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Data Brief: Hispanic Heritage Month 2024

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With more than 12 million people, Texas’ Hispanic and Latino population makes up 40% of the state’s total population. As the largest ethnic minority, Hispanic Texans profoundly influence the state’s cultural, economic, and political landscapes. From artists and activists to entrepreneurs and educators, the community’s contributions are far-reaching and vital in shaping our state’s identity.

Historical figures like José Sarria, the first openly gay person to run for public office in the U.S., paved the way for greater representation and civil rights. Leaders like Dolores Huerta, co-founder of the United Farm Workers, championed movements for social justice and labor rights. Selena Quintanilla, a cultural icon, brought Tejano music to the mainstream. Today, more than 8.9 million Hispanic and Latino Texans shape our industries, culture, and future through their contributions to the workforce. 

The Hispanic and Latino population in Texas is diverse; most identify as multiracial. We’re witnessing a sharp rise in multiracial identification among Hispanic and Latino Texans, from 2% in 2010 to 51% in 2023. The U.S. Census uses the terms “Hispanic” and “Latino” to describe people from Spanish-speaking cultures, based on standards developed in 1977 by the Office of Management and Budget (OMB). 

A Data Story of Hispanic and Latino Texans

As we honor Hispanic Heritage Month, this data story examines key trends — demographic growth, educational attainment, and workforce contributions — that underscore the vibrant roles of the Hispanic and Latino community in Texas.

While there is much to celebrate, significant disparities in economic standing and health care coverage persist in 2023: 

  • Poverty Rates: 2.2 million Hispanic and Latino Texans live below the poverty level, representing almost 54% of all Texans experiencing poverty. Their poverty rate stands at 18.3%, which is higher than the state average of 13.7%.
  • Household Income: The median income for Hispanic and Latino households is $62,906, one of the lowest compared to Asian ($113,899) and white ($90,486) households.
  • Health Care Coverage: Hispanic and Latino Texans have one of the highest uninsured rates in the state compared to other racial and ethnic groups at 25.6%, or 3.1 million Texans. 

Honoring the Legacy, Building the Future

The data tell a powerful story; Hispanic Texans are integral to the state’s growth and future. From education to construction, their contributions shape every corner of Texas. As we reflect on this heritage, we know that Texas’ Hispanic community will continue to play a pivotal role in driving progress for generations to come.

 

Note on Data Collection, Survey Instruments, and Inclusion: Unless otherwise noted, the data in this brief are from the U.S. Census Bureau’s 2023 American Community Survey, 1-Year estimates. Data collection efforts across many survey instruments have yet to fully include the diverse identities of Texans. Therefore, the demographic breakdown in this brief primarily reflects binary, cisgender sex-disaggregation of data, though such a binary focus excludes important information about transgender and gender-nonconforming populations. The categories of race and ethnicity also do not adequately reflect the multiracial and multiethnic populations of Texas. The primary sources for data collection in our state must evolve to be more inclusive and representative of the geographic, social, and cultural dimensions that define race and ethnicity.



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Press Mentions

Erin O’Malley in The Texas Tribune: Despite warnings, Texas rushed to remove millions from Medicaid. Eligible residents lost care.

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Senior Policy Analyst Erin O’Malley spoke with The Texas Tribune about Medicaid Unwinding, which ended in more than 2 million Texans – most of them children – being removed from coverage.

Read an excerpt here:

“For three years during the coronavirus pandemic, the federal government gave Texas and other states billions of dollars in exchange for their promise not to exacerbate the public health crisis by kicking people off Medicaid.

When that agreement ended last year, Texas moved swiftly, kicking off more people faster than any other state.

Officials acknowledged some errors after they stripped Medicaid coverage from more than 2 million people, most of them children. Some people who believe they were wrongly removed are desperately trying to get back on the state and federally funded health care program, adding to a backlog of more than 200,000 applicants. A ProPublica and Texas Tribune review of dozens of public and private records, including memos, emails and legislative hearings, clearly shows that those and other mistakes were preventable and foreshadowed in persistent warnings from the federal government, whistleblowers and advocates.

