Uninsured Texans: Who are they?

This is a preview of our Texas 2036 newsletter about uninsured Texans. To receive this weekly highlight of our work, sign up here.

Six wooden blocks with images of health care icons are stacked in a pyramid shape on a table. The Texas 2036 logo is top right.

Who Are the Uninsured in Texas? 💊

Did You Know: Roughly five million Texans are uninsured.

  • Texas has the nation’s highest uninsured rate—about 18% in 2021, compared to the national average of 8.6%.

Closing the Gap: Most uninsured Texans qualify for a government health program or for federal subsidies that would help pay for coverage but they have not signed up.

  • Texas 2036 has launched a multi-year study to find out why.

The Study: We are seeking to understand the state’s uninsured population and to better identify barriers and personal decisions that result in not having access to affordable care.

  • Over the past two months, we have surveyed more than 2,000 uninsured Texans and conducted dozens of focus groups around the state.

A pie graph depicts "state figures" of the "uninsured population in Texas by income level relative to federal poverty guidelines for a family of four".

Key Facts and Trends 📈

New Perspective: We launched this research project partly in response to data points that differ from common narratives about Texas’ uninsured population.

🩻 Affordable Care Act: In our initial survey research, 70% of respondents are unsure of their eligibility for financial assistance through ACA.

  • According to some analyses, more than 40% of all uninsured Texans likely qualify for federal subsidies.

🕵 Employment: The most-cited reasons for not having health coverage among uninsured Texans are connected to employment.

  • Our early study findings show that 30% of uninsured Texans say they don’t have health insurance because they are not currently employed.

💵 Income: Roughly half of uninsured Texans have incomes of about $55,500 annually for a family of four.

  • This shows that access to affordable care is a challenge for working, middle-class Texas families.

🩺 Medicaid: While expanding Medicaid offers a cost-effective solution to increase coverage eligibility, it would only result in 16% of Texas’ uninsured population becoming newly eligible for coverage.

  • Regardless of whether Texas decides to expand eligibility for Medicaid, additional work is required to meet the needs of the remaining 84% of uninsured Texans.

Learn more.

A bar graph lists the percentages of "reasons stated for being uninsured" from Texas 2036's "Who are the uninsured" early survey findings.

Next Steps for “Who Are the Uninsured?” 🪜

Dive Deeper: Surveys and focus groups are being conducted through 2022.
As open enrollment for the ACA Marketplace begins in November, we aim to identify where disconnects arise as people sign up and what might be done to reduce challenges in the enrollment process.


  • 2023: Further evaluate initial findings, develop follow-up studies and inform key stakeholders, including legislators, through testimony before state commissions and Legislative committees
  • 2024: Analyze and report additional findings, conduct flash surveys, and develop policy recommendations
  • 2025: Support state policymakers by sharing data and findings as health care reforms are considered during the 2025 Legislative session

A blue quote card with an image in the bottom right of Texas 2036 Senior Policy Advisor Charles Miller. It states: "We hope and believe this study will help policymakers and elected officials chart paths and devise solutions that all sides can rally around to effectively reduce the number of Texans who face unexpected medical debt or who skip care due to cost."

Texans, we want to know:

What’s your experience with signing up for health care insurance?

Take our brief survey about the Affordable Care Act Marketplace.