Nearly 20 Years at the Bottom: Texas Fails Children on Health Coverage as Costs Rise

McAllen, TX — As families across the country continue to grapple with rising costs, a new report released today by UnidosUS — the nation’s largest Hispanic civil rights and advocacy organization — finds that for 19 consecutive years, Texas ranks as America’s worst state at providing health care coverage for its children with Hispanic families being disproportionately impacted — 66% of uninsured children in 2024 were Latino, approximately 750,000 kids. Overall, more than one million Texan kids lacked health coverage in 2024 — nearly 14% of all children in the state. By comparison, 6% of American children nationwide were uninsured.

The findings come at a critical moment, as recent federal policy changes — including proposed revisions to the public charge rule and federal funding cuts to enrollment assistance programs — threaten to push even more Texas children off coverage. These developments risk compounding an already dire situation as the state also ranks as one of the worst in the nation for health overall.

“Being born in Texas more than doubles the likelihood that a child will grow up uninsured — pushing families into impossible choices between paying for rent, groceries or medical care.” said UnidosUS Texas State Director Eric Holguín. “For Latino children the problem is even more acute and exposes them to serious harm that damages their long-term health and ability to thrive. If Governor Greg Abbott truly wants to protect children, he should start by ensuring barriers to health insurance for these children come down and accepting Medicaid expansion — something well within his control. Other states are taking action while Texas continues to fall further behind.”

At the same time, rising costs remain top of mind for families across Texas. A recent UnidosUS poll found that nearly 7 in 10 Latino voters believe that President Trump and Republicans in Congress are not focusing enough attention on the economy. Texas has failed to fully use existing programs to keep children covered amid rising health care costs, despite sitting on a projected $24 billion budget surplus and a nearly $28 billion rainy day fund, according to UnidosUS’s report. This forces families to shoulder higher out-of-pocket medical costs.

“Texas has the financial resources needed to cover its children, yet at a moment when federal policy changes and cuts to enrollment assistance threaten to leave even more Texas kids uninsured, state leaders continue to fail to act,” Holguín added. “That’s not just a policy failure, it’s a cost-of-living crisis that Gov. Abbott continues to ignore, which in turn will impact the state’s future.”

In almost every region of Texas, the percentage of uninsured children is significantly higher than in the rest of the country, but the issue grows more acute in specific regions. The top five most impacted regions include:

• West Texas, where 16% of children are uninsured and 83% of them are Latino.

• Panhandle, where 15% of children are uninsured and 42% of them are Latino.

• Rio Grande Valley, where 15% of children are uninsured and 97% of them are Latino.

• North Texas, where 15% of children are uninsured and 58% of them are Latino.

• Southeast Texas, where 14% of children are uninsured and 70% of them are Latino.

The top five Texas regions in which Hispanic children fare worst in terms of health coverage include Rio Grande Valley (97%), West Texas (83%), San Antonio (74%), Southeast Texas (70%) and the Golden Triangle (69%).

UnidosUS’s report also found, based on other organizations’ research, that more than 8 in 10 uninsured children in Texas qualify for but are not enrolled in Medicaid, CHIP or federal Premium Tax Credits that help families buy their own insurance. Without affordable health care, children are more likely to experience delayed treatment, poorer long-term outcomes and greater economic instability — consequences that weaken Texas’s future workforce and economy.

To address this ongoing affordability and coverage crisis, UnidosUS recommends that Texas leaders take immediate action by:

• Streamlining Medicaid and CHIP enrollment and renewal. Texas should eliminate unnecessary red tape that causes eligible children to lose or miss coverage by simplifying applications and renewals, maximizing automatic renewals using existing state data and modernizing eligibility systems so families can enroll and stay enrolled without burdensome paperwork.

• Strengthening public-private partnerships to help families enroll. The state should expand partnerships with trusted community organizations, navigators, health plans and outstationed eligibility workers to provide families hands-on assistance navigating Medicaid and CHIP, particularly in communities with high rates of uninsured children.

• Expanding Medicaid coverage for low-income adults to boost children’s enrollment. Covering uninsured parents would significantly increase children’s participation in Medicaid and CHIP, as evidence shows children are more likely to be insured when their parents have coverage. Texas should pursue Medicaid expansion or a federal waiver option that maximizes federal funding while covering low-income adults.

• Establishing a bipartisan Blue-Ribbon commission to address root causes. Texas lawmakers should create a Blue-Ribbon commission to examine why the state continues to lag the nation in children’s coverage and to develop long-term solutions, including evaluating structural reforms that would improve enrollment and retention.

UnidosUS’s report also breaks down the percentage of uninsured children per state in 2024, the percentage of uninsured children in both Texas and other states from 2006 to 2024, and the percentage of uninsured children per region, race and ethnicity in Texas in 2024.