsville (26.7%). Even in major metros, rates are high: 18.7% in Houston, 16.3% in Dallas and 12.1% in Austin. The Texas metro with the lowest uninsured rate — College Station, at 11.9% — is still 56th nationwide.
- Most uninsured Texans are part of the workforce, but many still struggle to afford coverage. Among uninsured residents 16 and older, 70.0% are in the labor force. The average employee contribution for family coverage in the state is $7,391 annually (or $142 a week) — 7.3% higher than the national average.
17.4% of Texans don’t have health insurance
A whopping 5.1 million Texans don’t have health insurance. That’s 17.4% of the state population — and about double the national uninsured rate of 8.6%.
While that rate has decreased from 22.8% in 2013, it’s held relatively steady in recent years. Overall, with Texas’ large population and significant uninsured rates, 18.1% of uninsured Americans live in the state.
One reason Texans may not be insured is that the state doesn’t offer much support for those who can’t afford coverage. Texas hasn’t expanded Medicaid under the Affordable Care Act (ACA), so adults under 65 who aren’t disabled or raising a child are ineligible for Medicaid regardless of their income.
ValuePenguin health insurance expert Divya Sangameshwar says Texas can learn from the 41 states that have successfully boosted health care access by expanding Medicaid.
"Texas can also boost enrollment in health insurance with bilingual and multilingual outreach to its non-English-speaking populations," she says. "Investment in state-run insurance marketplaces, which has been very successful at boosting enrollment in California, is another strategy that could help. By adopting similar policies and investing in the appropriate health care infrastructure (like rural hospitals, telehealth and community health clinics), Texas could significantly improve health care accessibility, especially for low-income and underserved residents."
All age groups face insurance discrepancies
The gap between national and Texas uninsured rates is significant across every age group.
The discrepancy is largest among adults 19 to 25. In Texas, 28.5% of this age group is uninsured, compared with 14.0% nationally — a difference of 14.5 percentage points. Among adults 26 to 34, 27.3% of Texans are uninsured, while 14.9% of Americans in this age group are uninsured. That’s a difference of 12.4 percentage points — the next highest.
Uninsured rates in Texas and U.S. by age
Age | Uninsured rate, Texas | Uninsured rate, U.S. | Difference (% point) |
|---|---|---|---|
| Under 6 | 8.8% | 4.5% | 4.3 |
| 6 to 18 | 13.1% | 5.8% | 7.3 |
| Under 19 | 11.8% | 5.4% | 6.4 |
| 19 to 25 | 28.5% | 14.0% | 14.5 |
| 26 to 34 | 27.3% | 14.9% | 12.4 |
| 35 to 44 | 24.0% | 12.8% | 11.2 |
| 45 to 54 | 20.7% | 10.8% | 9.9 |
| 55 to 64 | 16.0% | 8.1% | 7.9 |
| 19 to 64 | 23.2% | 12.0% | 11.2 |
| 65 to 74 | 2.2% | 1.0% | 1.2 |
| 65 and older | 1.9% | 0.8% | 1.1 |
| 75 and older | 1.3% | 0.5% | 0.8 |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 American Community Survey (ACS) with five-year estimates.
Conversely, the uninsured rate is lowest among Texans 75 and older, at 1.3%. Nationally, that figure is 0.5% — a difference of just 0.8 percentage points.
Low-income, immigrant Texans significantly uninsured
Looking at other demographics, low-income Texans are also significantly uninsured. Over a quarter (26.1%) of Texans in households earning $25,000 to $49,999 are uninsured, compared with 10.1% in those earning six figures.
Meanwhile, 34.5% of the foreign-born population (including permanent residents, temporary migrants, refugees, undocumented immigrants and more) in the state doesn’t have insurance. Comparatively, 13.8% of native-born Americans in Texas are uninsured.
Samgameshwar says that discrepancy could reflect barriers around immigration.
"Many immigrants (especially undocumented individuals) are categorically ineligible for Medicaid, Children’s Health Insurance Program (CHIP) and ACA marketplace coverage by federal law, and even those lawfully present are often uninsured due to a five‑year bar or gaps in state Medicaid expansion."
Other barriers among this group could include misinformation, processing delays (sometimes over 90 days), limited interpretation and outreach services, and confusing application systems. "Costs also remain a significant challenge, even for those eligible," she says. "Out‑of‑pocket fees, premiums after subsidies or employer‑offered plans priced out of reach for low‑income immigrants all reduce health insurance enrollment rates."
