Texas has 19 out of the 20 counties across the U.S. with the highest proportion of their population aged under 65 having no health insurance, according to a new study. The investigation was conducted by SmartAsset, a financial technology company.
Newsweek contacted the press office of Texas Governor Greg Abbott for comment on Thursday by email outside of regular office hours.
Why It Matters
The proportion of Americans without health insurance is a major concern, both in terms of their own wellbeing and of the state and civil society having to pick up the pieces via Medicare and other programs. Nationally around eight percent of Americans had no medical insurance as of March 2024, according to the federal Centers for Disease Control and Prevention.
Republican-controlled Texas is one of just a handful of states that chose not to adopt the Affordable Care Act’s Medicaid expansion.
What To Know
The SmartAsset study found that in 2024 nine of the ten counties with the most under-65s without health insurance are in Texas.
These were Hidalgo County with 32.1 percent uninsured, Cameron County on 30.1 percent, Webb County with 29.7 percent, Starr County with 29 percent, Ector County on 25.3 percent, Potter County on 24.4 percent, Dallas County with 24.2 percent, Harris County at 23.8 percent and El Paso County on 23.5 percent.
These were followed by the only non-Texas county to make the top ten, with 23.4 percent of under-65s in Whitfield County, Georgia, not having health insurance.
The remaining ten of the 20 states with the most uninsured under 65s were all in the Lone Star State. These were Liberty County with 23.2 percent, Bastrop County on 22.8 percent, Jefferson County on 22.7 percent, Angelina County at 22.5 percent, Gregg, Nacogdoches and Henderson counties each on 22 percent, Smith County on 21.2 percent, Nueces County with 21.2 percent and Wise County at 20.9 percent.
The SmartAsset research also found Tom Green County in Texas, which was ranked 25th for number of uninsured under 65-year-olds, declined from 17.5 percent uninsured in 2023 to 20.2 percent in 2024. The company added that in 2024 the average annual health insurance premium per American was nearly $9,000, or $25,500 for a family of four.
What People Are Saying
Speaking to Newsweek Joshua Blank, research director for the Texas Politics Project which is based out of the University of Texas at Austin, said the number of Texans without health insurance was not high on the state’s political radar.
He said: “Texas is a young, diverse state spread out over a huge landmass with a lot of needs, and providing medical care and coverage has proved a challenge here. Yet, as much as political people and healthcare professionals lament Texas’ low rates of insurance coverage, few regular Texans pay much attention to the issue.
“In February 2023 University of Texas/Texas Politics Project polling, only 15 percent of Texas voters said that they had heard “a lot” about the number of Texans without health insurance—even though the state has been and remains the home of the highest share of uninsured adults.”
Blank added that Republican hostility to the Affordable Care Act means Medicaid is unlikely to be expanded in Texas anytime soon.
He said: “In Texas, discussions about the state’s large, uninsured population inevitably turn to discussions about Medicaid expansion, as Texas remains one of the few states not to expand eligibility in the wake of the Affordable Care Act (ACA).
“But for Republican elected officials in Texas, Medicaid in general, but the ACA in particular, may as well be a four letter word, meaning there’s little appetite to expand coverage in the most obvious, available way possible.”
What Happens Next
Texan Democrats are likely to continue pushing for Medicaid to be expanded in the state, but as Republicans control the governor’s office and both chambers of the Texas Legislature there are no signs of this happening anytime soon.
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