Texas’ zealousness in removing people from Medicaid was a choice that contradicted federal guidelines from the start. That decision was devastating in Texas, which already insures a smaller percentage of its population through Medicaid than almost any other state and is one of 10 that never expanded eligibility after the passage of the Affordable Care Act.

“The difference in how Texas approached this compared to a lot of other states is and was very striking. It wanted everybody off, anybody extra off, even though we knew that meant that state systems would buckle under the pressure,” said Erin O’Malley, a senior policy analyst with Every Texan, a left-leaning statewide advocacy group.”

Read the full article on The Texas Tribune. 

 

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Blog

Data Brief: Bilingual Texans

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Being a Texan means having pride in your identity and the vast opportunities in our state’s diversity. Texas’ rich cultural diversity makes it a desirable home for many, while also playing a key role in our economic growth. Considering the more than 9 million people who speak a language other than English in Texas, – 6 million of whom are bilingual – it’s necessary to study the trends surrounding the languages Texans speak. These data sets offer insight into the opportunities these populations lack or possess in comparison to their English monolingual counterparts, thereby guiding policy decisions to address any identified disparities. 

Method 

This data brief explores the outcomes experienced by the various language speakers in Texas. For context, the bilingual population is calculated by taking the intersection of two variables: “speaks language other than English at home” and reports English proficiency “well” or “very well.” The English monolingual population reports only being able to speak English. The non-English, monolingual group speaks English “not well” or “not at all,” and reports speaking a language other than English at home.  

Who Are Bilingual Texans?  

Language diversity across the state provides different trends to explore. Explore the geographic distribution and household structures by language below. 

Language Isolation 

The linguistically-isolated population in Texas consists of households where: 

  • No person age 14+ speaks only English at home, or
  • Households where no person age 14+ who speaks a language other than English at home also speaks English “very well.”

This population’s cultural richness is an asset to the state, yet these Texans also face unique social and economic challenges. Exploring these different characteristics and trends is crucial to better identifying local and state support for these linguistically isolated communities.

Economic Well-Being of Linguistically Diverse Texans  

Multilingualism is a crucial part of the Texas economy. With such a diverse landscape, multilingual employees are able to cater linguistically and culturally to different clientele. Although reports showcase the benefits that dual speakers bring to the workforce, it’s important to dive deep into Texas trends to explore how we compare to the national landscape.

Even though bilingualism is considered an asset in many workplaces, there seems to be a slight disproportionate benefit based on what types of languages someone speaks. It is also important to note that the economic benefit of bilingualism seems to be context-dependent; jobs that don’t require higher education may be more receptive to those who speak another language because they are able to interact with a larger customer base. It could also be that bilingual speakers – specifically immigrants – bring valuable skill sets that aren’t captured by formal education, whereas jobs that require advanced degrees likely have English as their dominant language and use communication skills that benefit English monolinguals.  

Nevertheless, dual speakers play a significant role in our cultural landscape and economic growth with their unique skill set, one that must be preserved through education policy. Every Texan supports policy proposals that involve hiring and retaining bilingual teachers and programs. 

A Texas for Everyone 

At Every Texan, we believe the most effective way to ensure every Texan has access to good health care, education, and jobs is to strengthen public policy. In our exploration of Texas’ language landscape, the data in this brief provide valuable insight into specific policy priority areas. For example, we uncover disparities in health care coverage for bilinguals and non-English monolinguals compared to their English monolingual counterparts – not a new data trend, but one that’s grown over time in part due to Texas’ Medicaid unwinding. National reports conclude that the language barrier leads to a greater likelihood of food insecurity for those with limited or nonexistent English-speaking abilities. 

Creating a more prosperous state means investing in every Texan at every crossroads. The diversity of language populations in Texas will only continue to grow, along with the disparities, unless policy is implemented to change course. To give every Texan the best opportunity to care for themselves and their families, policy intervention is necessary to make public resources more accessible without diluting the diversity these groups bring to our growing state.  

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Press Mentions

Lynn Cowles in The Associated Press: Florida hospitals ask immigrants about their legal status. Texas will try it next.

