Why Texas has the highest percentage of uninsured people in the U.S.

(KAREN BLEIER) As Brad wrote earlier today, there are a lot of Texas statistics that we’ll hear about this campaign season. You can expect Texas Gov. Rick Perry (R), for example, to bring up how his state has generated 37 percent of the country’s new jobs since 2009.

Here’s one statistic, though, you won’t hear him touting: Texas has the highest percentage of uninsured people in the country. Twenty-six percent of Texas residents lack health insurance, compared with a national average that hovers around 17 percent. That works out to about 6.3 million uninsured Texans, a population nearly equal in size to the entire state of Massachusetts.

Texas has led the country in its percentage of uninsured residents since well before Perry took office in 2000, says Anne Dunkelberg, who directs the Austin-based Center for Public Policy Priorities. “We literally started out in the 1990s at the end of the line and nothing has moved to change that position,” she explains. “Basically, it’s everything about our job market in the state and our public programs, that really were the formula for having low levels of coverage.”

Here are four main factors that contribute to Texas’ high number of uninsured:

Many Texas jobs don’t offer insurance. Texas has a higher number of retail and service jobs, as well as a decently large agricultural sector, all industries that are less likely to offer health benefits. So while Texas’ unemployment rate of 8.2 percent beats the national average, the state falls below national trends on employer-sponsored health coverage. Seventy-one percent of the uninsured in Texas are part of a family that includes a full-time worker, according to the Kaiser Family Foundation. Put another way, 63 percent of uninsured, working-age Texans do have a job —just not an offer of insurance to go with it.

The Medicaid program is relatively limited. As I touched on in an earlier post, some states have used Medicaid waivers to cover low-income populations they’re not required to cover. Texas doesn’t do this much: The state covers some optional populations, pregnant women and those in long-term care, but largely sticks with the federally-mandated minimums. That means a decent number of residents who might receive coverage in another state don’t in Texas.

Insurance rates are largely unregulated. Texas takes a pretty hands-off approach to regulating its individual market. The state does not require insurers in the individual market to sell to anyone who applies for a policy. Nor does Texas limit “rating” of customers, where insurance carriers charge more to older subscribers and women, who tend to have higher health care costs. Taken together, those two factors can make insurance prohibitively expensive - or unobtainable -- for those who are older or have a pre-existing health condition.

A large immigrant population. Non-citizens make up about one-quarter of Texas’ uninsured population, according to the Center for Public Policy Priorities’ Texas Health Care Primer. Regardless of immigration status, immigrants tend to have a higher rate of uninsurance than non-immigrants. Of the 1.2 million foreign-born, naturalized U.S. citizens in Texas, for example, 31 percent are uninsured, compared to 22 percent of U.S.-born Texans.