Texas health coverage: the evidence, including the inconvenient parts

About 605,000 Texas adults earn too little to get help buying insurance, and too much (or have no children) to qualify for Medicaid.

Texas has the highest uninsured rate in the country: 16.7% of Texans in 2024, compared with 8.2% nationwide.¹ Adults in the "coverage gap" have no affordable option today.²

The problem

A parent in a family of three generally qualifies for Texas Medicaid only below about $342 a month (15% of the poverty line); the state's own published limit is $230 a month for a single parent with two children.³ Most adults without children have no path to Medicaid at all.
Of the roughly 1.2 million uninsured adults in the national coverage gap, about half live in Texas.²
In the High Plains and West Texas regions, about one in five residents under 65 is uninsured, and 69 of 71 counties carry a federal primary-care shortage designation.^4,5

Monthly income limit for a parent in a family of three, 2026. Based on the 2026 federal poverty guidelines ($27,320 for three people) and KFF's 15%-of-poverty estimate of the Texas parent limit.^6,3

The proposed change

Extend Medicaid to adults ages 19–64 with incomes up to 138% of the federal poverty line, as 40 states and D.C. have done. In 2026 that is $22,025 a year for one person or $37,702 for a family of three.⁶ The federal government pays 90% of the cost for this group, compared with about 58.5% for most of Texas Medicaid.⁷

Why it matters

Lives: Strong studies found fewer deaths among low-income adults after expansion, for example a 9.4% drop in annual mortality among adults 55–64. Some other studies could not detect an effect.^8,9,10
Mental health and money: In Oregon's randomized lottery, Medicaid cut depression by about 30% and nearly eliminated catastrophic medical bills.¹¹
Medical debt: Coverage reduced unpaid medical bills sent to collections.^12,13
Regular care: Compared with Texas, low-income adults in Kentucky and Arkansas became far more likely to have a usual source of care.¹⁴

See the evidence by topic →

Costs and limits, up front

It costs more, not less. Coverage increases health care use and total medical spending (about 35% more per person in Oregon). The case rests on what that care buys, not on savings.¹⁵
Texas would pay a share. The state would cover 10% of the cost plus administration. Older Texas estimates of that share are dated and disputed.^16,17
New federal strings. Under the 2025 federal law, Texas would have to apply work requirements, renew coverage every six months, and accept tighter limits on hospital-financing tools it relies on.^18,19,20
Emergency room use went up in Oregon, not down.²¹
Coverage is not the same as access. Texas physicians have accepted new Medicaid patients less often than the national average.²²

