Texas Coverage Gap Project

Rural & West Texas

The High Plains and West Texas have long distances, few hospitals in many counties, and widespread shortage designations. Coverage is not a complete answer to any of those problems.

Uninsured rate under 65, 2024: West Texas regions vs. TexasBar chart. All incomes: High Plains 19.1 percent, West Texas region 20.7 percent, Texas 19.1 percent. At or below 138 percent of poverty: High Plains 28.4, West Texas 30.8, Texas 31.5 percent. 0% 10% 20% 30% 40% High Plains (41 counties) 19.1% West Texas (30 counties) 20.7% Texas 19.1% High Plains, ≤138% FPL 28.4% West Texas, ≤138% FPL 30.8% Texas, ≤138% FPL 31.5%
Uninsured rate among residents under 65 in 2024, for all incomes and for those at or below 138% of poverty. Regions are the Texas Comptroller's High Plains (41 counties, including Lubbock and Amarillo) and West Texas (30 counties, including Midland, Odessa, and San Angelo) regions.1

About one in five residents under 65 is uninsured Official data

In 2024, 19.1% of High Plains residents under 65 were uninsured, the same as the Texas rate; in the West Texas region the rate was 20.7%. Among residents at or below 138% of poverty, the people expansion would reach, 28–31% were uninsured. Lubbock County's rate was 16.6% (±1.2); Ector County's was 24.4% (±1.7).1

Limits: These are model-based Census estimates, and small counties have wide margins of error.

Many counties have no hospital Official data

25 of these 71 counties have no hospital listed in Medicare's hospital directory, including Borden, Glasscock, Loving, and Terrell in West Texas and Briscoe, Dickens, King, and Motley in the High Plains.2

Limits: This is a count of listed hospitals, not a measure of driving time. Some residents live close to a hospital in a neighboring county.

Shortage areas almost everywhere Official data

69 of the 71 counties have at least one federally designated primary-care Health Professional Shortage Area, and 48 have a geographic (whole- or part-county) designation.3

Limits: Clinics such as rural health clinics and community health centers can carry facility-based designations automatically.

Hospital finances and closures Association

Expansion has been associated with lower uncompensated-care costs and a lower likelihood of hospital closure, especially in rural markets.4,5

Limits: Texas has had more rural hospital closures since 2005 than any other state (25), but none of those closures was in these 71 counties. The nearest were in Jones County (near Abilene) and Hardeman County.6 Closures have many causes.

Texas also receives about $281.3 million in the first year of the temporary federal Rural Health Transformation Program. That money supports rural health systems, but it is not health coverage.7

Sources for this page

  1. U.S. Census Bureau Small Area Health Insurance Estimates (SAHIE) 2024, county file; regions = Texas Comptroller High Plains (41 counties) + West Texas (30 counties) (2026-08). https://www2.census.gov/programs-surveys/sahie/datasets/time-series/estimates-acs/sahie-2024-csv.zip [evidence WT1]
  2. CMS Provider Data Catalog, Hospital General Information (modified 2026-07-22); county lists per Texas Comptroller regions (2026-07-22). https://data.cms.gov/provider-data/dataset/xubh-q36u [evidence WT2]
  3. HRSA Health Professional Shortage Areas, primary care detail file (BCD_HPSA_FCT_DET_PC), status 'Designated' (accessed 2026-10-24). https://data.hrsa.gov/data/download [evidence WT3]
  4. Blavin, JAMA 2016;316(14):1475-83, doi:10.1001/jama.2016.14765; Dranove, Garthwaite, Ody, Health Affairs 2016, doi:10.1377/hlthaff.2015.1344 (2016). https://jamanetwork.com/journals/jama/fullarticle/2565750 [evidence R2]
  5. Lindrooth, Perraillon, Hardy, Tung, Health Affairs 37(1):111-20, doi:10.1377/hlthaff.2017.0976 (2018-01-08). https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0976 [evidence R1]
  6. UNC Sheps Center Rural Hospital Closures list (updated 2025-12-04) (2025-12-04). https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ [evidence L12]
  7. CMS press release 2025-12-29; Texas HHSC bulletin (Year 1 budget approved 2026-04-07) (2025-12-29). https://www.cms.gov/newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states [evidence L13]

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