New report ranks Texas among worst states for healthcare disparities. Here's why

Where you live, how much you earn and whether you can afford health insurance can shape far more than your medical bills in Texas. According to a new report, those differences can also have lasting effects on your access to care and overall health.

The Commonwealth Fund analyzed data from 2022 through 2024 to compare health system performance across racial and ethnic groups nationwide. Researchers found health disparities persisted across Texas, with some gaps appearing more severe than in other Southwestern states.

The report ranked Texas 45th out of 49 states measured for Hispanic residents, 43rd out of 51 for white residents and 22nd out of 39 for Black residents.

Texas performed better for Native Americans, ranking second out of 21 states measured, and ranked 17th out of 33 states measured for Asian Americans, Native Hawaiians and Pacific Islanders.

“Texas has the highest uninsured rate for working-age adults in the country, and that makes it harder for people to get care,” Commonwealth Fund Senior Scientist for Health System Tracking David Radley told the Star-Telegram.

The report examined everything from insurance coverage and delayed care to cancer screenings and preventable deaths.

Here’s how Texas compared.

How equitable is access to healthcare in Texas?

The report found uninsured rates in Texas were highest among Hispanics at 34%, followed by Native Americans at 21% and Black people at 17%. White people had an uninsured rate of 13%, while Asians had the lowest rate at 10%.

“Disproportionately we know that Black and Hispanic people tend to be lower-income, and the Medicaid program really is designed to help lower-income people get health insurance and get access to care,” Radley said.

“Texas is a non-expansion state that didn’t accept those federal funds to broaden eligibility for its Medicaid program, so that’s definitely having an impact.”

Children in Texas also had higher uninsured rates than the 6% national average, with 19% of Hispanic children uninsured compared to 12% of Black children and 9% of white children, according to the report.

Many Texans also reported delaying or going without treatment because of cost, including 26% of Native Americans, 24% of Hispanics, 18% of Black people and 12% of white people.

“It doesn’t matter how good the care is or how technologically advanced it is, if people can’t get in the door,” Radley said.

How does access affect healthcare quality and outcomes in Texas?

The report found gaps in access to care were often linked to poorer long-term health outcomes in Texas.

In Texas, Native Americans had the highest colorectal cancer screening rates at 70%, while Asians had the lowest at 48%. Screening rates were 67% for white people, 66% for Black people and 50% for Hispanics.

Breast cancer screenings showed a different pattern. Black women in Texas had some of the highest mammogram screening rates at 84%, compared to 76% of white women, 74% of Hispanic women and 70% of Asian women. But despite higher screening rates, Black women in Texas still experienced higher breast cancer death rates.

“Coming back to the access issues, because Black women are less likely to be insured, if that screening comes back identifying potential cancer, it’s a lot harder for them to actually go get high-quality care to help treat the disease,” Radley said.

The disparities also extended to preventable deaths before age 75, including deaths tied to drug overdoses, car crashes and treatable illnesses.

The report found Black Texans had the highest death rate at 234 deaths per 100,000 people, compared to 204 deaths for white people, 155 for Hispanics, and 105 for Asians.

“The long-term effects can be devastating,” Radley said. “If you can’t go to the doctor, either because you don’t have insurance or maybe you have insurance, but the deductibles are too high, and you just can’t afford the copay, it leaves diseases that may otherwise be treatable to go untreated.”

Black infants in Texas also died at higher rates than other groups.

The report found infant mortality rates were 10.3 deaths per 1,000 live births for Black infants, compared to 5 deaths for white infants, 5.3 for Hispanic infants and 3.8 for Asian infants.

What could help reduce health disparities in Texas?

Radley said expanding access to health insurance and lowering barriers to care could help narrow some of the gaps highlighted in the report.

“The glaring thing in Texas really is the high uninsured rates,” he said. “Separate from that, states can help manage healthcare costs, like the deductibles and the kinds of insurance products people enroll in.”

The report said policymakers could also help by strengthening access to affordable housing, transportation, child care and other social supports that can affect whether people are able to consistently seek treatment.

Expanded preventive care, earlier treatment and stronger community-based health programs were also identified as ways to improve long-term health outcomes across underserved communities.

“I think politically, the Medicaid expansion is off the table in Texas, but that would make a difference for low income people in the state, regardless of their race or ethnicity,” Radley said. “This is a policy issue, and it’s within Texas policymakers control to make changes if they wanted to.”