New Survey Confirms Big Gaps in Texas Health Care Availability and Coverage

University of Houston and Texas Southern University Project Examines Levels of Coverage, Opinions About Change

Photo shows doctor using stethoscope to listen to patient’s heartbeat
Survey respondents were overwhelmingly in favor of lowering or controlling costs of prescription medicines. The survey’s most popular proposals were allowing Medicare to negotiate prices directly with drug companies and streamlining paths for bringing generic drugs to market. Regarding health insurance, respondents with coverage reported employers or unions as the most frequent sources of policies. Medicare was second, and Medicaid third. Photo credit: Getty

Texas policies surrounding health care remain stalled in a fragile balancing act, a report released today by the University of Houston and Texas Southern University confirms.

“Some of the world’s most renowned hospitals and impressive medical research can be found in the state. But so can the country’s lowest rate of health insurance coverage and surprisingly spotty access to hospitals and even basic medical care,” said Gail Buttorff, associate director of the Center for Public Policy at the UH Hobby School of Public Affairs. 

“The picture isn’t particularly good, starting with who is insured and who is not. Our survey found 21% of respondents reported being without medical coverage compared with the national average of just 8.6% reported by the U.S. Census Bureau’s American Community Survey,” said Maria Paula Perez, Hobby School research associate. 

The new survey continued its examination of the state of health in Texas by looking at access to health care providers and policy preferences on Medicaid expansion and prescription drug prices. 

The survey found 77% of respondents have a regular doctor, clinic or similar source for health care and advice. When the remainder were asked why they lacked a medical home, about 18% said doctor visits and medicine are too expensive, but almost half said they were healthy enough to not need one.

“Texas Trends 2022 – Health Care,” is part of the five-year Texas Trends collaboration between UH Hobby School of Public Affairs and TSU Barbara Jordan–Mickey Leland School of Public Affairs, was fielded by YouGov between Aug. 11-29 and included 2,140 Texans 18 and older, resulting in a confidence interval of +/-2.1%.

According to the findings:

  • Among respondents covered by health insurance, policies from employers and unions were the most frequent (29% of respondents), especially among those with higher incomes. Medicare ranked second, at 23%. Medicaid, at 13%, covered more of the survey’s lower income participants.
  • Highest uninsured rate was among millennial and Gen Z generations; 11% lacked any form of health coverage.
  • Almost three out of 10 survey participants in the lowest income group reported they did not have a regular doctor, clinic or other health care source. By comparison, one out of five in higher income groups lacked a medical home.

Medicaid Expansion

“Texas is one of 12 states in the U.S. to not expand Medicaid even though the federal government would pay at least 90% of the cost of expansion. The issue remains a frequent source of debate in the state, but agreement has been elusive,” said Michael O. Adams, founding director of the Executive Master of Public Administration Program and professor of political science and public administration at TSU. The federal funding for Medicaid expansion is part of the Affordable Care Act, which became law in 2010.

When asked if Texas should expand Medicaid to cover more low-income uninsured people, 52% of respondents said “yes” and 30% wanted Medicaid to stay as it is. The others were unsure or undecided.

When considered by political affiliation: 72% of Democrats favored expanding Medicaid, compared to 48% of Republicans who did not. 

Prescription Drugs

Survey respondents overwhelmingly supported all seven proposals in the survey aimed at lowering or controlling costs of prescription medicines.

Largest pools of support favored creating easier paths for bringing generic drugs to market and allowing Medicare to directly negotiate prices with drug companies. Among other choices, the fewest (although still a 69% majority) favored federal caps on drug prices.

About the Survey

A significant number of survey respondents said they were unsure or did not know about health care issues they were asked about, perhaps indicating a need to provide more information about gaps in the state’s coverage and alternatives in policy.

For detailed examination of the issues, including demographic comparisons, see the full “Texas Trends 2022 – Heath Care” report. The newly released report is this year’s seventh and final contribution to the Texas Trends survey project, a five-year collaboration of the University of Houston and Texas Southern University that has been measuring shifts in opinions among the changing population of Texas since 2021.

Previous 2022 Texas Trends reports examined criminal justice and immigration, inflation expectations and the economy, school safety, the Nov. 8 general election’s state races, the Nov. 8 ballot for Harris County judge, and gun safety. The series will continue with new surveys in 2023.