Healthcare Report: Texas Healthcare Status Overview

Texas ranks 31st in overall health among U.S. states. Many Texans cannot afford health insurance, and struggle to afford necessary medical treatment. There is a shortage of healthcare providers and the public health system is underfunded.

1. High Uninsured Rate:
   Texas has the highest uninsured rate in the U.S. (16.6% in 2022), with nearly 5 million uninsured and projections rising to 6.1 million by 2040. The Affordable Care Act (ACA) permits states to expand Medicaid coverage to adults with incomes up to 138% of the poverty level, translating to $20,780 per individual or $35,630 per family of three. Texas has consistently refused to expand Medicaid to this level. Many qualify for subsidized ACA plans or public insurance programs like CHIP but face awareness, access, and bureaucratic challenges. Uninsurance causes serious economic costs, projected to reach $178.5 billion by 2040.  
   
   

2. Limited Access and Provider Shortages:
   Primary care access is inadequate, especially in rural areas—32 counties have no primary care doctors. Rural hospitals are under-resourced, with only 43% offering labor and delivery services. There are growing nurse shortages, with Texas projected to lack 57,000 nurses by 2036, while nursing schools turn away qualified applicants due to limited capacity.   
   
   

3. Underfunded Public Health System:
   Texas's public health spending is among the lowest in the U.S., which left it unprepared during COVID-19. Currently we rank fourth in the country in per capita public health spending. Outdated infrastructure and politicized public health measures worsened response efforts. Childhood vaccination rates have dropped, contributing to a major measles outbreak in 2025.
   
   

Recommended Strategies:

• Expand Medicaid to levels allowable by the ACA and streamline enrollment in Medicaid and the Children’s Health Insurance Program (CHIP).

• Grow telemedicine to reach rural areas.

• Incentivize rural practice with loan forgiveness and offer medical training in rural areas.

• Expand medical/nursing education and rural-specific training.

• Broaden provider scope of practice to boost capacity.

• Increase transparency in healthcare and pharmaceutical pricing to make health care more affordable.

• Significantly boost public health funding so that Texas ranks in the top half of the country in per capita spending and modernize infrastructure in readiness for future health crises.

Healthcare Bills Supported by Texas Forward:

• HB 3794 / SB 1859:
  Expands scope of practice for nurse practitioners; simplifies APRN licensing; strengthens price transparency by limiting billing unless a physician is directly involved.

• HB 2556 / SB 1232:
  Targets rising healthcare costs by regulating “facility fees”; bans them for telehealth and preventive services; requires 10-day patient notice.

• HB 541:
  Expands direct patient care billing rights to include all healthcare practitioners, not just physicians.

• SB 2093:
  Speeds up credentialing for federally qualified health center providers under Medicaid managed care.

• HB 2641:
  Prohibits preauthorization requirements for many essential services (e.g., emergency, mental health), easing patient access and provider burden.

• SB 2792:
  Criminalizes harassment of hospital workers, including exposure to bodily fluids, to address post-pandemic violence against healthcare staff.

• HB 4051:
  Allows physicians to delegate authority to prescribe or dispense limited medications to expand care access.

• HB 3348 / SB 1578:
  Permits county health care providers to serve high-population counties lacking hospital districts but bordering larger counties.

• HB 4799 / SB 2655:
  Enables care expansion in rural counties with 46,000–50,000 people adjacent to state capital counties and lacking public hospitals.

• HB 4622:
  Directs Texas Education Agency to assess career tech education in health fields to meet growing demand for healthcare tech workers.