Texas has officially been ranked the worst state in the nation for health care access and affordability, according to the latest 2025 State Health System Scorecard released by the Commonwealth Fund, a nonpartisan healthcare research organization.

Photo Credit: Houston Chronicle

This alarming ranking underscores long-standing issues in the Texas healthcare system, including high uninsured rates, low preventive care, and stark racial and income-based disparities.

Texas at the Bottom: Key Findings from the 2025 Health Scorecard

Out of all 50 states and Washington D.C., Texas ranks 51st in multiple key health indicators:

• Access and Affordability: Dead last
• Equity: Among the bottom five
• Health Outcomes: Among the worst for maternal and infant care
• Uninsured Rate: The highest in the U.S., with more than 5 million Texans lacking coverage

The Commonwealth Fund evaluated states based on 58 metrics across five major categories, including healthcare access, quality, outcomes, efficiency, and equity. Texas consistently performed below average in nearly every domain.

What’s Driving the Crisis?

Experts point to several core issues contributing to the state’s low ranking:

• No Medicaid Expansion: Texas is one of only 10 states that have not expanded Medicaid under the Affordable Care Act, leaving millions without coverage.
• Rural Hospital Closures: Over 26 rural hospitals have closed in the past decade, severely limiting care access.
• High Cost of Care: Many Texans are underinsured, meaning they technically have health insurance but still face unaffordable medical bills.
• Provider Shortages: A shortage of primary care doctors in both urban and rural areas continues to affect routine and preventive care access.

Racial and Economic Disparities Worsening

The report also highlights significant racial health disparities in Texas:

• Black and Latino populations are disproportionately uninsured.
• Preventive care, maternal health, and chronic disease outcomes are significantly worse in low-income and minority communities.
• The state ranks among the lowest in life expectancy and mental health support for underserved groups.

“Texas is not investing in the infrastructure that leads to long-term health improvements,” said David Radley, lead author of the Commonwealth Fund report.

Calls for Reform

Health experts and advocacy groups are calling for:

• Medicaid expansion to reduce the uninsured rate
• Increased funding for rural hospitals and clinics
• Policies that ensure health equity, especially for marginalized communities
• Greater support for mental health services, which remain drastically underfunded

Without urgent reforms, Texas risks falling further behind as other states improve their healthcare systems and coverage policies.

Key Takeaways:

• Texas ranks last (51st) in healthcare access and affordability in the U.S.
• The state has the highest uninsured rate and one of the worst health equity scores.
• Factors include lack of Medicaid expansion, provider shortages, and rising medical costs.
• Experts urge Texas to adopt reforms or risk deepening its healthcare crisis.

Source: Houston Chronicle – Texas Ranks Worst in Nation for Health Care Access and Affordability