Texas remains nation’s most uninsured state, new study finds

A new study reports that Texas has retained the unenviable distinction of the being the U.S. state with the highest rate of uninsured residents. The Lone Star State also has the nation’s second-worst overall healthcare system, researchers found.

About 22% of Texas’ entire working-age population lacked health insurance in 2023, a higher rate than any other state, according to the latest report by New York-based Commonwealth Fund, a private nonprofit that supports independent research and grants to improve U.S. healthcare. Texas is one of just 10 U.S. states that continue to refuse the federal Medicaid expansion made possible under the Affordable Care Act (ACA).

Even so, Texas has made significant improvements over the past decade due to expanded coverage provided by the ACA, also known as Obamacare. Since ACA’s 2013 adoption, Texas’ uninsured rate has dropped 8%.

Even so, that improvement still hasn’t been enough to prevent nearly 1 in 5 Texans from living without health insurance, and state leaders’ refusal to accept the Medicaid expansion is a significant contributor to the overall rate.

As a result of this lack of coverage, approximately 18% of Texans 18 or older reported forgoing medical care in the past 12 months due to concerns about the cost of care — the nation’s highest rate of residents doing so.

Those two factors led the Commonwealth Fund to name Texas’ healthcare system the nation’s second-worst behind Mississippi.

It’s not all doom and gloom, however.

Despite the state being the epicenter for one of the worst measles outbreaks in recent memory, more than 70% of Texas children have received all their recommended childhood vaccines as of 2023. That’s the 11th-highest childhood vaccination rate in the nation.

Even so, Texas’s infant mortality rate rose by 0.2% in 2023 to 5.7 deaths per 1,000 live births, according to the report. The state’s highly restrictive abortion ban and lack of accessible reproductive healthcare for women both attributed to that rise, researchers noted.

Cuts to Medicaid as part of President Trump’s “Big Beautiful Bill” spending package would likely mean further harm to Texans’ access to health care, according to a separate study also published by the Commonwealth Fund this week.

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This article appears in Jun 12-25, 2025.