Despite a booming local economy and influx of new residents, Texas has the largest percentage of Americans without basic health insurance.
A shocking annual report from the U.S. Census Bureau shows that nearly 10 percent of Americans between the ages of 18 and 65 do not have health insurance, even though more adults have insurance than the year before.
In Texas, nearly one in five people lack basic health insurance, nearly double the national rate of one in 10. And in some rural areas of the Lone Star State, nearly 40 percent had no health insurance.
The problem could lie in Texas, one of the key border states, which has a large number of people who do not qualify for insurance, such as illegal immigrants.
Data from the U.S. Census Bureau suggests that in some areas, as many as one in three Americans lacks health insurance.
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The finding comes as Texas’ economy is booming, with metropolitan suburbs growing by more than 50 percent in just a few years as young people flee coastal areas.
Meanwhile, Massachusetts had the most insured residents, with just 3 percent uninsured. This could be because the state requires all adults who can afford insurance to buy it or face tax penalties, and also because its large Medicaid program offers free health insurance to people under a certain income.
These findings come at a time when health insurance prices are at an all-time high, having risen nearly 50 percent in just 10 years.
Despite these bleak findings, the total number of uninsured Americans decreased in more than 600 of the 3,100 U.S. counties, while only 23 counties saw an increase.
About 45 percent of provinces managed to reduce the percentage of uninsured people to below 10 percent in one year, 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 biggest barrier. About 64 percent of adults said coverage was too expensive in 2022.
Many adults do not have insurance through their work, and southern states such as Alabama and Oklahoma have limited access to state-run insurance programs such as Medicaid.
The consequences of not having health insurance can be serious, including limited access to vaccines and the inability to afford potentially life-saving treatments like chemotherapy.
Health insurance costs rose this year by the most since 2011, according to an annual survey by the nonprofit health care research organization KFF
Texas has emerged as an economic powerhouse in recent years, largely due to an influx of young people and large corporations taking over metropolitan areas.
Taylor, a sleepy suburb of Austin, will soon be home to a $44 billion high-tech Samsung factory.
Many Americans from urban states like California have also fled to Texas because of the lower rents, low taxes, and more real estate than they could get on the coast.
But despite this, Kenedy County, Texas, had the highest number of adults without insurance, a total of 38 percent. Located just 20 miles from the U.S.-Mexico border, the tiny county has a population of just 350.
It is America’s fourth least populated county, with an estimated 100 times more cattle than people. Rural areas like Kenedy County tend to have lower median incomes due to fewer job opportunities and isolation.
According to U.S. Census data, three-quarters of Kenedy County residents are Hispanic or Latino. This group is the least likely to have health insurance.
The county’s proximity to the border suggests that many residents are immigrants from Mexico, who are more likely to work jobs that don’t provide insurance or are often undocumented, making them ineligible for insurance.
Overall, Texas has the second largest number of illegal immigrants, after California, at 1.6 million. This could contribute to the gaps in insurance coverage.
And according to the U.S. Census Bureau, one in five Texans lives in a rural area. These areas typically have few options in insurance markets, forcing residents to pay high premiums or go without if they can’t afford it.
Additionally, Texas does not have expanded access to Medicaid, meaning many low-income people who would qualify in other states are not eligible for free coverage.
Further east, Holmes County, Ohio, followed closely behind, with 35 percent uninsured. Just under half of its 44,000 residents are Amish, a group that largely eschews health insurance due to religious beliefs, opting instead to have the community as a whole contribute to medical costs.
Presidio County, Texas, had the third highest number of uninsured adults, with 33 percent lacking coverage. Like Kenedy County, this may be due to its predominantly Hispanic/Latino population and predominantly rural location.
Health insurance premiums and deductibles rose sharply from 2011 to 2021, while HHS warns that prices of many prescription drugs have skyrocketed between 2016 and 2022. The biggest culprit was Fluconazole, which is used to treat fungal infections.
In terms of state data, Oklahoma, Wyoming and Florida follow closely behind Texas, with about 14 percent of adults uninsured in these states.
None of the three states have expanded access to Medicaid, meaning the state-run insurance may not cover all residents who need coverage.
Los Alamos County, New Mexico, had the lowest percentage of uninsured adults, at just 2.1 percent. This may be due to high household incomes.
A 2023 report from American 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 state average income of $58,722.
Middlesex County in Massachusetts is the state with the most insured residents. Only 2.4 percent of adults are uninsured.
This could have something to do with Massachusetts’ health care reform law, which requires most residents 18 and older who can afford insurance to have coverage for a full year or pay a penalty on their taxes.
Massachusetts, Washington DC and Hawaii had the lowest rates of uninsured adults, averaging between three and four percent.
For D.C., that could be because many residents work for the federal government, which provides access to insurance. And in Hawaii, the state’s Prepaid Health Care Act requires employers to provide insurance to all employees who work at least 20 hours per week.