Texas is one of 19 U.S. states where premium contributions and deductibles for employer-sponsored health insurance plans consume 10% or more of families’ median household incomes, according to new study.
Lone Star State employees and their families spend an average of 10.9% percent of their household income on the cost of premiums and deductibles, healthcare-equity advocate the Commonwealth Fund found in its research. That figure doesn’t even include additional costs such as plan copays.
To get its results, the nonprofit looked at the most recent available national data from 2024 on what employees paid for premiums and deductibles in all 50 states and the District of Columbia compared to state median income.
The average employee contribution in Texas is $6,851 for family coverage, and the average deductible is $4,176, or a combined total of $11,027. Countrywide, the spectrum ranges from a low of $9,179 in Oregon to a high of $13,030 in California.
Those numbers are important because the larger the percentage of a family’s income that is tied up in health coverage, the more risk they face both to their finances and physical wellbeing, study author David Radley told the Current.
“If you’re paying out too much, there’s a good chance you end up forgoing care you need because you’re worried you can’t afford it due to your deductible,” he said.
Similarly, families with sky-high coverage costs could face financially shaky ground because their plan eats up income needed for housing, food, transportation and savings. Those grappling with a health crisis often are forced to make tough choices about what other bills not to pay, Radley said.
Escalating costs
More than 60% of working-age adults under age 65 — about 167 million people — get their health insurance through an employer or a family member’s employer, and those people face rapidly rising premiums and deductibles, according to the data.
Health costs in 2026 are projected to grow at a faster pace than in recent years for the third year in a row, driven by factors such as hospital consolidation, medical-industry labor shortages, expanding drug costs and overall inflation.
However, Radley said state governments can make policy changes to protect residents from the financial crunch.
For example, one reason health insurance rates are so high in Texas is that it’s one of just 10 states that hasn’t accepted the federal Medicaid expansion, Radley noted. As a result, the Lone Star State has the nation’s highest rate of uninsured residents.
When Texans can’t get health coverage, that often means they end up in emergency rooms instead of physicians’ offices. Those high bills often go unpaid, resulting in escalating costs for hospitals, and in turn, insurance providers.
“When hospitals are put in the position of providing uncompensated care, that’s getting passed on to consumers,” Radley said.
But that isn’t the sole reason for Texas’ high coverage costs, Radley said. A complex set of circumstances factor into insurance rates, and there’s no single magic cure to drive them down.
Even so, states can adopt proposals to make health coverage more equitable, he added, pointing to a Hawaii law stipulating that insurers can’t charge more than a certain percentage of individuals’ income when determining coverage costs.
In that state, employees and their families spend an average of 9.5% percent of their household income on the cost of premium contributions and deductibles, compared to Texas’ 10.9%.
“There’s no silver bullet, or we’d know it already,” Radley said. “But states do have levers to pull. They can take action.”
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