Texas Ranks Among Nation's Worst States for Quality of Life Despite Economic Strength

Texas earned a dismal quality of life score of 72 out of 265 points in CNBC's 2025 Top States for Business study released July 14, ranking as the nation's second-worst state for quality of life despite maintaining one of America's strongest economies, with researchers citing inadequate healthcare access, limited worker protections, and restrictive social policies as primary factors dragging down the state's livability index.

The comprehensive analysis evaluated all 50 states across multiple quality-of-life indicators, including crime rates, healthcare accessibility, air quality, childcare availability, worker protections, and reproductive rights. Texas received an "F" grade for quality of life, improving only marginally from last year, when it held the dubious distinction of being the worst in the nation.

According to CNBC, the study measures factors that "dictate where people live, and where businesses locate," making the findings particularly significant for a state that has attracted 220,000 educated workers in 2022 alone.

Healthcare Crisis Undermines State's Quality Rating

Texas's healthcare system emerged as the study's most damaging factor, with the state ranking dead last nationally in primary care physicians per capita. According to the United Health Foundation, Texas has just 182 primary care providers per 100,000 residents, which is well below the national average.

The healthcare crisis extends beyond provider shortages. CNBC found that Texas leads the nation "by far" in residents without health insurance, with data from The Commonwealth Fund showing the state has the highest uninsured rate in the country. This healthcare access problem creates cascading effects throughout the population.

"Despite world-class institutions like Texas Medical Center and the MD Anderson Cancer Center, access to care for the average Texan is poor," CNBC researchers noted in their analysis.

The study also revealed that Texas ranks second-lowest nationally for mental healthcare providers, creating additional barriers for residents seeking psychological services. A staggering 19% of all Texans with credit scores have medical debt in collections, according to the analysis.

Worker Protections Lag Behind National Standards

Texas's approach to worker protections significantly contributed to its poor ranking in quality of life. The state provides minimal legal safeguards for employees, beyond basic equal pay laws and prohibitions against sexual harassment.

According to US 105 FM's analysis of the CNBC data, "Texas is also one of the states with the least amount of legal protections for workers. That means that the average Texan does not have many legal rights when it comes to fair pay, no termination without cause, or protection from discrimination".

The study found that Texas unemployment benefits cover less than 10% of the average cost of living, providing inadequate support for workers between jobs. This weakness in the social safety net exacerbates the challenges faced by Texas workers who already have limited workplace protections.

Crime Rates Add to Quality of Life Concerns

While not the highest in the nation, Texas's crime rates contributed to its poor quality of life score. The state maintains relatively high violent crime rates that affect residents' sense of security and overall well-being.

CNBC researchers noted that "crime is on the high side" in Texas, though they did not rank it among the worst states for violent crime. The crime factor, combined with healthcare and worker protection issues, created a cumulative negative impact on the state's overall livability score.

Air Quality and Childcare Availability

Despite the overwhelming negative factors, Texas earned positive marks in specific categories. The state scored highly for air quality, representing one of its few strengths in the quality of life assessment.

Childcare availability also emerged as a relative strength for Texas families. According to US 105 FM, "We scored highly for air quality and availability of child care. These are two respectable positives when raising a family".

These limited bright spots, however, proved insufficient to offset the significant weaknesses in healthcare, worker protections, and other critical quality-of-life factors.

Regional Performance Creates Stark Contrasts

The poor statewide ranking contrasts sharply with the performance of individual Texas cities in other quality-of-life assessments. According to Spectrum News, Houston ranked 13th, Dallas 14th, and Austin 15th in the 2025 America's Best Cities Report, which evaluated cities with over 500,000 residents.

This disparity between state and city-level performance highlights the complex relationship between local governance, state policy, and quality of life outcomes. Major metropolitan areas appear to overcome some statewide deficiencies through local initiatives and resources.

A University of Texas at Dallas survey of North Texas residents found that "three out of 4 North Texas residents were somewhat or very satisfied with where they live," with satisfaction highest in Collin County at 86%. This local satisfaction contrasts with the state's poor national ranking.

Business Success Amid Quality Challenges

The quality of life rankings create a paradox for Texas, which CNBC simultaneously ranked as having the second-best business climate in the nation. This disconnect raises questions about the long-term sustainability of the state's economic growth model.

According to Texas 2036, a nonpartisan organization focused on state policy, Texas "ranks 11th among 12 peer states in an index of quality of life" while maintaining strong economic indicators. The organization warns that quality-of-life factors could impact future economic competitiveness.

"For Texas to have a prosperous, growing economy, a strong quality of life and economic opportunity for all the state needs to make significant progress on the goals found across the six policy pillars," Texas 2036 researchers noted.

The state continues to attract residents and businesses, despite quality of life challenges, with projections indicating that 10 million additional residents are expected by 2036. However, rising housing costs and persistent quality of life issues may threaten this growth trajectory.

National Context and Regional Comparisons

Texas's poor ranking places it among predominantly Southern states struggling with quality of life issues. Tennessee earned the worst ranking nationally with 61 out of 265 points, while Indiana, Utah, and Louisiana ranked just above Texas in the bottom five.

According to Taste of Country, Tennessee's last-place finish was attributed to the third-highest violent crime rate nationally and its poor performance on inclusiveness measures. This regional pattern suggests broader systemic challenges affecting quality of life across the South.

The geographic concentration of low-ranking states raises questions about regional policy approaches, economic development strategies, and social priorities that may be contributing to widespread quality of life challenges.

Policy Implications and Future Outlook

The CNBC study's findings suggest that Texas may need to reassess its policy priorities to maintain its competitive edge in attracting residents and businesses. Healthcare access improvements, worker protection enhancements, and crime reduction initiatives could significantly boost the state's quality of life rankings.

"Texas should be at the front lines of quality of life instead of somewhere near the bottom due to our booming economy and robust employment numbers," according to US 105 FM's analysis of the situation.

The study warns that continued poor quality of life performance could eventually undermine Texas's economic attractiveness, particularly as remote work options allow people to decouple employment location from residence.

Challenges and Opportunities

As Texas grapples with its quality of life challenges, the state faces critical decisions about policy priorities and resource allocation. The sharp contrast between economic success and livability concerns creates both urgency and opportunity for improvement.

The 2025 rankings serve as a warning that business-friendly policies alone may not sustain long-term growth if residents' basic needs for healthcare, worker protections, and public safety remain unaddressed. Whether Texas can maintain its economic momentum while improving quality of life outcomes will likely determine its competitive position in the coming decade, as other states work to close the gap in business attractiveness while offering better living conditions for their residents.