While every state has seen coverage growth since the implementation of the Affordable Care Act’s (ACA) coverage reforms in 2014, the states choosing to expand Medicaid eligibility have seen the largest increases in coverage. Texas has the highest uninsurance rate in the country with 4.7 million people under age 65 estimated to be uninsured in 2018. We estimate that 19 percent of people in that age group are uninsured in 2018, more than 70 percent higher than the national rate of 11 percent . Although the Texas uninsurance rate remains high, this represents a significant increase in coverage across a diverse group of residents since implementation of the ACA. Urban Institute researchers have analyzed the characteristics of people who are uninsured in Texas at both the statewide and local area level.