Texas' Uninsured Children Crisis – A Failure of State Leadership

This commentary by Eric Holguin, Texas Director of Unidos US, originally appeared in multiple media outlets, including the Austin American-Statesman.

Recently, the Census Bureau released data showing that, in 2023, Texas was the state with the highest percentage of uninsured children.

Texas left all other states in the dust, with 12% of its children lacking health insurance. In distant second place was Arizona, where 7% of children were uninsured. The national average was 5%. Put simply, a childhood without health insurance is more than twice as common in Texas as in the rest of America.

This ranking is nothing new. Texas has held this shameful title for 15 years straight. And every year, two out of every three uninsured children in Texas have been Hispanic.

Administrative hurdles and paperwork were responsible for removing more than 1.35 million eligible children from Medicaid and CHIP last year. In a September 2024 ProPublica and Texas Tribune investigation, Texas Health and Human Services acknowledged errors in rushing to remove children from their coverage. This is despite several warnings from federal officials and from advocates including us at UnidosUS. 

While many states, including those led by Republican governors, have successfully reduced their uninsured child populations by leveraging federal funds, Texas has not and continues to lag behind all other states in children’s health. 

Texas’ bureaucracy and red tape confront working families when trying to maintain Medicaid or CHIP coverage. Due to complicated paperwork, tough eligibility checks and inconsistent communication, many eligible children lose coverage each year. Families are often unaware that their children have lost coverage until they’re at the doctor’s office, creating confusion and hardship. 

Texas has a harsh eligibility verification process that forces families to constantly reapply or submit new documentation which leads to delays and denials. These requirements put more burden on working families who already face significant challenges to access and maintain health coverage. This creates a cycle where children lose and regain coverage, resulting in interrupted care and poor health outcomes. 

Texas, under Governor Greg Abbott’s leadership, has taken minimal action to reform these processes, instead maintaining a tougher approach that adds to problems. Abbott and legislators have chosen not to extend Medicaid for low-income Texans or to fully use available federal funds allocated in 2021 to update the state’s healthcare system. 

Children without health insurance are less likely to receive necessary vaccinations, preventive care, or treatment for chronic conditions. They’re more likely to miss school due to illness, which affects their long-term educational and economic prospects. Untreated asthma, diabetes, or infections can lead to hospitalizations that could have been easily prevented with timely care.  

Additionally, a lack of routine doctor visits means that many developmental and mental health issues go undiagnosed, compounding the challenges these children face.  

Despite these alarming trends, the Texas government fails to act. The state has refused to invest in solutions that could reverse this trend, such as simplifying Medicaid/CHIP renewal processes, expanding outreach to families, and improving communication from state agencies. Abbott has largely ignored calls for change, leaving thousands of children to face the harsh realities of being uninsured. This lack of action shows a disturbing disregard for the health and future of Texas’ children. 

The solutions are clear. Our September 2024 UnidosUS polling shows that Hispanic communities want quality and affordable healthcare. Medicaid and CHIP can ease the financial burden on working families. Texas must reform its administrative processes for Medicaid and CHIP to ensure that children who are eligible remain enrolled and those who are uninsured but eligible can access the care they need to thrive. This can be done through simpler eligibility verification, better outreach, and removing unnecessary bureaucratic barriers.  

The human cost of inaction is too great. Texas cannot continue to lead the nation in uninsured children—it’s a crisis that demands immediate attention. The health and future of Texas’ children are at stake, and it’s time for Governor Abbott and the Texas legislature to prioritize their well-being. 

The longer Texas delays addressing this issue, the more children will suffer. They are waiting for the leadership they deserve.