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Every Texan’s Health and Food Justice Programs Manager Lynn Cowles spoke to The Associated Press about Gov. Abbott’s Executive Order GA-46, which requires the Texas Health and Human Services Commission to direct public hospitals in the state to collect demographic information on patients that will enable hospital staff to determine how many inpatient and emergency care patients at the hospital are undocumented. The processes outlined in the Executive Order begin Nov. 1, 2024, also the date DACA recipients around the U.S. will first be able to enroll in Marketplace health insurance through the Affordable Care Act.
 
Read an excerpt below:
 
Whatever data Florida and Texas do collect likely will be unreliable for several reasons, researchers suggested. Health economist Paul Keckley said the report released by Florida state officials could have “incomplete or inaccurate or misleading” data.
 
…
 

In Florida and in Texas, people who aren’t in the U.S. legally can’t enroll in Medicaid, which provides health insurance for low-income people — except in the case of a medical emergency.

Multiple factors can affect the cost of care for people who are in the U.S. without legal permission, experts said, especially the lack of preventive care. That’s especially true for people who have progressive diseases like cancer, said Dr. James W. Castillo II, the health authority for Cameron County, Texas, which has about 22% of the population uninsured compared to the state average of 16.6%.

At that point, he said, “it’s usually much harder to treat, much more expensive to treat.”

Texas community groups, policymakers and immigration attorneys are partnering with Every Texan, a nonprofit focusing on public policy and health care access, to encourage people to not answer the status question, said Lynn Cowles with Every Texan.

Read the full article on The Associated Press.

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Blog

Celebrating 60 Years of Food Assistance

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As a centerpiece of his War on Poverty, President Lyndon B. Johnson signed the Food Stamp Act of 1964 on August 31 of that year. Now known as the Supplemental Nutrition Assistance Program (SNAP), more than 3.3 million Texans currently rely on this program to provide food for their families. In a state as great as ours, too many families experience food insecurity and face difficulties meeting basic food needs. When Texas families struggle to make ends meet – juggling finances to cover rent, utilities, and transportation – often little is left for food. 

Texans who provide kinship care to the children of family members are particularly in need of food assistance programs; nearly 42% of Texas children in state care are placed with relatives after being removed from their homes by Child Protective Services. Many more are living away from their parents in informal or voluntary kinship care placements, though the vast majority of those children live with grandparents. Often on fixed income, grandparents who take in grandchildren are at greater risk of experiencing poverty and food insecurity. 

President Johnson understood and addressed these struggles by creating a permanent food assistance program, which has evolved significantly in the last 60 years. Initially, people would purchase “stamps” at a level similar to what the family would spend on food and then receive a bonus, or benefit, based on income level. The Food Stamp Act of 1977 eliminated the need to purchase “stamps” to receive the benefit while also establishing national eligibility for participation. As a result, the amount of benefits a family receives is based on the household’s size, income, and expenses. 

In the early 2000s, Electronic Benefit Transfer (EBT) cards – similar to credit or debit cards – started to replace paper stamps. The transition to EBT cards reduces stigma for the families using food stamp benefits while also reducing costs and fraud within the program. The program was renamed SNAP in the 2008 Farm Bill. 

While the federal government fully funds SNAP benefits, the state and federal governments share the administrative costs. Health and Human Services Commission (HHSC) administers SNAP and is charged with making accurate eligibility determinations, issuing payments, overseeing participating retailers, and preventing fraud. 

Unlike the 38 states that do not count assets, Texas chooses to impose a vehicle asset test (VAT) on all SNAP applicants in addition to income limits. That means our state factors in a car’s value when determining if a family is eligible for SNAP benefits. In 2001, Texas set a resource limit of $5,000 in countable cash, a first vehicle worth up to $15,000, and any additional vehicles could be worth up to $4,650 (any excess vehicle value counts towards the cash resource limit). Those limits were never indexed to inflation, so they’ve lost purchasing power over the decades and no longer reflect the cost of safe and dependable family cars or trucks. Fortunately, in 2023 the Legislature updated Texas’ SNAP VAT to $22,500 for first vehicles and $8,700 for each additional vehicle. This change will help thousands of Texans – including families with young children, the elderly, and kinship care providers – who face hunger every month simply because they need a car to survive.

