Dental Care Insurance Primary Care Safety Net Clinics

Access Indicators: Insurance

Texas has the highest rate of uninsured residents in the U.S. at 22.1%, and the Houston region is even higher at 22.8%. Harris County at 28% had the highest percentage uninsured in 2011, while Fort Bend County had the lowest at 19%. More below…

In the U.S., the main source of payment for health care is health insurance, including public plans like Medicare and Medicaid, employer-sponsored group plans, and privately purchased individual and family plans. Numerous studies have documented that having health insurance improves health status and saves lives (Levy & Meltzer, 2008; IOM, 2009; Finkelstein et al., 2011). In addition to the adverse health impacts due to lack of insurance, the cost of care is much higher because people without insurance often delay seeking care, ultimately going to emergency rooms where the costs are substantially higher. Delaying care may result in more advanced disease at the time of diagnosis and treatment, when access to preventive care could have mitigated the disease and its costs. The cost of medical care for a child under the age of 17 in an emergency room is 3.75 times the cost in a doctor’s office. For those 45-64 years of age, it is approximately 4.6 times more expensive in an emergency room than in a doctor’s office.

The high number of uninsured people impacts the entire region, not just the uninsured. Taxpayers and insured people bear the cost of large numbers of uninsured people by paying more taxes to support city, county, and hospital district clinics. Insurance premiums paid by families and businesses include a hidden tax in the form of additional premiums that are collected to offset costs for the uninsured that providers pass along to insured patients and employers. Inappropriate use of emergency rooms strains the capacity to respond to true community emergencies. If Texas employers met the national average for providing insurance, an additional 1.25 million Texans would be covered.

Across the U.S., more than half of all people are covered by employer-sponsored plans. In Texas, however, only 46% are covered through their employers. Uninsured residents include many people who work in jobs less likely to provide health insurance, including restaurant, retail and construction. Many work for small businesses that are increasingly less likely to provide insurance to their employees (Robertson, Stremikis, Collins, Doty and Davis, 2012).

Sources cited

Finkelstein A., Taubman S., Wright B., Bernstein, M., Gruber, J., Newhouse, J.P., Allen, H., Baicker, K., “The Oregon health insurance experiment: evidence from the first year,” NBER working paper no. 17190, Cambridge, MA: National Bureau of Economic Research, 2011, Retrieved from:,%20Finkelstein%20et%20al%20FINAL.pdf.

Institute of Medicine (IOM), “America’s uninsured crisis: consequences for health and health care,” Washington, DC: National Academies Press, 2009, Retrieved from:

Levy, H., Meltzer, D., “The impact of health insurance on health,” Annual Review of Public Health, 29, 399-409, doi: 10.1146/annurev.publhealth.28.021406.144042, 2008.

Robertson, R., Stremikis, K., Collins, S.R., Doty, M.M., Davis, K., “Jobs Without Benefits: The Health Insurance Crisis Faced by Small Businesses and Their Workers,” Commonwealth Fund, 2012, Retrieved from: