Everything's bigger in Texas.
And, as the devastating floods in Texas Hill Country this month remind us, tragedies are no exception.
Natural disasters in Texas are nothing new.
But, like most of the problems now plaguing Texas, they're getting worse. The reasons for that are mostly man-made. And the men doing the making are elected Republicans.
After decades of Republican rule, Texas is failing its people bigly
Texas has had a Republican Governor for more than 30 years straight, since George W. Bush defeated Democrat Ann Richards in 1994.
Republicans won control of the Texas Senate in 1996 and the Texas House in 2002.
That GOP "trifecta" has been in control for more than 20 years.
And it doesn't end there. Republicans have controlled every other statewide office in Texas since 1999 or earlier.
The state's Supreme Court and Court of Criminal Appeals both have 9-0 GOP majorities.
Texas is America's second-most populous state, now home to more than 31 million people.
Given the size of both its population and its economy — based on GDP, if Texas were a country it would rank 8th in the world, ahead of Canada, Russia, and Italy — it's a perfect test case to see how well-served its people are by decades of one-party rule.
Well, the results are in and the data doesn't lie.
The sad state of Texas healthcare
One thing that's definitely bigger in Texas is the health insurance coverage gap.
Texas has had the highest uninsured rate in the nation for “quite some time,” Charles Miller, a senior policy advisor for the nonprofit research organization Texas 2036 told the Texas Tribune in 2023.
Texas proudly stands as one of 10 states that has failed to expand Medicaid since 2013, content to leave millions of its citizens one illness aways from bankruptcy, even before the passage of Trump's "Big Beautiful Bill,"
According to the Commonwealth Fund's 2025 Scorecard on State Health System Performance, 21.6% of working-age Texans lacked health coverage in 2023, double the national average of 11%. (In the top three most-insured states — Massachusetts, Hawaii, and Vermont — the uninsured rate is below 4%.)
In the overall rankings on health system performances for 50 states plus Washington DC, Texas ranks 50th out of 51, ahead only of Mississippi.
According to the Commonwealth Fund, "in Texas, the state with the highest uninsured rate, more than 18 percent of adults reported going without care because of cost in 2023."
With the exception of Mississippi, Americans who live in even the poorest states in the nation — such as Louisiana, West Virginia, Kentucky, New Mexico, Oklahoma, Arkansas and Alabama — can expect better overall healthcare services than people unlucky enough to live Texas.
The worst place to be a woman
Decades of one-party rule has given Republicans the opportunity wage a relentless war on women.
The result: Texas (with a GDP bigger than all but seven countries) is now more dangerous for women than any other "rich country" economy.
By 2020, Texas already had a maternal mortality rate nearly 3X the OECD (38-nation) average.
And Greg Abbott was just getting started.
In 2021, one year before Roe v. Wade was overturned, the Texas Governor signed into law Senate Bill 8, one of the strictest and most unscientific abortion bans in the country, with no exceptions for rape or incest.
A pregnant woman is 3X more likely to die in Texas than in California
SB.8 was a major factor why the maternal mortality rose 58% in Texas between 2019 and 2022, vs. an 11% increase nationally.
Today, pregnant women in Texas are 10X more likely to die than women in Norway or Belarus and 3X more likely to die than women in the UK or Canada—or the only US state with a higher population, California.
After relentlessly pushing "pro-life" policies for decades — and after more than 10 years with Greg Abbott as Governor — Republicans have left women hanging in the wind.
As The Texas Tribune reported in December 2024:
Almost half of all Texas counties offer no maternity care services, and more than a quarter of rural mothers live more than 30 minutes away from the nearest provider. Living in a “maternity care desert” contributes to delayed prenatal care, increased pregnancy complications and worse delivery outcomes.
Maternity care is not the only thing severely lacking in Texas. So is protection from domestic violence.
27% of pregnancy-related deaths in Texas are caused by violence, with guns the leading cause
Alarmingly, 50% of domestic violence victims in Texas are turned away from shelters due to lack of space, leaving many with no place to turn. Two hundred domestic violence victims are killed in the state each year.
According to The Network for Public Health Law, violence in the form of homicide or suicide accounts for 27% of all pregnancy-related deaths in Texas, with firearms the most frequent cause of the fatal injury.
In Texas, the fetus is protected, the child swiftly abandoned
For all its "pro-life" talk, the Texas GOP treats actual children more harshly than kids are treated by any other state.
