Talking Health Care For Texas’ Sake

For years, Texans have known through difficult personal experience that health care in Texas has challenges. Over the last six months, those issues have hit home for millions more.

Texas leads the nation in uninsured residents. But this pandemic has shown that an affordable, sustainable, effective health care system requires far more than insurance coverage.

Current and future Texans need leaders to get to work creating that system. That means setting aside politics, preconceptions, and past battles. It also means creating policy not only for the nearly 30 million people in this state right now but also for the roughly 10 million more who will be here when Texas celebrates its bicentennial in 2036.

By creating a healthy population, we also ensure that each Texan can participate fully in the economy and reach their potential. Texas has not fared well on this front. According to America’s Health Rankings, we rank poorly on measures such as the prevalence of diabetes (41st out of 50), cardiovascular deaths (34th), and maternal mortality (43rd).

Texans can do better, as we have in reducing COVID cases recently and cancer deaths over time (we rank 11th in the latter). That requires a data-driven, comprehensive approach — focused on prevention, providers, prices, and coverage —that increases access to the care when and where Texans need it.

It’s also critical to consider the roughly 80 percent of Texans who have coverage but can’t always access care. Even for insured Texans, costs have become a significant barrier to health.

A stronger health system also means having enough doctors, nurses, and other providers to serve Texans who need care.

Texas health care spending jumped 13.8 percent between 2014 and 2018. Soaring costs leave more than a quarter of people with employer-sponsored health insurance “underinsured,” according to the Commonwealth Fund, with out-of-pocket costs and deductibles eating up their income. Further, nearly a quarter of those with insurance say they’ve skipped or delayed care due to cost.

A stronger health system also means having enough doctors, nurses, and other providers to serve Texans who need care. This access issue is especially acute in rural communities — more than 100,000 Texans live in a county without a primary care physician. 

Addressing coverage, cost, and access demands a wide-ranging statewide conversation: everyone must be at the table, and everything must be on it. It means acknowledging government-funded insurance can’t solve everything and insurance doesn’t always equal care — but it also means maximizing the value of available resources, including federal dollars, to help Texans get care when and where they need it.

The most important person in this conversation is you. The state cannot create the comprehensive, sustainable system it needs without engaged citizens demanding solutions. Please visit and sign up for email updates about key policy issues shaping Texas’ future.

Together, we can create the health care system Texans need today — and will need even more tomorrow.

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Margaret Spellings

Former U.S. Secretary of Education Margaret Spellings, of Highland Park, is president and CEO of Texas 2036. The nonprofit, championed by SMU alumnus Tom Luce and others, pursues long-term, data-driven strategies for the state.

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