By specific race or ethnicity, Hispanic Texans have the highest uninsured rate in the state at 27.0%. Meanwhile, that figure is 17.5% among the U.S. Hispanic population — the second-highest nationally (behind American Indians and Alaska Natives at 19.2%).
Uninsured rates in Texas and U.S. by race
Race | Uninsured rate, Texas | Uninsured rate, U.S. |
|---|---|---|
| Some other race alone | 32.1% | 19.7% |
| Hispanic or Latino (of any race) | 27.0% | 17.5% |
| American Indian and Alaska Native alone | 24.6% | 19.2% |
| 2 or more races | 24.2% | 13.0% |
| Native Hawaiian and other Pacific Islander alone | 21.9% | 11.6% |
| Black or African American alone | 15.0% | 9.5% |
| White alone | 13.7% | 6.6% |
| Asian alone | 10.1% | 5.9% |
| White alone, not Hispanic or Latino | 9.9% | 5.7% |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 ACS with five-year estimates.
Black Texans have an uninsured rate of 15.0%, while Asian Texans have a rate of 10.1%. Nationally, those figures are 9.5% and 5.9%, respectively.
In comparison, white, non-Hispanic Texans have the lowest uninsured rate at 9.9%. That figure is 5.7% across white, non-Hispanic consumers in the U.S.
Uninsured rate reaches 29.7% in one metro
Across all Texas metros, McAllen has the highest uninsured rate at a staggering 29.7%. Laredo (28.4%) and Brownsville (26.7%) follow.
In major metros, rates are still high. In Houston, the uninsured rate is 18.7%. That figure is 16.3% in Dallas and 12.1% in Austin.
In fact, Texas dominates the list of U.S. metros with the highest uninsured rates, holding 10 of the top 11 spots. (Gainesville, Ga., ties with Tyler, Texas, for No. 10.)
The Texas metro with the lowest uninsured rate — College Station, at 11.9% — still ranks high nationally, at 56th across U.S. metros.
By county, at least 1 in 4 people in 20 Texas counties are uninsured. The highest rates are in rural areas like Dallam County (36.3%), Bailey County (33.7%) and Hudspeth County (33.6%).
Full rankings: Uninsured rates in Texas by metro
Rank | Metro | Uninsured rate |
|---|---|---|
| 1 | McAllen, TX | 29.7% |
| 2 | Laredo, TX | 28.4% |
| 3 | Brownsville, TX | 26.7% |
| 4 | Eagle Pass, TX | 24.6% |
| 5 | El Paso, TX | 21.9% |
| 6 | Odessa, TX | 21.6% |
| 7 | Beaumont, TX | 19.4% |
| 8 | Houston, TX | 18.7% |
| 9 | Corpus Christi, TX | 17.4% |
| 10 | Tyler, TX | 16.7% |
| 11 | Victoria, TX | 16.5% |
| 12 | Dallas, TX | 16.3% |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 ACS with five-year estimates. Note: The Texarkana metro includes neighboring Texarkana, Ark.
Uninsured rates in Texas by county
Rank | County | Uninsured rate |
|---|---|---|
| 1 | Dallam County | 36.3% |
| 2 | Bailey County | 33.7% |
| 3 | Hudspeth County | 33.6% |
| 4 | Gaines County | 32.4% |
| 5 | Jim Hogg County | 31.3% |
| 5 | Starr County | 31.3% |
| 7 | Hidalgo County | 29.7% |
| 8 | Webb County | 28.4% |
| 9 | Culberson County | 28.1% |
| 10 | Zapata County | 27.7% |
| 11 | Coleman County | 27.3% |
| 12 | Cameron County | 26.7% |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 ACS with five-year estimates.
70.0% of uninsured Texans in workforce
Many Texans still struggle to afford coverage despite being employed.
Among uninsured Texans 16 and older, 70.0% are in the labor force. In Texas, the average employee contribution for family coverage in the state is $7,391 annually. That’s $142 a week — 7.3% higher than the national average. That means Texas has the 11th-highest employee contributions by state.
Average employee health insurance contributions in Texas
Avg. contribution for family coverage | Avg. contribution for single coverage |
|---|---|
| $7,391 | $1,645 |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 ACS with five-year estimates.
For individual coverage, Texans pay $1,645 a year, or $32 a week. That’s a minimal $5 above the annual U.S. average and 30th by state.
