The state of health care for Texas families
This is a preview of our Texas 2036 newsletter where describe the state of health care in Texas, rooted in data. To receive this weekly look at our work, sign up here.
What is the state of health care in Texas?
Access to affordable health care can improve health outcomes, quality of life and financial stability. However, affordable health care is increasingly out of reach for many Texans.
Today our newsletter diagnoses the state of health care in Texas and highlights what can be done to address the biggest health care challenges we’re facing.
Health care prices, they’re going up!
Nearly half, or 47%, of Texans have employer-sponsored health insurance. On average, a Texas family pays over $7,500 per year in premiums for employer-sponsored health insurance.
The employer, meanwhile, pays an additional $15,000, and those prices are expected to go up even more next year.
📈 Analysts at global professional services firm Aon expect the average price of employer-sponsored health care coverage in the U.S. to increase by 9% in 2025 to more than $16,000 per employee.
Price transparency is a first step toward reducing the price barrier to care
Our latest Texas Voter Poll found that 41% of likely Texas voters — including 52% of mothers — had skipped medical treatment or surgery in recent years because they didn’t know what the final price might be.
By publishing prices, hospitals provide crucial market data that health plans can use to optimize care in ways that reduce expenses. But transparency is only the first step toward removing barriers to health care in Texas.
Compliance rates with machine-readable file requirements have improved dramatically, with over 80% of hospitals now receiving our highest grade, an increase of nearly 20% since our last evaluation.
A case study: Childbirth in Texas
Every 90 seconds a child is born somewhere in Texas, so let’s take a look at the price of giving birth — a starting point for Texas families.
In North Texas, for example, childbirth had a median price of $7,788 in 2022. But the actual negotiated price can vary widely, from as low as $1,827 to as high as $16,250, depending on which hospital you go to and which health insurance plan you have.
CLICK THE IMAGE BELOW TO VIEW OUR PRICE TRANSPARENCY TOOL.
Source: Texas 2036, Hospital Pricing Transparency tool, DRG Code 805
Check back in a few weeks when we update our dashboard with the latest pricing data for services like childbirth, knee replacement surgery and others.
How big a concern are medical bills to Texans?
Across the country, unexpected medical bills and the price of health care services are the top two financial worries for Americans, according to a recent Kaiser Family Foundation tracking poll:
- 45% of adults are very worried about being able to afford unexpected medical bills.
- 39% of adults are very worried about their ability to cover the price of health care services.
Texas has the highest percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months at 14.9%.
These financial fears have real-world consequences. The high price of health care is leading many Texans to make tough choices — often at the expense of their health.
A recent statewide poll by the Episcopal Health Foundation found that 65% of insured Texans skipped or postponed medical care in the past year because of expenses, including check-ups, treatments and filling prescriptions.
Did you know? According to the Kaiser Family Foundation’s Health System Tracker, an average 10.7% of Texas adults — 2,300,000 people — report having medical debt in a given year.
In 2022, Kaiser Health News found that more than half of U.S. adults report they’ve gone into debt because of medical or dental bills and that a quarter of adults with health care debt owe more than $5,000. KHN also found that:
- In Tarrant County, 27% of the population had medical debt with a median debt amount of $984.
- In Dallas County, 23% of the population had medical debt with a median debt amount of $994.
- In Bexar County, 21% of the population had medical debt with a median debt amount of $776.
What role do rising pharmaceutical drug prices play in family health care expenses?
In 2022, pharmaceutical expenditures reached $633.5 billion in the United States, a 9.4% increase over 2021.
In response to concerns about drug price increases, the Legislature created the Prescription Drug Price Disclosure Program, which created price reporting requirements for pharmaceutical manufacturers.
Unfortunately, compliance with the program is lacking. Pharmaceutical manufacturers rarely provide the comprehensive information that the statute requires, and if they are penalized for non compliance, they are penalized for administrative missteps.
Texans can now find annual reports about which drugs have gone up in price on the Texas Department of Health and Human Services website.
Did you know? In 2023, Texas 2036 supported legislation to allow pharmacists to order and administer some vaccinations — an authority that was granted during the COVID pandemic.
Versions of this bill passed both the House and Senate, but they were not reconciled prior to the end of the legislative session. Texas 2036 will work in support of similar legislation during next year’s Legislature.
Why aren’t more Texans signing up for free or low-cost health insurance?
Texas has the largest uninsured population of all states — but it shouldn’t be that way. We estimate that:
- Nearly 1.5 million uninsured Texans appear to be eligible for subsidies through the Affordable Care Act (ACA) large enough to cover the full premium for at least one plan.
- Another 400,000 uninsured Texas children appear to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP).
So, why aren’t they signing up?
Our multi-year, in-depth research found that the primary barriers were lack of awareness of eligibility for existing programs, misperceptions around their affordability, and bureaucratic difficulties with enrollment.
Learn more about opportunities we’ve identified for reducing the number of uninsured Texans in our report, “Who are the uninsured?”
A Texas success story: Lawmakers move to improve mothers’ health
Many Texas moms face medical issues and complications in the year following pregnancy, including postpartum depression, cardiac arrest, infection and extreme blood loss or hemorrhage.
Too often, low-income and uninsured new mothers would rely on hospital emergency rooms for care that could have been prevented — or treated earlier and more cost-efficiently — by a doctor or clinic.
To help ensure Texas mothers and babies have access to the care they need, Texas passed House Bill 12 last session, extending postpartum Medicaid coverage for qualifying mothers up to 12 months.
▶️ On Tuesday, the Governor’s Healthcare Workforce Task Force met to discuss Texas’ health care workforce needs.
Texas 2036’s Senior Vice President of Policy and Advocacy John Hryhorchuk testified on how strengthening the health care workforce starts in public schools and community colleges. Watch his full testimony.
A second barrier: Access to primary care
Access to affordable primary care is essential to good health. However, many families, regardless of their ability to pay, do not have immediate access to these vital services.
According to the Health Professions Resource, in 2020, Texas had 56,765 direct patient care physicians. Of our state’s 254 counties, 32 counties had no primary care physicians.
Who can help grow the health care workforce pipeline? Community colleges
In a 2023 workforce analysis prepared with Alexander Research & Consulting, Texas 2036 found that health care jobs in the state will increase by 8% from 2021 to 2026.
At Texas’ community colleges, registered nursing (No. 3), licensed practical nursing (No. 7), emergency medical technology (No. 12), biological sciences (No. 16) and psychology (No. 20) all place in the top 20 academic programs by enrollment.
Texas 2036 policy advisor Rahul Sreenivasan told the Fort Worth Report this summer that “I think Texas is no different (than the rest of the country) in that the health care sector is expected to continue to have increased needs.”
CLICK THE IMAGE BELOW TO VIEW THE CHART ON P. 58 OF THE WORKFORCE COMPOSITION, TRENDS & ALIGNMENT.
