A new report found that Texas has more severe racial and ethnic health disparities than other states in the Southwest.
Hispanic people experienced the worst health outcomes, access and quality in Texas, according to a new report from the Commonwealth Fund – a private foundation focused on health equity in the U.S. The report notes that racial and ethnic health disparities "persist across every state" and may worsen as recent policy changes take hold.
"In most states, American Indian and Alaska Native people and Black and Hispanic people and communities really continue to bear the highest burden and have the worst health access and affordability," said Dr. Laurie Zephyrin, senior vice president for Achieving Equitable Outcomes at the Commonwealth Fund.
The report also finds that these populations are more likely to die from "premature and avoidable deaths" – while being less likely to have health coverage.
Researchers analyzed the most recent state data available on 24 measures related to health care access, quality and use of services and health outcomes to produce the state-by-state report. Based on that performance data, the report evaluates differences across racial and ethnic groups both within and between states.
"The Hispanic population had some of the lowest scores achieved in the report, particularly in a handful of southern and southeastern states, including Arkansas, Georgia, Oklahoma, and Texas," said Kristen Kolb, a research associate for the Commonwealth Fund.
She said the Hispanic population tended to be among the lowest performance on measures of affordable access to care.
"When health services are not affordable, people are more likely to forgo needed care," Kolb said.
Nationally, the report shows the rate of people skipping care because they can't afford it is increasing – after hitting historic lows in 2021 and 2022. Hispanic and American Indian and Alaska Native communities saw the steepest increases.
In all but seven states, Hispanic adults were the most likely to go without care they couldn't afford – and in most states, they were also the most likely to lack a regular source of care.
Among the 48 states the report was able to rank and the District of Columbia, Texas ranked 45th for health system performance for the Hispanic population – just ahead of its neighbors, Oklahoma, which ranked 46th, and Arkansas, which ranked last.
However, the authors of the report highlight that the most recent data doesn't account for several factors that will likely worsen health disparities – including federal and state policy changes targeting social service programs, like Medicaid and the Supplemental Nutrition Assistance Program, or SNAP.
In addition to funding cuts and tightened eligibility requirements, there are new restrictions that will bar "most legal immigrants and asylees from [federal healthcare] marketplace and Medicaid Coverage."
Advocates in Texas have raised concerns about Texas' high uninsured rate – the highest in the country. There are more than 1 million uninsured children in the state, which is more than 13% of the total population of Texas children. Unidos, the nation's largest Hispanic civil rights and advocacy organization, published a report in February that found two-thirds of Texas' uninsured children are Latino.
The data is also from before the enhanced premium tax credits for Affordable Care Act, or ACA, marketplace coverage expired at the beginning of 2026 – causing premiums to more than double for most ACA enrollees.
In 2025, Texas has more than four million people enrolled in marketplace coverage.
"The thing that stands out in Texas, sort of is that really high uninsured rate," said Dave Radley, senior scientist for the Commonwealth Fund's Tracking Health System Performance initiative. "Having health insurance sort of is the first step to making sure that people can get access to primary care or any kind of health care."
Researchers also pointed out the changes to immigration policy could lead to worse health system performance that wouldn't be accounted for in the most recent data.
For example, the Trump administration proposed a rule change related to immigrants' use of public benefits. Experts warned it could create a "chilling effect" in migrant communities and worsen uninsured rates among Texas children.
Health officials have also noted fewer community members engaging with preventive services because of fears about immigration crackdowns and recent U.S. Immigration and Customs Enforcement, or ICE, activity.
Dr. Joseph Betancourt, president of the Commonwealth Fund, said providers and researchers expect "with the current environment" that health disparities will worsen, which could have significant implications for communities that are already experiencing vast disparities.
He said some of the "more drastic immigration actions" started in 2025 and are still happening. As a provider himself, Betancourt said there's "no doubt" that there's been a chilling effect on people seeking out health care and critical services – regardless of their legal status.
"If a virus emerges, it's not asking its victim if it's documented or not," Betancourt said. "We really need to be more thoughtful in a public health approach and a thoughtful approach to immigration enforcement. Our concerns today are real, and I think that's what we're beginning to see. Our data doesn't reflect that quite yet."
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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