New Census Data Show Texas Needs to Expand Health Coverage

For health and economy to recover from COVID-19, long-overdue state action to address Texas’ uninsured problem is needed more than ever

Texas continues to have dangerously high levels of uninsured residents, according to newly released U.S. Census data. These numbers are especially alarming since they don’t take into account the COVID-19 pandemic and how the associated job losses have made things worse.

About 3.4 million Texans have filed for unemployment relief since mid-March, and researchers estimate that more than 1.5 million workers and family members lost their health coverage along with their jobs. 

The new U.S. Census Bureau data point to a very serious challenge—but one for which practical policy solutions exist—for Texas’ recovery from the COVID-19 pandemic and the acute financial crisis that it has created. Making health insurance a priority in Texas’ recovery strategy is indispensable if we are serious about reversing structural racism in our government choices. Lack of health insurance in Texas harms Texans of color at much higher rates, just as COVID-19 hospitalization and mortality rates for Black and Hispanic Texans have been far higher than for non-Hispanic white Texans. 

Depending on where they live, many Texans without health insurance have no program in their county to provide free or low-price care—whether for COVID-19 or cancer or anything else. Too often, uninsured Texans already skip medical care because they cannot afford it and fear accumulating medical debt that could prevent them from ever getting ahead. With the added financial strains of losing a job or hours of work due to the pandemic, more Texas families need action from both state leaders and Congress. Without relief for medical debt and access to health care, generations of family asset-building work will be wiped away, and new generations will be unable to move up and ahead.

Number and Share of Texans Who Are Uninsured by Year 

Uninsured in 2019: What We Learned Today

The number of uninsured Texans in 2019 was 5.2 million, meaning 18.4% of Texans were uninsured, which is 231,000 more than in 2018. This is the worst Texas rate since 2014, and it’s twice the U.S. uninsured rate for 2019 (9.2%). California had the second worst number at 3 million people uninsured. Oklahoma had the second worst percentage of uninsured at 14.3%. Note that Oklahomans recently voted to expand Medicaid, which Texas has not done yet.

  • Texas had three years of historic improvements in our uninsured rates from 2014 to 2016, but then lost ground from 2017 to 2019, as both the number and the percentage of Texans without health coverage got worse. 
  • Texas is the state with both the largest number and percentage of uninsured residents in the United States. Texans make up 9% of the U.S. population, but 18% of U.S. uninsured.
  • From 2018 to 2019, coverage of Texans decreased for individual direct-purchase health insurance (which includes both the Affordable Care Act Marketplace and Texans who purchase directly from a health insurance company) and for public insurance like Medicaid and the Children’s Health Insurance Program (CHIP).  Employer Based and Medicare coverage  increased or stayed similar.
How Much Worse Has COVID-19 Made the Texas Uninsured Problem?

The U.S. Census Bureau’s highly accurate American Community Survey estimates of uninsured Texans in 2020 won’t exist until September 2021, but researchers have projected the impact of job loss on job-based health coverage. The Kaiser Family Foundation estimates that 1.6 million Texans of all ages had already lost employer coverage by early May 2020; presumably that number has grown in the months since then. Projecting ahead, Kaiser researchers estimate that by January 2021, nearly 800,000 more working-age adult Texans will have become uninsured and have low enough incomes that they could be covered under a Texas Medicaid expansion (compared to before the pandemic). This would bring the number of uninsured Texas adults who could be covered under a Texas Medicaid expansion to 2.2 million.

Age Matters



Rate for age group











Working-age Texans 19-64 make up the biggest share of our uninsured.  One in every four Texas working-age adults is uninsured, but in 2018 Hispanic working-aged Texas adults were more than twice as likely as non-Hispanic white working-aged Texans to be uninsured, with Black Texas adults about 1.5 times as likely to be uninsured compared to non-Hispanic whites.  Watch for updates at that detailed level next month. 

Children (under age 19) are far less likely than adults to be uninsured because they have access to Medicaid and CHIP, yet Texas still has the worst child uninsured rate in the U.S. at 12.7%–more than twice the U.S. average of 5.7%.  Nearly one in four uninsured children in the U.S. live here in Texas.

Solutions are Right on the Shelf!

The Texas legislature and governor can dramatically reduce the number of uninsured by:

  • Accepting billions in federal funds to cover Texas’ working poor adults via Medicaid expansion, 
  • Taking steps to stabilize and reduce premiums in our state insurance markets,
  • Providing strong outreach and enrollment help, and cutting red tape that keeps eligible Texans uninsured
Congress and the federal Administration can:
  • Fix the glitches in the Affordable Care Act (ACA) that shut too many low-income families out of low-cost coverage,
  • Increase the ACA subsidy structure so that every American has a real affordable cap on out-of-pocket health care costs,
  • Fund Navigators and marketing to help all Americans without good job-based coverage to access ACA coverage through 

Want to know more? In October 2020, the Census will release data files that allow us to provide more details, like the income and poverty status, detailed race and ethnicity, household work status, and citizenship status of uninsured Texans. Watch for a new fact sheet then, that pulls the information above and those additional statistics into one resource. 

Acknowledgement:  Tara Blagg, Research and Data Intern for Every Texan, contributed indispensable research support for this post.

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