Texas health policy survey reveals cost of care and accessibility trends

This week, the Episcopal Health Foundation published findings from the 2019 Texas Health Policy Survey. The survey seeks to better understand Texans’ opinions on a variety of health care policies on both a state and national level. The survey asked respondents about cost of care, accessibility, and avoidance of care.  

Survey results revealed some stand-out trends in Texas in each of those categories, starting with the cost of care.


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The affordability of health care remains a top concern for Texans. Fifty-five percent of  respondents report that it is difficult to pay for health care, and 27 percent report this to be nearly impossible. And, one in four Texans report not being able to pay for a medical bill in the past year alone.

Many reported that health care is more difficult to afford than other living expenses, as the graph below demonstrates:


The high cost of health care, the survey reveals, has forced many Texans to forgo care altogether. The survey revealed that 60 percent of patients either skipped a required appointment, chose not to fulfill a prescription, or did not follow through with medical referrals for fear of cost.

“A closer look at finances shows that income is one of the greatest divides when it comes to affordability of health care. Texans with family incomes under 250 percent of the federal poverty level (FPL) are more than twice as likely as those with higher incomes to indicate it is difficult for them or their family to afford health care, by a 73 percent to 31 percent margin,” the report explained.

Seventy-six percent of Texans report having a regular place where they receive medical care, while 24 percent report that they do not have a usual place for care, or are unsure where to go. Five percent responded that they typically go to an urgent care or emergency room to seek care. Embedded in this statistic are several demographic trends, as well.


Lower-income, lower-education, Hispanics, immigrants and uninsured Texans report that they were unsure where to seek care in higher numbers than other populations. These same populations report that traveling to receive this care is an additional burden, whereas the 76 percent who have a regular care facility report this burden to be less.

“When it comes to the places that Texans report receiving their medical care, the survey finds racial/ethnic, immigration status, income, insurance status, and educational disparities. Overall, lower-income, Hispanics, immigrants, lower-educated, and uninsured Texans are more likely than their counterparts to say they have no usual place for medical care or they go to the emergency room,” the report states.

The uninsured rate among elderly Texans is nearly twice the national average. The rate in Texas is 19.6 percent, compared to a national average of 10.2 percent. The report reveals that this high uninsured rate may be traced to the fact that Texas is among the 14 states that have not yet expanded Medicaid under the ACA.

This elderly uninsured population reports having extreme difficulty in paying for health care. Three-fourths of elderly Texans also claimed that they often refuse or forgo care due to cost. Sixty-one percent skipped care that was needed to sustain life, according to the survey.

You can dive into the entire report, here.