According to CoverTexasNow, in 2023:
The Texas uninsured rate for children was 11.9%, more than twice the national rate of 5.4%... the children’s uninsured rate in Texas was much worse than the rate in nearby states such as as Arizona (8.6%), Arkansas (6.7%), Louisiana (4.3%), New Mexico (5.9%), and Oklahoma (7.5%.)
And because children in Texas are "much more likely to go without health insurance than kids in any other state," Republicans are condemning children to a lifetime of negative health outcomes.
Half of the uninsured children in Texas are entitled to coverage, but Republicans have worked aggressively to deny it to them
In a recent The New Yorker article headlined: "Sick Children Will Be Among The Victims of Trump's Big Bill, pediatric physician and author Rachel Pearson described the aggressive tactics Texas Republicans used to deny children healthcare:
During the pandemic, the federal government required states to automatically reënroll people in CHIP and Medicaid. But the requirement ended in 2023. After that, Texas set about disenrolling poor children from benefits with such cold vigor that the Biden Administration’s Department of Health and Human Services threatened to take action. According to a joint investigation by ProPublica and the Texas Tribune, more than two million Texans, most of them children and most of them eligible for Medicaid or CHIP, lost their coverage. Some were disenrolled because they filled out forms incorrectly or turned them in late.
Even before Trump's "Big Beautiful Bill" brings new barriers to healthcare for poor kids in Texas, the state has already "demonstrated just how 'effective' a bureaucratic barrier can be," adds Pearson. Republicans have already successfully deprived "half of the state’s uninsured children" from coverage to which they are legally entitled.
In the poorest neighborhoods of Dallas, childhood asthma rates are above 17% — more than 2X the national averge
Schools in the poorest and most heavily polluted neighborhoods of Dallas now report childhood asthma rates above 17% — more than double the national average. "It's not just a health issue," notes Texas Standard. "It’s also taking a toll on education. Respiratory issues are a leading cause of absenteeism among students in Dallas ISD."
Texas became the epicenter of this year's US measles epidemic — the worst in more than three decades. As Leana S. Wen wrote in The Washington Post:
In Texas, nearly 100 measles patients have been hospitalized this year, and two school-age children have died. As many as 1 in 20 children with measles end up with pneumonia, and about 1 in 1,000 develop brain swelling that could lead to permanent disability. And measles doesn’t just cause acute illness; it can also reset the immune system’s memory... leaving people susceptible to diseases they were once protected against.
Measles also costs money. With the cost per hospitalized patient running to tens of thousands, estimates are that his year's measles outbreak could end up costing Texas public hospitals more than $10 million.
And trying to get kids vaccinated after the fact hits parents hard, too: One Texas dad was charged $1,400 when he took his 4-year-old to receive a missed second measles shot.
Texas has the 6th highest childhood obesity rate in America, "significantly above" the national average.
As Rice University's Baker Institute for Public Policy notes, the problem has grown worse since 2000, a period in which the state has lived under unified GOP rule:
As children become more obese, they begin developing comorbidities such as diabetes, hypertension, depression, and asthma. There are indications of an association between childhood obesity and mental health disorders. Depending on its severity, obesity can significantly reduce life expectancy, potentially shortening lifespan by five to 20 years.
Texas Republicans have actively promoted the policies that create a vicious circle for Texas children: A lack of primary care and preventive medicine, combined with rising rates of vaccine hesitancy, leads to more spread of infectious diseases, higher childhood asthma and obesity rates.
It's an approach that is guaranteed to create long-term fallout for the entire state in terms of lower educational achievement, lost lifetime earnings and higher adult chronic‑disease rates.
As Trump attacks Medicaid, Texas faces more pain ahead
Instead of learning the lessons of the Texas disaster, with the passage of the "Big, Beautiful Bill," Trump and the Republican majorities in DC are doubling down on the same failed policies.
That spells more pain for Texas.
KFF predicts Texas will lose $39 billion in federal Medicaid funding in the decade ahead. In a state where 5 million already lack healthcare, Trump's signature policies will lead to more rural hospital closures—and an additional 1.7 million Texans losing coverage.
As Texas Tribune reports:
The cuts could be particularly potent in the Rio Grande Valley, which has an outsized number of Medicaid recipients, and in rural areas, where hospitals rely on Medicaid payments.
Meanwhile, families across America will begin to experience the same kind of abysmal healthcare access that the Texas GOP has pioneered.
As Rachel Pearson warned in The New Yorker: "What Texas pediatricians are encountering now will grow more common nationally, as Trump’s cuts are enacted over the next decade."
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