Health Care Access

Too few Houston-area residents are able to access affordable, high-quality health care consistently, contributing to poor health outcomes for a significant portion of our neighbors

Uninsured rates in the three-county Houston region have declined since 2010 but have stagnated in recent years. Additionally, Texas has had the highest rate of uninsured residents among all states since 2010, and Harris County’s uninsured rate is higher than Texas’. While primary care physician availability hasn’t increased meaningfully there has been a significant decline in the rate of preventable hospitalizations.

The data

Affordable Care Act (ACA) was passed in 2010, its goal was to expand health insurance coverage by making it more affordable to more people. Many aspects of the program were implemented in 2014, including the establishment of health insurance marketplaces and the optional expansion of Medicaid eligibility.

Across the country, Texas, and in each of Houston’s three counties there were immediate gains in health insurance coverage, as the percentage of people without health insurance fell between 3–4 percentage points from 2013 to 2014—the largest year-over-year decrease in uninsurance rates seen in the last twelve years.  The uninsured rate across the U.S. was halved to 8% in 2023 from 16% in 2010.

Texas has had the highest percentage of residents without health insurance among all states in the U.S. each year since at least 2010. In 2023, 16% of Texans didn’t have health insurance, double the U.S rate for that year. Not only is the uninsured rate in Texas eight points above the national rate, it is also five points above Georgia, the state with the second highest uninsured rate in the U.S.

Texas has had the highest percentage of residents without health insurance among all states in the U.S. each year since at least 2010.

Texas is one of 10 states that has not expanded Medicaid to cover additional low-income residents. Currently, legal residents of Texas can qualify for Medicaid if they are pregnant, responsible for a minor, have some kind of disability or a household member with a disability, or are older than 65 with low incomes. In Texas, if you or your household does not meet one of these conditions you are not eligible for Medicaid no matter how low your income is.

For those who do meet one of the previously mentioned criteria to be considered for Medicaid, the income threshold to be eligible changes depending on your, and your household’s circumstance. As an example, for a three-person household with one parent and two children, monthly household income must not exceed $230 for the parent to be eligible for Medicaid coverage. It is estimated that over 1.1 million more Texas residents would be covered if Medicaid was expanded. In 2025, an estimated 570,000 adult Texans were in what is known as “the coverage gap.” The coverage gap is experienced by people with incomes below the poverty level who are not eligible for financial assistance in the ACA marketplace.

The percentage of residents without health insurance in Houston’s three-county region has declined since 2010, however, it remains well above the national average. Residents in Fort Bend County have historically had the lowest uninsured rates in the region, though figures have ticked up after 2016 and have fluctuated since then. At its lowest in 2014, Fort Bend County’s uninsured rate was the same as the nation overall. As of 2023, Fort Bend County’s uninsured rate (12%) is 4 points higher than the U.S. overall (8%). Montgomery County’s uninsured rate was 16% in 2023, the same as Texas. Harris County has consistently had the highest rate of uninsured residents in the three-county region and in Texas overall. As of 2023, 20% of residents in Harris County do not have health insurance­—two and a half times the rate of uninsured residents across the country.

1 in 5 Harris County residents do not have health insurance. Two and a half times the rate of the nation.

The majority of the area’s residents are enrolled in private health insurance (61%), mostly through employer-based health insurance. An additional 28% have public health coverage through programs such as Medicare and Medicaid. Between 2010 and 2023, the Houston region made substantial progress in reducing the number of uninsured residents, with the rate decreasing by 7 percentage points. This improvement matched the gains seen both nationwide and across Texas during the same period. However, the types of insurance coverage grew at different rates. Nationally, public health insurance access increased by 7 percentage points between 2010 and 2023, compared to just 4 points in the Houston region. Meanwhile, private health insurance rates across the U.S. increased by only 1 percentage point. As of 2023, 37% of the U.S. population had public health insurance compared to 29% across Texas and in Harris County, 26% in Montgomery County, and 21% in Fort Bend County.

Uninsured Rate for Nonelderly Residents

Another important measure of health care coverage is the uninsured rate for the nonelderly population — defined as residents younger than 65 years old who are not eligible for Medicare. As of 2023, over 1.17 million individuals under 65 in the Houston region were uninsured, with Harris County alone being home to nearly 1 million.

Nearly 1.2 million residents under 65 in the Houston region were uninsured in 2023.

Overall, the trends over time of uninsurance rates for people younger than 65 almost identically mirror that for the entire population. The uninsured rate for this population dropped in each county during the last decade — peaking in 2010 and reaching the lowest levels in 2015 and 2016. However, despite this progress, non-elderly uninsured rates in the region remain consistently higher than the U.S. average. The non-elderly population is, on average, 2 percentage points more likely to be uninsured than the population overall, likely due to people 65 and older generally being eligible for health insurance through Medicare. Texas’ non-elderly (under 65) uninsured rate is nearly two times the nation’s rate while Harris County’s is more than double.

To learn about uninsured rates specifically for children, visit our Maternal and Child Health page.

Uninsured Rate for Nonelderly Adult Residents by Race/Ethnicity

Most people who remain uninsured are non-elderly adults aged 19-64. In 2023, the uninsured rate among non-elderly adults was 24% across the three-county area.

In 2023, the uninsured rate among Houston-area adults aged 19–64 was 24%.