In Texas, the 54.1% of residents who worked full-time, year-round in the past 12 months accounted for just 41.7% of the state’s uninsured population. Meanwhile, the 22.8% who didn’t work accounted for 27.9% of the uninsured.
Share of employment status and uninsured population among Texans 16 to 64
Employment status | Share with employment status | Share of uninsured |
|---|---|---|
| Worked full-time, year-round in past 12 months | 54.1% | 41.7% |
| Worked less than full-time, year-round in past 12 months | 23.1% | 30.4% |
| Didn’t work | 22.8% | 27.9% |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 ACS with five-year estimates.
By industry in Texas, the 8.6% of workers in construction accounted for 18.7% of the state’s uninsured population. A similar 8.5% in arts, entertainment and recreation and accommodation and food services accounted for 14.6% of the state’s uninsured population.
By occupation in Texas, service workers made up 16.1% of the workforce but accounted for 26.4% of the uninsured. In contrast, those in management, business, science and arts roles represented 40.2% of state workers but only 17.5% of the state’s uninsured.
Share of industry workers and uninsured population among Texans 16 to 64
Industry | Share of workers in industry | Share of uninsured |
|---|---|---|
| Educational services and health care and social assistance | 21.6% | 12.7% |
| Professional, scientific and management and administrative and waste management services | 12.6% | 11.6% |
| Retail trade | 11.1% | 12.2% |
| Construction | 8.6% | 18.7% |
| Manufacturing | 8.5% | 6.6% |
| Arts, entertainment and recreation and accommodation and food services | 8.5% | 14.6% |
| Finance and insurance and real estate and rental and leasing | 7.0% | 3.5% |
| Transportation and warehousing and utilities | 6.5% | 6.9% |
| Other services (except public administration) | 4.9% | 7.3% |
| Public administration | 4.1% | 0.9% |
| Wholesale trade | 2.5% | 2.0% |
| Agriculture, forestry, fishing and hunting, and mining | 2.4% | 2.2% |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 ACS with five-year estimates. Note: Totals may not add to 100% due to rounding.
Share of occupation workers and uninsured population among Texans 16 to 64
Occupation | Share of workers in occupation | Share of uninsured |
|---|---|---|
| Management, business, science and arts | 40.2% | 17.5% |
| Sales and office | 20.7% | 18.2% |
| Service | 16.1% | 26.4% |
| Production, transportation and material moving | 12.9% | 16.9% |
| Natural resources, construction and maintenance | 10.1% | 20.9% |
Source: ValuePenguin analysis of the U.S. Census Bureau 2023 ACS with five-year estimates. Note: Totals may not add to 100% due to rounding.
How can employers help improve insurance rates among their employees?
"Employers (especially small business owners) can provide lower‑cost pooled plans via services like Texicare, which offers zero copays for preventive visits and specialist care," Sangameswhar says. "These plans can bring cost‑effective benefits to employees of small businesses who might otherwise go uninsured."
From a policy perspective, Sangameshwar says lawmakers and officials can also cut back on regulatory mandates that drive up employer plan costs, and encourage alternatives like Association Health Plans (AHPs) or reinsurance pools to lower premiums. Finally, streamlining administrative processes to boost enrollment, simplifying renewals and offering multilingual enrollment assistance would help many working people overcome barriers to health insurance coverage in Texas.
Getting on insurance: Top expert tips
If you’re an uninsured Texan, Sangameshwar encourages you to review your options. Particularly, we recommend the following:
- Double-check your eligibility for Medicaid or CHIP. "Many children and pregnant women in low-income households — including those with undocumented parents — can still qualify for coverage," she says. "Do some digging to see if you’re eligible."
- Explore ACA marketplace plans. "Don’t assume that private health insurance plans are out of reach," she says. "HealthCare.gov offers subsidized plans, often for free or low-cost, for lawfully present immigrants and low-income earners."
- Use community clinics and public hospitals. "Even if you don’t qualify for insurance, you can still find affordable health care via Federally Qualified Health Centers (FQHCs), charity clinics and public hospitals that offer sliding-scale or free care regardless of immigration status," she says.
Methodology
ValuePenguin researchers used the U.S. Census Bureau 2023 American Community Survey (ACS) with five-year estimates to calculate the number and percentage of the uninsured population in Texas, its metros and its counties. The analysis compares Texas and national uninsured rates, focusing on the civilian noninstitutionalized population.
Additionally, 2023 data on average annual employee contributions for employer-sponsored health insurance (both family and individual coverage) comes from KFF.