In 2023, HHSC formally recognized food security as a significant, non-medical component of individual, family, and community health. HHSC’s 2023 Non-Medical Drivers of Health (NMDOH) Action Plan includes ways to build on the foundation laid by the 1964 Food Stamp Act by assessing current HHS SNAP enrollment and utilization data to enhance the program’s use. By increasing the number of people enrolled in SNAP and ensuring that eligible community members are able to use the program to its fullest, Texas can improve health outcomes and stabilize access to healthy food.

However, Texas is currently experiencing an eligibility system crisis that requires legislative intervention. SNAP benefits have lapsed for anywhere from tens to hundreds of thousands of eligible Texans due to paperwork backlogs at HHSC. These failures not only expose Texas to the threat of federal financial sanctions and/or the loss of federal funds, but far more importantly, these failures cause real suffering. Failure to take immediate action to address the eligibility system crisis amounts to an explicit decision to increase financial hardships and human suffering among low-income Texas children, the elderly, and individuals with disabilities today and for years to come. 

An effective eligibility and enrollment system forms the foundation for meeting the needs of eligible, low-income Texans. Its most basic function is to process eligibility accurately and without delay. Maintaining a system that can do that consistently takes meaningful investments. 

When the Legislature goes back into session this January, they should reflect on the vision of President Johnson and ensure no Texas family goes hungry due to an inadequate eligibility system and unnecessary barriers to participation.

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Testimony

Testimony on Harris County’s Guaranteed Income Program in the Senate Committee on Local Government

Read this testimony as a PDF here.

Unlocking the Potential of Guaranteed Income for Every Texan 

Every Texan deserves the opportunity to thrive and ensure a bright future for themselves and their families. 

In recent years, guaranteed income (GI) programs have been invaluable for many families. These piloted and means-targeted programs have enabled individuals to afford groceries, ease housing costs, cover medical expenses, and better care for their families. The immediate, tangible benefits of guaranteed income have garnered strong support nationwide. 

Guaranteed income has deep U.S. roots, gaining traction in the 1960s through civil rights leaders like Dr. Martin Luther King and President Nixon’s negative income tax proposal that would have provided a minimum income to low-income families. It is a proven approach used for decades in Alaska, where direct cash transfers from the state’s oil and mineral revenues are distributed to all residents annually.

Harris County’s GI pilot program joins at least 150 initiatives across the country, including cities like Austin and San Antonio. Many of these programs are at least partially funded using federal funding from the American Rescue Plan Act (ARPA).

Meeting the Demand to Address Our State’s Economic Precarity 

The immediate demand for Harris County’s GI program is clear: despite our state’s economic power, working Texans and their families are not reaping the benefits of the booming economy we create. Texas’ widening economic gap has resulted in one of the nation’s highest poverty rates, with nearly two in five Texans struggling to meet their basic needs. This disparity is particularly acute among Black, Latino, and rural communities.

The lack of economic security and concern over insufficient family budgets is driven by stagnant wages created by an outdated minimum wage, underpaid jobs, and a tax system that overburdens low-income Texans. This affects people’s ability to save. In Houston, about 43% of Houstonians cannot cover a $400 emergency from savings, with Black (67%) and Hispanic/Latino (53%) residents more than twice as likely to face this challenge than other racial and ethnic groups.   

Leveraging Local Governance for More Resilient Communities 

Localities have a deep understanding of their communities’ needs and are best positioned to allocate resources effectively. Investing in direct cash policies using ARPA funds is not just an opportunity—it’s a necessity. These federal dollars must be spent, or they will be forfeited, missing a critical chance to support those who need it most. Direct cash investments empower families during uncertain times, providing immediate relief that can drive long-term stability.  

