New data shows more than 5 million Texans don’t have health insurance, including about 1 million children – but advocates warn the numbers doesn’t reflect policy changes that have led to more people losing coverage.
The U.S. Census Bureau recently published data that shows Texas had an overall uninsured rate of 16.5% in 2025 – almost double the national rate of 8.4%.
“We still have the highest rates of uninsured adults and uninsured children anywhere in the United States,” said Lynn Cowles, director of health and food justice at the advocacy organization Every Texan. “And that was before the expiration of the Enhanced Premium Tax Credits from the health insurance marketplace that have caused so many more people to go uninsured this year in 2026.”
Advocates say Texas’ rate is likely already worse
Cowles said it will take another year for data from the Census Bureau’s American Community Survey, or ACS – an annual survey that asks U.S. households a wide range of questions, including about healthcare coverage – to reflect changes to programs like Medicaid, Medicare and the Affordable Care Act, or ACA, health insurance marketplace.
The Enhanced Premium Tax Credits, subsidies that made Marketplace coverage more accessible for low-income individuals and families, expired at the end of 2025. Despite that expiration, a record number of Texans – almost 4.2 million – selected an ACA plan for 2026. But Cowles said more than 850,000 of those Texans never activated those plans.
“At the end of last year, the federal government was wavering so much,” Cowles said. “People were still enrolling and they were hoping that Congress would extend the tax credits and their health insurance premiums would drop and they would be enrolled. But then that never happened. So, people saw these really expensive health insurance, premiums, and they just never paid for their plans to activate them.”
Cowles said that number is not counted right now in the uninsured rate.
In addition, Texas’ total Medicaid enrollment decreased by more than 130,000 people from January to July of this year, according to analysis from the Georgetown Center for Children and Families.
Cowles said she expects Texas’ uninsured rate to climb a few percentage points when 2026 data is released. She also said healthcare costs and premiums have continued to increase, meaning more Texans may be priced out of ACA plans during the current open enrollment period, which started this week and ends on Jan. 15, 2027.
What does the 2025 American Community Survey Data tell us?
In Texas, more than two out of 10 adults reported not having health coverage in 2025. The rate for Texas children was 13%, down about 0.6% from 2024, but experts – including the Census Bureau itself – said people should use caution when comparing the 2025 rate to previous years due to a change in how the health insurance question is asked.
In a webinar before the report was published, Census Bureau staff said it will take some time for the agency to complete the necessary research to “bridge the estimates.”
Edwin Park, a research professor at the Georgetown Center for Children and Families, said there are several factors that could make it difficult to compare the 2025 data to previous years, including a “hostile, anti-immigrant landscape.”
“That includes potentially reduced response rates among Latino and Hispanic kids due to a chilling effect [and] changes in population due to deportation, people voluntarily leaving the U.S.,” Park said.
Park said that “chilling effect” could be deterring people in immigrant communities, especially Hispanic and Latino communities, from responding to the survey – similar to how experts worried changes to the public charge rule could lead eligible immigrants to avoid public benefits programs.
Park also said the Census Bureau put the survey out at the same time there was a government shutdown, which could have impacted the response rate.
While changes to the survey and how people choose to respond to it may affect the results, Park said researchers and analysts are confident that uninsured rates will get worse.
“It’s very likely that, at least in future years, the uninsured rate is going to considerably rise,” he said.
What does this mean for Texas and Texans?
Lynn Cowles, with Every Texan, said Texas’ uninsured rate reveals a lot about the realities of the state’s economy.
“There are people who say that ‘the Texas miracle’ is that fact that…anyone can make it,” she said. “The uninsurance rate is one metric that undercuts those narratives …. The idea that Texas’ economic miracle extends to everyone is just not true.”
As more people lose coverage or are unable to afford it, Cowles said people in the state will feel the weight of higher uninsured rates.
“We’ll see the consequences in the short term in higher costs for people,” Cowles said. “We’ll see consequences in 10 to 15 years as people have higher rates of chronic conditions and high acuity conditions like cancer…. It’s devasting to say that out loud, but the decisions the federal government has made are going to lead to people who end up with these conditions and don’t have treatment options anymore.”
While advocates and experts discuss solutions, data lags and questions around the reliability of the data can get in the way of policymakers taking action.
Cowles said it’s clear that more people in the state will struggle with rising healthcare and health insurance costs in the next few years.
Cowles said when state lawmakers meet in January for the next legislative session, they should make “very, very immediate and small steps to protect financial security” for as many Texans as possible – including requiring hospitals to tell low-income patients about “charity care,” ensuring medical debt doesn’t end up on credit reports and exploring Medicaid expansion.
“The long-term benefits to people’s health in Texas and also to the state healthcare financing system will improve if we do take this logical step to draw down federal dollars to help our uninsured population,” Cowles said.
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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