Texas’ Healthcare Insurance Crisis: The Nation’s Highest Uninsured Rates

Texas has the highest uninsured rate in the nation, and for those patients. Overall, more than 5 million Texans are uninsured, with the problem concentrated in both major cities and rural areas across the state. In this study, LabCafe analyzes statewide uninsured data to highlight where coverage gaps are most severe and how these disparities impact Texas residents at every age and income level.

Key Takeaways

• Texas uninsured rates are more than double the national average, with 16.7% of all residents.
• Border metros such as McAllen (29.7% uninsured), Laredo (28.4%), and Brownsville (up to 28.6%) report the nation’s highest rates, while major counties like Harris (Houston) and Dallas each have more uninsured residents than some entire states.
• Rates spike among low-income families, non-citizens (46.8% uninsured), and young adults ages 19–34, making access and affordability hardest for those with the greatest need.

States with High Uninsured Rates

The national uninsured average across states rose to 7.54 percent in 2024 from 7.18 percent in 2023, a +0.35 percentage-point uptick. Most states (40) saw that percentage increase, and 11 decrease, though the all-ages rise is smaller than the jump among children. 

Texas remains the outlier: at 16.7 percent uninsured, it sits 9.16 points above the national average and is about 2.21 times higher than the typical state, underscoring just how far Texas is from the national norm.

Top 5 states with the highest uninsured rates in 2024 (all ages)

• Texas — 16.7%
• Georgia — 12.0%
• Oklahoma — 11.5%
• Nevada — 11.4%
• Alaska — 11.0%

Texas Uninsured

Texas leads the nation in uninsured rates for every major age group, with 2024 Census data showing 13.6% of children, 21.6% of working-age adults, and 16.7% overall lacking health coverage. Each rate is more than double the national average. Texas also saw one of the largest recent jumps in uninsured children.

• Texas has the highest uninsured rates for children, adults, and all ages, ranking worst in the nation for 2024.
• Texas children under 19: 13.6% uninsured (8.08 points abovethe  national average, 2.46x higher).
• Texas adults 19–64: 21.6% uninsured (11.15 points above national average, 2.07x higher).
• Texas all ages: 16.7% uninsured (9.16 points above national average, 2.21x higher).
• The child uninsured rate in Texas grew by +1.7 points from 2023 to 2024—making Texas’ increase 2.7x the national child uninsured trend.

Texas uninsured profile

Texas’s uninsured problem is not only the highest in the nation overall, it is concentrated in specific groups. Uninsured rates spike as Texans age out of childhood coverage and enter the workforce, with the highest rates among young adults 19–34 and persistently high levels well into midlife.

Age patterns in Texas (2023, SHADAC)

Nonelderly 0–64

• 18.5% uninsured
• 4.82 million people without coverage

Seniors 65+

• 2.0% uninsured
• 80,000 people, mostly shielded by Medicare

Children vs adults  

• Children 0–18: 11.9% uninsured (943,000 kids)
• Adults 19–64: 21.4% uninsured (3.88 million)

Detailed age breakdown  

• 0–5 9.0% uninsured (206,000)
• 6–18 13.0% uninsured (737,000)
• 19–25 26.8% uninsured (779,000)
• 26–34 24.9% uninsured (969,000)
• 35–44 22.0% uninsured (945,000)
• 45–54 18.9% uninsured (702,000)
• 55–64 14.7% uninsured (485,000)

Citizenship and coverage gaps in Texas

Nearly 1 in 2 non‑citizen Texans is uninsured, compared with about 1 in 8 U.S. citizens, showing how immigration status sharply shapes access to coverage and helps drive Texas’ nation‑leading uninsured rate.

U.S. citizens in Texas

• 12.8% uninsured
• 3.45 million people

Non‑U.S. citizens in Texas

• 46.8% uninsured
• 1.45 million people

Family income and uninsured rates in Texas

Texans in low‑income families are 3–4 times more likely to be uninsured than those in higher‑income households, and even middle‑income families see double‑digit uninsured rates. Combined with high uninsured levels among non‑citizens and working‑age adults, this helps explain why Texas sits so far above the national average and remains an outlier among states.

Under $25,000

• 26.9% uninsured
• 1.89 million people

$25,000–$49,999

• 21.9% uninsured
• 1.29 million people

$50,000–$74,999

• 17.3% uninsured
• 771,000 people

$75,000 or more

• 7.4% uninsured
• 925,000 people

Geographic Concentration of the Uninsured in Texas

High uninsured rates are concentrated in border metros, major urban counties, and isolated rural areas with limited access to providers.​

South Texas and the Border Region:
Border metros reflect a mix of low incomes, high non-citizen populations, and limited access to employer insurance; all rank among the highest uninsured rates nationally

• McAllen metro: 29.7% uninsured (highest in the nation).
• Laredo metro: 28.4% uninsured.
• Brownsville metro: 26.7% to 28.6% uninsured, depending on source.

Major Urban Counties:
Major counties house more uninsured people than many states, intensifying pressures on local hospitals and clinics.

• Harris County (Houston): Over 1,000,000 uninsured residents.
• Dallas County: 558,424 uninsured residents.
• Tarrant County (Fort Worth): 351,295 uninsured.
• Bexar County (San Antonio): 316,738 uninsured.
• Travis County (Austin): 158,906 uninsured​

Rural and West Texas:
These regions face both high costs and extreme provider shortages, compounding healthcare access barriers with distance and lack of facilities.

• Hudspeth, Dallam, Gaines counties: More than one-third of residents are uninsured (22%–36% range); some counties approach 40%.
• Bailey County: 40% of women are uninsured—the highest female uninsured rate in Texas.

Texas stands out as the nation’s leader in uninsurance, with a rate that consistently doubles the national average. Coverage gaps are most severe in border metros and major counties, but rural regions with limited health infrastructure also face crisis-level rates. The disparities are sharpest for low-income families, non-citizens, and young adults—groups often least able to absorb high health costs. 

Methodology and Data Sources

• State Health Compare by SHADAC:
  Core demographic and uninsured rate figures for Texas were sourced from the State Health Access Data Assistance Center’s State Health Compare tool. This nonpartisan data platform aggregates American Community Survey (ACS) data from the U.S. Census Bureau, allowing breakdowns by age, race/ethnicity, citizenship, and income for every state.
• Comparisons and Additional Demographics:
  National, regional, and subgroup uninsured comparisons (state rankings, gaps by race/ethnicity, income, citizenship, and industry) combined the above SHADAC data with findings from latest U.S. Census ACS microdata, Kaiser Family Foundation State Health Facts, and in-depth analyses from the Texas Medical Association, Texas 2036, and Every Texan.​
• Geographic Granularity and Context:
  Geographic distributions—including data by metro area (McAllen, Laredo, Brownsville), large urban counties (Harris, Dallas, Tarrant, Bexar, Travis), and rural/high-need counties—oscilate between SHADAC visualizations, ACS estimates, and fine-grained reporting from ValuePenguin, Texas 2036, and local news outlets.
• Coverage Dynamics and Medicaid Unwinding:
  Trends in child uninsurance and Medicaid disenrollment are backed by child coverage updates from the Georgetown University Center for Children and Families and Texas-based health policy research groups using official ACS and Medicaid enrollment data.