Harris County’s GI program would establish a minimum income level to prevent participants from falling below it. This is a rare opportunity to invest in their future; letting these funds go unused would be a missed opportunity for meaningful change. Evidence shows that direct cash transfers are spent prudently on necessities, and over time, participants can use this support to build toward long-term goals. GI programs can:  

  • Help workers invest in themselves and their communities: Guaranteed income programs empower individuals to take risks and pursue better jobs by providing financial stability. In Austin’s pilot program, participants used guaranteed income to invest in education at times by adjusting their work hours and having better access to transportation options, all of which helped them advance in their careers.
  • Nurture stronger families with time to care for loved ones: Guaranteed income programs strengthen families by relieving financial stress, giving caregivers the time and support they need to care for loved ones. This financial stability enhances access to quality food and medical care, helping families meet their basic needs and fostering a healthier, more supportive environment for everyone.
  • Improve family budgets to meet rising living costs: Guaranteed income programs help families keep up with rising living costs and offer crucial relief during financial crises. By providing a steady income, these programs help cover unexpected expenses, such as emergency care or unforeseen bills. Participants also experienced better housing affordability, with fewer late rent payments and reduced eviction rates.

Read this testimony as a PDF here.

 

 

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Blog

Gov. Abbott’s Executive Order Will Increase Distrust in Texas Health Systems, Diminish Health Outcomes, and Harm State Economy

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On August 8, 2024, Texas Gov. Greg Abbott  issued Executive Order GA-46, which requires the Texas Health and Human Services Commission (HHSC)  to direct public hospitals in the state to collect demographic information on patients that will enable hospital staff to determine how many inpatient and emergency care patients at the hospital are undocumented. HHSC must also direct hospitals to collect and report back to HHSC the health care costs that those undocumented patients incur. The processes outlined in the Executive Order begin Nov. 1, 2024, also the date DACA recipients around the U.S. will first be able to enroll in Marketplace health insurance through the Affordable Care Act.

The governor seeks to use hospital reports to justify his understanding that “the federal government may and should be obligated to reimburse the State of Texas for the costs” of treating undocumented patients. However, statewide public health systems are not appropriate environments for testing out policies that the governor believes “may and should” exist. 

Abbott’s Executive Order will lead to fewer Texans and their families seeking medical care when they need it, even when dire medical needs make expensive health care necessary at the emergency room. These are Texans who generally already avoid less expensive medical care in settings like clinics and health centers because they are uninsured and often concerned about the cost and documentation requirements. The well-documented “chilling effect” of policies like this one will further marginalize undocumented individuals and their family members  – even those who are lawfully present – from enrolling in health coverage programs and seeking out necessary medical care.

Texas’ economy — particularly our construction, agricultural, and service sectors — will suffer as a result, as injured and sick workers are unable to  return to work. Meanwhile, Texas families will suffer the governor’s policies as he threatens their rights to seek medical care in emergencies. 

The Federal Government Already Funds Most Charity Care 

Just over 64% of the public funds used to reimburse hospitals for the health care they provide to people without health insurance comes from federal dollars. Therefore, most health care services for which hospitals are uncompensated already get reimbursed by federal funds, not by state or local dollars.  

The federal government requires public hospitals to provide funds – called “charity care” – to uninsured patients in exchange for tax breaks. Thus, the uncompensated care that Abbott is concerned about is already part of established funding relationships and tax structures that exist to improve community health. 

In Texas, other federal funding reimburses the state for uncompensated care; some of those funds are codified in one of the state’s 1115 waivers granted by the federal Centers for Medicare and Medicaid Services. It provides directed payment programs to hospitals that are providing care to uninsured patients. The waiver allows for the federal government to pay Texas hospitals for treatment that no one can pay for, since so many uninsured people seek emergency medical care in the state.

Because pregnant citizens and adults with qualified immigration status do qualify for Medicaid in Texas, the state does accept Social Security Act’s Title XIX Grants to States for Medical Assistance Programs for undocumented pregnant people in emergency rooms for labor and delivery. Those undocumented pregnant people are also currently eligible for CHIP-Perinatal, which covers unborn children. In these circumstances, the federal government does contribute billions to Texas health programs and hospitals for providing coverage and care to undocumented residents. Every Texan supports that federal funding and initiatives designed to increase coverage and affordable care for Texans – regardless of immigration status. When more people have access to affordable health care, entire communities have improved health and economic outcomes.