Read the full costs and tradeoffs →

Sources for this page

U.S. Census Bureau, ACS Brief ACSBR-024 (Health Insurance Coverage by State: 2023 and 2024) (2025-09). https://www2.census.gov/library/publications/2025/demo/acsbr-024.pdf [evidence L4]
KFF, Cervantes, Bell, Tolbert, Damico, 'How Many Uninsured Are in the Coverage Gap...' (2026-07-27). https://www.kff.org/medicaid/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/ [evidence L2]
Texas HHSC Medicaid for Parents and Caretakers page; KFF coverage gap report (accessed 2026-10-24). https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-programs-services/programs-children-families/medicaid-parents-caretakers [evidence L3]
U.S. Census Bureau Small Area Health Insurance Estimates (SAHIE) 2024, county file; regions = Texas Comptroller High Plains (41 counties) + West Texas (30 counties) (2026-08). https://www2.census.gov/programs-surveys/sahie/datasets/time-series/estimates-acs/sahie-2024-csv.zip [evidence WT1]
HRSA Health Professional Shortage Areas, primary care detail file (BCD_HPSA_FCT_DET_PC), status 'Designated' (accessed 2026-10-24). https://data.hrsa.gov/data/download [evidence WT3]
HHS 2026 Poverty Guidelines, 91 FR (FR Doc 2026-00755) (2026-01-15). https://www.govinfo.gov/content/pkg/FR-2026-01-15/html/2026-00755.htm [evidence L1]
Federal Register FMAP notice for Oct 1, 2026-Sep 30, 2027 (2025-11-28). https://www.federalregister.gov/documents/2025/11/28/2025-21332/federal-financial-participation-in-state-assistance-expenditures-federal-matching-shares-for [evidence L10]
Miller, Johnson, Wherry, 'Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data', QJE 136(3):1783-1829, doi:10.1093/qje/qjab004 (2021). https://academic.oup.com/qje/article-abstract/136/3/1783/6124639 [evidence H1]
Borgschulte & Vogler, 'Did the ACA Medicaid expansion save lives?' J Health Econ 72:102333, doi:10.1016/j.jhealeco.2020.102333 (2020). https://doi.org/10.1016/j.jhealeco.2020.102333 [evidence H2]
Black, Hollingsworth, Nunes, Simon, NBER w25568 'The Effect of Health Insurance on Mortality: Power Analysis...' (2019 (rev.)). https://econpapers.repec.org/RePEc:nbr:nberwo:25568 [evidence H4]
Baicker et al., 'The Oregon Experiment', NEJM 2013;368:1713-22, doi:10.1056/NEJMsa1212321 (2013-05-02). https://www.nejm.org/doi/full/10.1056/NEJMsa1212321 [evidence H5]
Finkelstein et al., 'The Oregon Health Insurance Experiment: Evidence from the First Year', QJE 127(3):1057-1106 (2012). https://pmc.ncbi.nlm.nih.gov/articles/PMC3535298/ [evidence F1]
Brevoort, Grodzicki, Hackmann, J Public Econ 187:104203, doi:10.1016/j.jpubeco.2020.104203 (2020). https://doi.org/10.1016/j.jpubeco.2020.104203 [evidence F2]
Sommers, Maylone, Blendon, Orav, Epstein, Health Affairs 2017, doi:10.1377/hlthaff.2017.0293 (2017-05). https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0293 [evidence H6]
Baicker et al. NEJM 2013 (Oregon) (2013). https://www.nejm.org/doi/full/10.1056/NEJMsa1212321 [evidence S1]
Legislative Budget Board staff estimate (Mar 4, 2013); HB 3376 fiscal note (Apr 16, 2013) (2013). https://capitol.texas.gov/tlodocs/83R/fiscalnotes/html/HB03376I.htm [evidence P3]
Fritz, Pitts & Pitts (Sept 2020); Dague & Hughes, Texas A&M Bush School (Sept 2020), both for Episcopal Health Foundation (2020-09). https://episcopalhealth.org/wp-content/uploads/2020/09/Fritz-Pitts-Pitts-Sept-2020-Impact-of-Medicaid-Expansion-on-State-Budget-1.pdf [evidence P4]
CMS Interim Final Rule CMS-2454-IFC, 91 FR 33348 (FR Doc 2026-11094); CMS fact sheet (2026-06-03). https://www.govinfo.gov/content/pkg/FR-2026-06-03/html/2026-11094.htm [evidence L5]
KFF, 'Health Provisions in the 2025 Federal Budget Reconciliation Law' (P.L. 119-21) (2025-08-22). https://www.kff.org/medicaid/health-provisions-in-the-2025-federal-budget-reconciliation-law/ [evidence L6]
CMS Dear State Medicaid Director letter on OBBBA sections 71115/71117 (2025-11-14). https://www.medicaid.gov/medicaid/downloads/providertax_dcl_11142025.pdf [evidence L7]
Taubman et al., Science 2014, doi:10.1126/science.1246183; Finkelstein et al., NEJM 2016, doi:10.1056/NEJMp1609533 (2014; 2016). https://www.nejm.org/doi/full/10.1056/NEJMp1609533 [evidence H8]
MACPAC, 'Physician Acceptance of New Medicaid Patients: Findings from the NEHRS' (June 2021) (2021-06). https://macpac.gov/wp-content/uploads/2021/06/Physician-Acceptance-of-New-Medicaid-Patients-Findings-from-the-National-Electronic-Health-Records-Survey.pdf [evidence R4]

Last reviewed: 2026-10-24. Found a mistake? Report an error.