← Back to Texas Health Care Factsheets

Understanding Texas' High Uninsured Rate

Texas’ high overall uninsured rate does not fall equally across every part of the state. Instead, some areas of the state are subject to extreme levels of uninsurance, while other areas mirror national trends. These extremely high uninsured rates in turn serve to elevate Texas’ statewide average.

Counties in South Texas have consistently had uninsured rates much higher than the rest of the state. South Texas counties as a group also have a high percentage of employment in small business and a high poverty rate. The higher prevalence of small employers in the state overall means that many Texans employed in these establishments are unlikely to receive any form of employer-sponsored coverage. These employees are then left to either purchase their own private health care, which is often impossible for those whose earnings cannot support such high annual costs, or depend on Medicaid and the Children’s Health Insurance Program (CHIP) to offer some level of coverage – that is, if they meet the requirements.

The link between poverty, low wages, high prevalence of small employers unable to cover health insurance, and shortage of health care professionals further exacerbates the health care situation in the region of Texas south of I-10. When 47 percent of the population in Texas counties within 62 miles of the US-Mexico border live below the poverty line, it’s not much of a surprise that 42% of this population remains uninsured (based on data from 2000).[1] The map below shows a visual projection of county uninsured rates throughout the nation – the deep blue sea in the southern strip of Texas is indicative of a population that is disproportionately uninsured when compared to the rest of the state. It is important to note that the south Texas counties also have high percentages of people covered under Medicaid, so the high rates of uninsured they register reflect extremely low levels of private insurance.

Percent of Total Population Without Health Insurance, 2000: County-Level Estimates

Source: US Census Bureau. Model-based Small Area Health Insurance Estimates for Counties and States. 31 July 2007 <http://www.census.gov/hhes/www/sahie/maps/base/est2000/aaUninsure2000.pdf>.

To understand the role of private business in this picture, it is also important to keep in mind that although the majority of those receiving health insurance both in the nation and in Texas are covered by some form of employer-sponsored coverage, as mentioned earlier, the state is a large employer amongst this group and the health care coverage sponsored through state employment really constitutes public dollars (tax payer money rather than private or business contributions).

In addition to low health insurance coverage, the border counties of Texas also signal inadequate access to health care providers – in 2000, “66 percent of the population…within 62 miles of the U.S.-Mexico Border resided in a primary care HPSA [Health Professions Shortage Area].[2] An HPSA designation implies that the respective region does not have a sufficient supply of health professionals to meet the health needs of the population.[3] Hispanics in general are also much more likely to be uninsured throughout the nation[4] – and in Texas, particularly in the border region, this implies that a large percentage of the uninsurance problem may be linked to disparities based on race/ethnicity.