By persistently rejecting the interests and preferences of their constituents, the Texas Legislature continues to avoid passing legislation that would close the health insurance coverage gap in the state by making low-income adults eligible for Medicaid. This refusal to expand Medicaid eligibility to low-income citizen adults and adults who are qualified immigrants prevents Texas hospitals from receiving federal Medicaid dollars made available by SSA Title XIX/Medicaid funds. These dollars would fund the emergency room costs of people who are not U.S. citizens — both undocumented and lawfully present people — and would qualify for Medicaid were it not for their immigration status. By refusing to close the health insurance coverage gap, state lawmakers have cost Texas billions of dollars of federal aid for undocumented Texans’ emergency room care since 2014.

The current system is costly and inefficient. Abbott’s order will only increase expenses and worsen community health outcomes by deterring undocumented Texans from seeking emergency care.  

Executive Order Adds Administrative Burden on State Agency 

While HHSC is currently under federal oversight and potential financial sanctions for its processing time of Medicaid, CHIP, SNAP, and TANF applications, and while the agency avoided implementing summer food security programs for children who receive free school meals specifically due to its lack of capacity, the governor’s Executive Order requires HHSC to have somehow the capacity to implement another program. Although the staff hours and infrastructures necessary for carrying out this hospital reporting program are less intensive than processing benefits applications and administering summer food benefits, Every Texan encourages the governor’s office to decrease the administrative strain HHSC is already operating under by rescinding GA-46.  

Importantly, the Executive Order does not require hospitals to subtract from the dollar amount of health care costs incurred by undocumented patients the amount of bills those patients themselves reimburse with out-of-pocket payments directly to hospitals. Whether the governor’s office will require hospitals and/or HHSC to track these direct payments is unclear. 

Conflicts with Texas and Federal Privacy Standards 

Abbott’s Executive Order acknowledges that public hospitals must treat patients regardless of their coverage or immigration status. However, it does not acknowledge the conflicting messages from state and federal offices, legal services programs, and community-based organizations that will confuse community members and ultimately increase distrust in Texas’ health systems. 

For example, the Texas Department of State Health Services (DSHS) posted a flyer from national immigrant rights organization Protecting Immigrant Families (PIF) on its website until Sunday, Aug. 11 – just three days after Abbott announced the Executive Order — which confirmed to Texas patients that “health care workers should not ask for immigration status information.” 

Although DSHS removed that flyer from their website as of Monday, Aug. 12, Every Texan refers advocates, analysts, and members of the media to the same “YOU HAVE RIGHTS: PROTECT YOUR HEALTH” flyer  on a California United Way office website. Shifting messaging and conflicting positions among federal, state, and local offices and organizations will increase hesitance to visit hospitals/clinics not only for people with noncitizen immigration status but for  mixed immigration status families as well. We anticipate concerns and potential lawsuits about patient HIPAA violations from federal oversight offices and national legal partners in the coming weeks.

Messaging to Community Members 

Every Texan encourages community partners, immigration attorneys, hospital staff, and members of the media to share widely that accessing public health and/or benefits programs – including charity care at public hospitals, sliding fee-scale programs at federally-qualified health centers, Medicaid, CHIP, CHIP-Perinatal, SNAP food benefits, and Marketplace health insurance – has NO EFFECT on public charge admissibility tests and WILL NOT affect immigration applications for legally permanent resident status.

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We urge the governor’s office to rescind GA-46. While some states are expanding access to affordable health care for people without current immigration status, Gov. Abbott strives to further marginalize those taxpayers from programs that would not just save lives and money for Texas families, but also benefit hospitals and local and state governments.

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Blog

Undocumented Texans Paid $4.9 Billion in State and Local Taxes in 2022

Undocumented immigrants are essential contributors to Texas’ economy and robust job growth. Regardless of their citizenship or immigration status, immigrant families pay state and local taxes to support vital public services that benefit all of us, such as schools and colleges, roads, parks, and libraries. A new report from the Institute on Taxation and Economic Policy (ITEP) confirms in 2022 1.9 million undocumented Texans paid a hefty $4.9 billion in state and local taxes. 