Uninsured rates vary among racial/ethnic groups within Greater Houston’s diverse population. The uninsured rate among Hispanics aged 19 to 64 in the three-county area (39%) is nearly four times that of whites (11%). Black adults also experience elevated uninsured rates at 20%. When compared to state averages, three of the four largest racial/ethnic groups in the Houston three-county region have higher uninsured rates than Texas overall. White adults (aged 19 to 64) are the only group in the three-county region with lower uninsured rates than the state average, though this advantage disappears in Montgomery County where 14% of white adults lack insurance compared to 13% statewide. Across all three counties, every major racial/ethnic group has higher uninsured rates than their counterparts nationally, highlighting the region’s persistent coverage challenges across demographics.

In the Houston region, Asian American and Hispanic adults saw the largest decrease in uninsured rates between 2010 and 2023, dropping by about 15 percentage points. In 2010, 28% of Asian Americans in the Houston region lacked health insurance—that fell to 12% in 2023. For Hispanic adults in 2010, 54% in the Houston region did not have uninsurance. As of 2023, that population’s uninsurance rate was 39%—still the highest in the region but an improvement from 2010.

The Kaiser Family Foundation identified several reasons why insurance coverage gaps differ and persist across race/ethnicity. For instance, people of color are more likely to live in low-income families that do not have coverage offered by an employer or to have difficulty affording private coverage when it is available. Additionally, uninsured nonelderly Hispanic and Asian people are more likely to be ineligible for coverage because of immigration status, reflecting higher shares of noncitizens among these groups.³

Primary care physician availability in the Houston region has improved slightly over the last decade

What factors affect access to health care? Sufficient availability of primary care physicians is crucial for preventative and primary care. Primary care physicians (PCPs) serve as the first point of contact with the health care system for many patients; thus, they are more likely to be the first to screen major health-related conditions, detect early signs of disease, and address health concerns at an early stage. Adults in the U.S. who have a primary care provider are more likely to report significantly better health care access and experience,⁴ and increasing the rate of PCPs in a region can increase life expectancy and reduce cardiovascular diseases and cancer. People with PCPs also have 19% lower odds of premature death than those who only see specialists for care.

Additionally, primary care also reduces overall costs. People with access to PCPs are less likely to use an emergency room for care. It is estimated that the U.S. could potentially save $67 billion a year if everyone saw a PCP first rather than a specialist.⁵ Access to providers can be measured by the ratio of the total population to the number of primary care physicians. This represents the number of residents potentially served by a registered primary care physician within a specific geography.

Although availability to primary care providers (PCPs) has improved slightly in Texas, the gap between the state rate (1,660:1) and the national rate (1,330:1) persists. In Houston’s three-county area, there were 3,891 registered primary care physicians in 2021. On average, for every 1,603 residents, there was one physician. The ratio of residents to PCPs ranges from 1,717:1 in Harris County to 1,181:1 in Fort Bend County, indicating residents in Fort Bend County generally have more access to PCPs than the other two counties. Access to primary care physicians in Fort Bend County has improved steadily since 2010, passing both the state and national rates. Montgomery County’s residents-to-PCP ratio decreased from 1,680:1 in 2020 to 1,583:1 in 2022.

Read about challenges and availability of mental health care in the Houston area.

Preventable hospital stays in the Houston region have declined

Reducing preventable hospitalizations is critical for increasing quality of care and controlling health care costs. Medical conditions such as asthma and diabetes are considered ambulatory care sensitive conditions (ACSC). Generally, these conditions can be treated in outpatient settings by primary or preventative health care providers, which reduces the need for emergency room visits or inpatient hospitalization.

Data show that the majority of preventable hospital stays occur in patients aged 65 and older. Preventable hospital stays are measured by the number of hospital stays for ACSC per 100,000 Medicare enrollees in a given time period. High hospitalization rates for ACSC suggest a tendency of overusing emergency rooms and urgent care as a main source of care. It also places financial burdens on patients, insurance providers, and hospitals as well.

In 2022, the preventable hospitalization rate in Montgomery County was the highest among the three counties and higher than the state. However, the incidence rate of these stays has declined in each Houston-area county, Texas overall, and nationally since 2016, with declines of41% in Fort Bend, 38% in Harris, 36% in Montgomery, 40% in Texas, and 41% in the U.S. overall.

Preventable hospitalization rates also vary by racial/ethnic groups, with Black residents having a much higher rate compared to Hispanic and white residents.

The number of ACSC hospital stays among Black adults in Harris County was 5,272 per 100,000 Medicare enrollees in 2022 compared to 3,067 per 100,000 Medicare enrollees for Hispanic adults in Harris County, 2,582 for white adults, and 1,865 for Asian American adults. While gaps between racial/ethnic groups have narrowed over time, they still persist.  In Montgomery County in 2016, white adults had a higher preventable hospitalization rate compared to Hispanic adults. By 2023, the preventable hospitalization rate for Hispanic adults surpassed that for white adults.

This is not a new trend. Since 1998, racial and ethnic disparities in hospitalizations from chronic ACSCs have increased, resulting in over 430,000 excess hospitalizations among non-Hispanic Blacks compared to non-Hispanic whites.⁶ According to one study, Black adults had significantly higher rates of ACSC hospitalizations than white adults, even after controlling for demographic, socioeconomic, and geographic factors.⁷ There is no biological reason for race or ethnicity to predict preventable hospitalizations. Reasons for these persistent disparities include, but are not limited to, health care providers’ attitudes and internalized biases, disease stereotyping and clinical nomenclature, and clinical algorithms, tools, and treatment guidelines.

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