5 Unexpected Costs That Push Texans Into Medical Debt

If you’ve ever opened a medical bill and felt your soul leave your body like it was late for another doctor’s appointment, you’re not alone.

A recent study found that an estimated 19% of families in Texas have medical debt in collections. In some rural counties, the share exceeds 40%. So it’s no wonder 3 in 5 Texans are worried about medical bankruptcy. 

Whether you’re on the left or the right, Texans across the political spectrum agree that getting sick shouldn’t mean getting buried in debt—or, worse yet, refusing treatment that could save your life.

Here are the medical costs that are killing Texas wallets.

1. Skyrocketing Insurance Deductibles and Premiums

Texas consistently has among the highest annual deductibles and premiums in the country. In 2025, they paid the sixth-highest burden of any state in the US. 

The Affordable Care Act (ACA) and Medicare markets saw some of the steepest increases. Texas ACA insurers hiked average monthly premiums by about 35% for 2025, one of the biggest percentage increases in the nation.

Those sky-high prices are a big reason routine care gets delayed, and delayed care often becomes expensive care. 

2. Steep Out-of-Pocket Medication Prices

Prescription costs hit Texans hard—especially those managing chronic conditions. A 2024 poll found 37% of Texans say they have “skipped doses of a medication, discontinued a medication, or delayed or avoided a medical procedure because [they] could not afford to pay for it.”

Texans often skip doses to stretch a prescription, pay out of pocket for drugs not fully covered, or discover at the pharmacy counter that a medication their doctor prescribed suddenly costs more than their electric bill.

3. Missed Work = Lost Income

Medical debt isn’t just about medical costs—it’s also about the money people aren’t making while they recover or care for someone else. Texas doesn’t require paid sick leave statewide, so workers often have to choose between getting better or getting paid.

Lost wages pile onto medical bills, especially for hourly workers, single parents, or anyone caring for a child or aging parent. One unexpected illness can unravel a family’s entire financial month.

4. Medical Credit Cards & Third-Party Lenders

About 1 in 4 Texas consumers has medical debt on their credit report. In communities of color, that number is as high as 1 in 3. When faced with a bill they can’t pay, many Texans turn to medical credit cards or third-party lenders. 

Medical credit cards can feel like lifelines, but often hide high-interest rates and deferred-interest traps. There isn’t a specific cap for interest rates on many medical credit cards and third party loans in Texas, meaning rates can be very high (often 20% to 30% or higher). 

A provider’s billing office offers medical credit cards during checkout or after a bill arrives. It’s framed as a way to “break payments into manageable monthly amounts.” But many patients don’t realize they’re signing up for a credit product, not a hospital payment plan.

Families get stuck paying far more than the original bill. It’s a quiet debt spiral that follows people long after they’ve left the hospital.

5. Gaps in Coverage

Texas still has the highest uninsured rate in the United States: 13.6% of Texas children and 21.6% of Texas adults lack coverage, according to a 2024 census report. 

For uninsured families, even a minor injury can feel like a financial emergency. And for insured Texans, gaps appear when plans don’t cover certain specialists, mental health providers, therapies, or essential follow-up care. Every gap in coverage becomes an opportunity for debt to creep in.

Gaps also make preventive care harder to access, which makes long-term problems more expensive—both for families and for the state.

Different views. The same medical bills.

Being a Builder doesn’t mean pretending our disagreements about healthcare aren’t real. It means remembering that the people on the other side of those disagreements are getting hit with the same hospital bills, the same insurance fine print, and the same late-night question of “How are we going to pay for this?”

It’s only when Texans start from that shared reality that we can find a way forward.

—Alex Buscemi (abuscemi@buildersmovement.org)

Art by Matthew Lewis

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