More than 13 percent of Texas children lack health insurance coverage, making the Lone Star State home to nearly one-quarter of all uninsured children in America, according to a new analysis by Georgetown University. This analysis reveals the most dramatic deterioration in child health coverage nationwide in nearly a decade.
Texas experienced a devastating 29 percent increase in uninsured children between 2022 and 2024, with 1.1 million kids now without coverage—the most significant jump of any state during the post-pandemic "Medicaid unwinding" period that stripped protections for millions of vulnerable families. The state's uninsured rate of 13.6 percent is more than double the national average of 6.0 percent and significantly higher than those of the next-worst states, Florida and Oklahoma.
Medicaid Unwinding Creates Perfect Storm
The surge in uninsured children stems largely from Texas's handling of the end of pandemic-era Medicaid protections in March 2023. When the federal continuous coverage requirement ended, states were required to check eligibility for all 94 million enrollees—a process that ultimately disenrolled nearly 15 million Americans, including about 5 million children.
Joan Alker, research professor and executive director of the Georgetown Center for Children and Families, said Texas "barely" used procedural renewals that could have prevented eligible people from losing coverage. "If all states had done as poorly as Texas did with the unwinding, we would have seen a much higher jump in the uninsured rate of children nationally," Alker told KERA News.
"Texas led the country by far, disenrolling 1.3 million children during the unwinding," according to the Georgetown analysis, which found that "almost one quarter of the nation's uninsured children live in Texas".
"Storm Clouds Gathering" for More Coverage Loss
Health advocates warn the situation will worsen significantly as federal budget changes take effect. Lynn Cowles, director of health and food justice at Every Texan, highlighted the vulnerability of more than 500,000 Texas children enrolled in federal health insurance marketplace plans who face the risk of losing enhanced premium tax credits.
"These are the middle-income families, who will really, really get hit by the expiration of the enhanced advanced premium tax credits," Cowles explained to KERA News. "These are the families that will see hundreds of dollars per month of increases on their marketplace health insurance premiums because the subsidies will reduce".
A comprehensive budget bill signed into law in July is projected to result in 480,000 Texans losing coverage overall, according to an analysis by the Kaiser Family Foundation.
Immigration Enforcement Creates "Chilling Effect"
Adding to the crisis, experts warn that aggressive immigration enforcement is deterring eligible families from seeking coverage. The Trump administration's unprecedented sharing of Medicaid enrollee data with Immigration and Customs Enforcement has created fear among mixed-status families, where one in four American children has an immigrant parent.
"With the extraordinary fear that's gripping these communities today based on aggressive deportations, as well as the unprecedented sharing of personal Medicaid data by [the Centers for Medicare and Medicaid Services] with ICE, the concerns that parents have about sharing their information with the government right now are very, very real," Alker warned.
Research shows this "chilling effect" significantly reduces Medicaid enrollment among eligible children in immigrant families, even when the children are U.S. citizens.
Economic Impact Spreads Beyond Healthcare
The uninsured crisis carries broad economic consequences that extend far beyond individual families. Studies demonstrate that uninsured children face significant barriers to healthcare access, including a lack of continuity with primary care providers and inadequate visit time, which particularly harms children with special healthcare needs.
As uninsured rates increase, emergency rooms become the primary point of access for healthcare, driving up costs for all patients and straining hospital systems. "Nobody should have to do this. This should not be regular," Cowles acknowledged, referring to the complex bureaucratic processes families must navigate to maintain coverage.
Research published in Health Affairs found that higher volumes of ICE enforcement activities correlate with lower enrollment in both Medicaid and nutrition assistance programs, particularly among adults in households with at least one noncitizen member.
National Context Reveals Broader Crisis
Texas's situation reflects a national reversal in child health coverage gains. The nationwide uninsured rate for children increased from 5.1 percent to 6 percent between 2022 and 2024—an 18 percent jump representing the highest rate in nearly a decade.
Twenty-two states experienced statistically significant increases in child uninsured rates, with only New Hampshire improving its coverage levels during this period. American Indian/Alaska Native children face the highest uninsured rate nationally at 12.4 percent, followed by Hispanic/Latino children at 9.7 percent.
The Georgetown analysis found that coverage losses affected all racial and ethnic groups except Asian children, whose coverage remained steady.
Advocates Sound Urgent Warnings
Healthcare policy experts emphasize that the current data reflects only the beginning of a more profound crisis. "This is data from 2024, and of course, we're in 2025 and the world has changed a great deal," Alker noted. "There are many reasons that the situation for children's access to healthcare will substantially worsen, we fear".
"The storm clouds are gathering for people who rely on public health insurance and Medicaid," Alker concluded. "But for children, sadly, they are already here".
What Families Can Do Now
Despite the complex challenges, advocates offer practical steps for families concerned about losing coverage. Cowles emphasizes the importance of staying vigilant about paperwork and deadlines. "Check your mail," she advised. "Be active health care consumers, and when I say be active health care consumers, I mean, re-enroll in your marketplace health insurance plan, log into yourtexasbenefits.com regularly".
Families can connect with community advocacy organizations like Every Texan or the Texas Organizing Project for assistance in navigating the system. "Expect frustration, take notes," Cowles warned, acknowledging the burden placed on families dealing with "giant bureaucracies that effectively set people up to fail".
Political Stakes Rise Ahead of Midterms
The health coverage crisis carries significant political implications as the 2026 midterm elections approach. Cowles urged Texans to discuss these issues with their neighbors and lawmakers, noting that coverage losses affect everyone through higher healthcare costs and increased reliance on emergency rooms.
As Texas grapples with the nation's worst child uninsured rate and faces additional federal policy changes that could strip coverage from hundreds of thousands more residents, the state stands at a crossroads that will determine the health and economic well-being of its most vulnerable children for years to come.