Undocumented Texans pay their fair share of state and local taxes. 

Without a state income tax, Texas’ state and local tax system relies heavily on sales and property taxes. Most revenue (58%) contributed by undocumented Texans (nearly $2.8 billion) was paid in sales and excise taxes, while 37% (about $1.8 billion) was paid in property taxes that support public education and local government services. Because Texas relies so heavily on its “two-legged stool” tax structure, undocumented Texans are even more likely to pay the same taxes as other Texas residents when compared to those undocumented in other states. 

The ITEP report estimates the effective tax rate — the percentage of annual income paid in taxes — for undocumented immigrant families. In Texas, the effective tax rate for undocumented Texans is 8.9%, the 15th highest in the nation. Given the regressive nature of Texas’ tax system, it is unsurprising that undocumented immigrants’ effective tax rate is higher than most. For perspective, the state’s wealthiest taxpayers (the top 1%) pay an average effective tax rate of just 4.6%, half of what undocumented Texans pay. 

Texas is one of six states that raised more than $1 billion in tax revenue from undocumented immigrants. On average, undocumented Texans pay $2,615 in state and local taxes per person. This means that public services receive an additional $1.3 billion in tax revenue for every half a million undocumented immigrants living in Texas. 

Undocumented immigrants pay federal taxes too but are denied many benefits.  

Undocumented Texans contribute to federal taxes and may help lower the federal deficit by a net $0.9 trillion over the next 10 years. Yet a substantial portion of their contribution goes to payroll taxes, which fund the major social insurance programs they are barred from accessing. In 2022, undocumented immigrants nationwide paid $25.7 billion in Social Security taxes, $6.4 billion in Medicare taxes, and $1.8 billion in unemployment insurance taxes. Despite contributing nearly $34 billion to the U.S. social safety net, undocumented Americans are unable to access that support. 

Undocumented immigrants also can face higher income tax payments than U.S. citizens due to laws that deny them and their U.S. citizen family members significant tax credits, such as the Earned Income Tax Credit and Child Tax Credit. Many do not claim tax refunds at all because of lack of awareness, fear of immigration consequences, or limited access to tax preparation help. 

Granting legal status to undocumented immigrants would not only raise their wages, but also enable them to claim more credits and refunds to which they are entitled. It also would mean more state revenue. If all current undocumented immigrants received work authorization, their annual state and local tax contributions would increase by $474 million, reaching $5.3 billion. This new revenue would include an additional $215 million from sales and excise taxes, $157 million from property taxes, and $102 million from other taxes. 

Undocumented Texans are critical contributors to the so-called “Texas Miracle.” Every Texan wants to provide for their family and improve the state — regardless of their legal status. This study reminds us how important our undocumented family, friends, and coworkers are to the economic productivity of Texas communities from Amarillo to Brownsville.  

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Blog

Why “Food is Medicine” Initiatives Are Important in Addressing Food Insecurity

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Lawrence Robinson was a Health and Food Justice Policy Intern from September 2023 to May 2024

The food we consume is a crucial determinant of health, as quality nutrition prevents and manages chronic diseases. However, 1 in 8 Texans experience food insecurity and rising rates of diet-related conditions. These data mirror the national average and contribute to the 117 million Americans who have at least one preventable chronic disease; the story is even more devastating for Texans of color. As food access plays a key role in public health and wellness, we must understand the root causes of food insecurity in order to promote healthy living. This report examines the current state of food insecurity in Texas while exploring how public health programming and policy can address these issues. 

View this report as a PDF.

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Blog

Another Year of Record Affordable Care Act Marketplace Enrollment

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Texas saw record enrollment growth in both new and returning customers on the Affordable Care Act (ACA) Marketplace for 2024. A number of factors drove these historic gains, including an extension of federal subsidies supporting low-cost coverage and mass coverage loss due to Medicaid unwinding.  

By the Numbers

More people enrolled in better plans for this year. 

