Texas is home to top-tier medical schools, world-renowned hospitals and physicians, and leading clinical researchers. Yet when it comes to something as fundamental as access to healthcare coverage, Texas ranks last in the nation.

Texas has the highest percentage of uninsured residents: 16.8%, more than double the national average and significantly higher than the next closest state, Georgia, at 12%.

That translates to roughly 5 million uninsured Texans—more than twice the population of our largest city, Houston (2.3 million), which is about the same number of people who live in the Republic of Ireland. To picture the scale another way, imagine Kyle Field filled with 100,000 Aggie fans on game day, then imagine that crowd multiplied 50 times.

Many Texans assume that most uninsured people are unemployed or living in poverty. In reality, uninsured Texans come from all walks of life, including people with modest incomes, middle-class families, entrepreneurs, and small business owners, the backbone of the state’s economy. About 70% of uninsured Texans are working or actively looking for work, and 8 out of 10 earn more than the federal poverty level. Among working-age adults (ages 18 to 64), the uninsured rate is even higher: 21.6%, or approximately 3.9 million people.

When asked, Texans without healthcare coverage overwhelmingly say they want it. However, the complexity of the system and the high cost of coverage put it out of reach for many.

And the problem doesn’t end there. Many Texans are underinsured, meaning they have health coverage but avoid using it because out-of-pocket costs are too high, even when care is needed. Nationally, as many as one in four people fall into this category.