Despite a roaring local economy and influx of new residents, Texas has the largest share of Americans without basic health insurance.
A shock annual report from the US Census Bureau found almost 10 percent of Americans 18 to under 65 did not have health insurance, though more adults were covered than the year before.
In Texas, nearly one in five lacking basic coverage, nearly double the national rate of one in 10. And in some rural areas of the Lone Star state, nearly 40 percent were not covered by health insurance.
The issue could be due to Texas, one of the main border states, having a large population of people ineligible for insurance, such as undocumented immigrants.
Data from the US Census Bureau suggests that, in some areas, as many as one in three Americans does not have health insurance
The finding comes as Texas’ economy booms, with metro-area suburbs exploding by over 50 percent in just a handful of years with young people fleeing the coasts.
Meanwhile, Massachusetts had the most insured residents, with just three percent lacking insurance. This could be due to the state requiring all adults who can afford insurance to purchase it or face tax penalties, as well as its large Medicaid program, which provides people under a certain income with free health insurance.
The findings come as health insurance prices hit an all-time high, with prices soaring by nearly 50 percent in just 10 years.
Despite the grim findings, the overall number of uninsured Americans has decreased in over 600 of the US’ 3,100 counties, and just 23 saw increases.
About 45 percent of counties brought their uninsured rates down in a year to under 10 percent, compared to 39 percent below this threshold in 2021.
According to a 2023 report from the Kaiser Family Foundation, most people who don’t have insurance cite high costs as their main barrier. For example, about 64 percent of adults said the coverage was too expensive in 2022.
Many adults do not have insurance through their jobs, and southern states like Alabama and Oklahoma have limited access to state-run insurance programs like Medicaid.
The consequences of not having health insurance can be severe, such as restricted access to vaccines and an inability to pay for potentially lifesaving treatment like chemotherapy
The cost of health insurance jumped this year by the biggest amount since 2011, according to an annual survey by healthcare research nonprofit KFF
Texas has become an economic powerhouse in recent years, largely thanks to an influx of young people and large companies taking over metro areas.
For example, Taylor, a sleepy suburb outside of Austin, is set to become home to a high tech, $44billion Samsung facility.
Many Americans from more urban states like California have also fled to Texas for cheaper rent, low taxes and more property than they could get on the coasts.
But despite this, Kenedy County, Texas, had the highest amount of adults without insurance, totaling 38 percent. Located just 20 miles outside of the US-Mexico border, the tiny county has just 350 residents.
It is America’s fourth-least populated county, with an estimated 100 times more cattle than people. Rural areas like Kenedy County are generally more likely to have lower average incomes due to fewer opportunities for work and isolation.
Additionally, according to US Census data, three out of four Kenedy County residents are Hispanic or Latino, the group least likely to have health insurance.
The county’s proximity to the border suggests that many of its residents may be immigrants from Mexico who are more likely to work jobs that do not provide insurance or be undocumented, making then ineligible for coverage.
Overall, Texas has the second most undocumented immigrants behind California, with 1.6million, which could contribute to the insurance coverage gaps.
And according to the US Census Bureau, one in five Texans lives in a rural area. These areas tend to have few options in insurance marketplaces, forcing residents to pay high premiums or go without if they cannot afford it.
And Texas does not have expanded access to Medicaid, meaning that many low-income individuals who would qualify in other states would not be eligible for free coverage.
Further up east, Holmes County, Ohio, followed closely behind, with 35 percent being uninsured. Just under half of its 44,000 residents are Amish, a group that largely shuns health insurance due to religious beliefs and instead opts for the community as a whole contributing to medical costs.
Presidio County, Texas, had the third-most uninsured adults, with 33 percent lacking coverage. Similar to Kenedy County, this could be due to the largely Hispanic/Latino population and the largely rural area.
Health insurance premiums and deductibles sharply rose from 2011 to 2021, while the HHS warns that many prescription drug prices surged from 2016 to 2022. The biggest offender was Fluconazole, used to treat fungal infections
In terms of state data, Oklahoma, Wyoming, and Florida followed closely behind Texas, all with about 14 percent of adults being uninsured.
All three states do not have expanded access to Medicaid, meaning that the state-run insurance plan might not cover all residents who need coverage.
Los Alamos County, New Mexico, had the lowest rate of uninsured adults, at just 2.1 percent. This could be due to the high household income.
A 2023 report from US News and World Report found that Los Alamos County had the highest median household income in the state at $135,801, nearly two and a half times the average state income of $58,722.
Rounding out the three states with the most insured residents, Middlesex County, Massachusetts has just 2.4 percent of adults lacking insurance.
This could be due to the Massachusetts Health Care Reform Law, which requires most residents over 18 who can afford insurance to have coverage for the entire year or pay a penalty on their taxes.
Massachusetts, Washington DC, and Hawaii all had the lowest rates of uninsured adults, ranging from three to four percent on average.
For DC, this could be due to many residents working in the federal government, ensuring access to insurance. And in Hawaii, the state’s Prepaid Health Care Act requires employers to provide insurance to all employees working at least 20 hours per week.