Almost a million new Texans have Marketplace coverage this year, meaning enrollment gains are about the same as the city of Austin’s population. Marketplace enrollment in Texas grew an astounding 44.5% between 2023 and 2024. 1 in 9 Texans are now insured through the Marketplace. 

Most Texans signed up for gold plans, and as a state, we had higher-than-average enrollment in gold plans and lower-than-average enrollment in bronze plans compared to the rest of the United States. Bronze plans have lower premiums on average but much higher deductibles and other cost-sharing, which can lead people to put off care or forgo it altogether in fear of high costs. Federal subsidies over the past few years have made gold and silver plans an accessible and attractive option for more people. 

Most Texans benefitted from cost-reduction policies and federal subsidies. 

Congress has repeatedly funded different financial supports for people using the Marketplace. These subsidies typically fall into two categories: 

  • Advanced premium tax credits (APTCs) apply to the monthly premium paid to the insurance company to maintain coverage. These are refundable credits applied to federal income taxes.  
  • Cost sharing reductions (CSRs) apply to the amounts paid when using insurance, such as a copay or coinsurance paid to a provider for care. CSRs are only available to people enrolled in silver plans.  

The  Inflation Reduction Act extended the subsidies provided by the American Rescue Plan Act, making APTCs and CSRs available again for the 2024 plan year. This extension made these benefits available to more people and resulted in more plans with low or no-cost premiums. These extended subsidies were likely a major driver of the huge Marketplace enrollment in Texas this year. In 2024, 96% of Texans got coverage supported by federal premium subsidies; nearly half (49%) of that 96% also got CSRs they could apply to deductibles, copays, or coinsurance.  

Most users comparison-shopped for coverage to find the best deal. 

Texans overwhelmingly used Healthcare.gov to compare plans and find the best price and fit for their health care needs. 72% of Texans on Marketplace coverage updated information and shopped to compare plans. This led around half of Texans using the Marketplace to switch plans from last year. Only about a quarter of Texans automatically renewed their coverage without first looking at other available options. In many cases, this is because a consumer knows ahead of time which plan reliably covers a preferred provider in their area.  

While federal policies and funding are in place to make gold plans a best option in most cases, for some, a silver plan would lead to better savings and comparable coverage because they qualify for CSRs. Annual changes to federal policy and funding can make choosing a plan daunting, which is why there is federal support for free assistance in navigating the Marketplace.  

Better access to enrollment assistance should be funded. 

Finding health coverage is stressful. Even navigating employer-sponsored insurance options or choosing the right Medicaid managed care plan can be difficult. How insurance works and what a plan will pay for is variable and confusing. This reality makes the availability of expert help — without financial interest in enrollment outcomes — a vital part of every state’s insurance ecosystem. Though Texas used to fund enrollment assistance support, the state stopped years ago for political reasons and left Texans to rely on the network of federally-funded  enrollment assisters in communities across the state. These wonderful groups can help individuals and families assess coverage options, enroll in coverage, and untangle access issues. More funding for more such support across Texas is a key step toward reducing Texas’ highest-in-the-nation uninsurance rate:  a staggering 16.6%. 

These Numbers Could Change. 

There are several threats to Texas’ coverage gains on the Marketplace, including: 

  1. The potential expiration of federal subsidies supporting access to coverage; 
  2. A lack of state funding for qualified enrollment assistance programs;  
  3. Fraud by bad actor agents and brokers illegally leaving people enrolled in more than one plan with limited options to fix their situation; and  
  4. “Junk” insurance-like products offering non-comprehensive coverage mistaken for true, ACA-compliant health insurance.  

State and federal funding is necessary to continue to support this progress. Comprehensive health insurance is expensive and health care costs are high — especially when accounting for high inflation. Congress must reauthorize the subsidies that make APTCs and other CSRs more broadly available in order to ensure people can afford coverage. Texas should invest state funds to support enrollment assistance programs to help Texans navigate comprehensive coverage options and find the best plan. Enrollment assistance and coverage information should be available in multiple languages, accessible to people with disabilities, and navigable by households with different eligibility for different programs, including food access programs.