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Texas has the 5th highest healthcare costs in the nation, Forbes says

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Texans are the most likely people in the nation to avoid going to the doctor due to cost, the report found.

A new Forbes Advisor study shedding light on Americans' top financial worries has revealed Texas has the 5th highest healthcare costs in the nation.

Forbes Advisor's annual report compared all 50 states and Washington, D.C., across nine different metrics to determine which states have the most and least expensive healthcare costs in 2024.

Factors that were analyzed include the average annual deductibles and premiums for employees using single and family coverage through employer-provided health insurances; the percentage of adults who chose not to see a healthcare provider due to costs within the last year; and others. Each state was ranked based on its score out of a total 100 possible points.

Texas was No. 5 with a score of 91.38 points. North Carolina was No. 1, followed in order by South Dakota, Nebraska, and Florida.

According to Forbes, out-of-state families considering a move to the Lone Star State should be aware of the state's troubling statistics when it comes to family healthcare. More specifically, nearly 15 percent of Texas children had families who struggled to pay for their medical bills in the past 12 months, the highest percentage in the nation.

Furthermore, Texans have the highest likelihood in the U.S. to skip seeing a doctor because of cost. The report showed 16 percent of Texas adults chose not to see a doctor in the past 12 months due to the cost of healthcare.

"Unexpected medical bills and the cost of healthcare services are the top two financial worries for Americans this year, according to a recent KFF health tracking poll," the report said. "These financial fears have real-world consequences. The high cost of healthcare is leading some Americans to make tough choices — often at the expense of their health."

In the category for the percentage of adults who reported 14 or more "mentally unhealthy" days out of a month, who could not seek healthcare services due to cost, Texas ranked No. 3 in the U.S., with 31.5 percent of adults experiencing these issues.

The report also highlighted the crystal clear inequality in the distribution of healthcare costs across the U.S.

"In some states, residents face much steeper healthcare expenses, including higher premiums and deductibles, which make them more likely to delay medical care due to costs," the report said.

For example, Texas' average annual premiums for both plus-one health insurance coverage ($4,626, according to the study) and family coverage ($7,051.33) through employer-provided policies was the No. 4-highest in the nation.

Elsewhere in the U.S.

The state with the most expensive healthcare costs is North Carolina, with a score of 100 points. 27 percent of adults in North Carolina reported struggling with their mental health who could not seek a doctor due to cost, and 11.3 percent of all adults in the state chose not to see a doctor within the last 12 months because of costs.

Hawaii (No. 50) is the state with the least expensive healthcare costs, according to Forbes. Hawaii had the lowest percentages of adults struggling with mental health (11.6 percent) and adults who chose not to see a doctor within the last year (5.7 percent). The average annual premium for employees in Hawaii using a family coverage plan through employer-provided health insurance is $5,373.67, and the average annual deductible for the same family coverage plan is $3,115.

The top 10 states with the most expensive healthcare are:

No. 1 – North Carolina
No. 2 – South Dakota
No. 3 – Nebraska
No. 4 – Florida
No. 5 – Texas
No. 6 – South Carolina
No. 7 – Arizona
No. 8 – Georgia
No. 9 – New Hampshrie
No. 10 – Louisiana

The full report and its methodology can be found on forbes.com.

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Austinite who kayaked 86 miles with one arm has Texas Book Fest debut

Photo by Daniel Cavazos

Avrel Seale is discussing his post-stroke kayaking expedition at the festival on November 16.

This year’s Texas Book Festival features more than 275 authors who have accomplished amazing things. But only one of them rowed nearly 90 miles down the Nueces River with one arm. (We think.)

Author of The River Nuts Avrel Seale is making his Texas Book Festival debut on November 16, and participating in the 4 pm panel "Memoirs of Adventure & Adversity Exploring Nature" in the Capitol Auditorium. He’ll talk about his feat of physical and mental endurance in a session alongside author Kevin Fadarko (A Walk in the Park) and moderated by outdoor journalist Pamela LeBlanc.

For all intents and purposes, January 19, 2018, was just another ordinary Friday for 50-year old author Seale. The writer and editor for the University of Texas' Marketing and Communications team was in his office on The Drag when he was hit with a devastating hemorrhagic stroke.

"My coworkers called an ambulance, which took me to Seton Main," says Seale. "I had emergency brain surgery that night that probably saved my life."

Avrel Seale Austin author Thankfully, Seale's story includes help from friends along the way.Photo by Daniel Cavazos

The stroke left Seale partially paralyzed on the right side of his body, with his right arm completely immobile. After two years of rehab and physical therapy — and still with just one working arm — Seale decided to undergo one of his biggest self-made challenges: attempting to kayak an 86-mile stretch of the Nueces River with lifelong friend Wade Walker in tow.

Seale's extensive journaling of the adventure would later become his 11th book, The River Nuts. The 182-page story didn’t just chronicle Seale and Walker's voyage down the South Texas river, but also covered the preparation for the journey in great detail.

"I had always wanted to. I thought it would be fun," explains Seale. "The stroke just forced me to find a different way."

Seale and Walker accomplished something that many others have in the past. Kayaking a river to the sea was not a groundbreaking idea, but few people — if any — had done it facing the same challenges as Seale did.

Avrel Seale Austin author with Wade Walker Avrel Seale and his rowing partner Wade Walker.Photo by Kirstin Seale

Someone who has had a dominant hand in a cast can understand how the immediate shift could test one’s patience. Even though most of the journey was spent cruising downstream — not to mention having someone else in the kayak doing the lion’s share of the work — there was quite a bit more to the experience than a spectator might expect.

From pulling up rudders to adjusting foot pedals that help propel the craft, using his functioning arm to man an oar, and helping set up camp each night, Seale started facing difficulties shortly after their launch. Sometimes he was his own worst enemy.

"I had mistakenly reversed the left and right pedal arms for both pedal drives when we first assembled the kayak months earlier,” he explains. “This led to us stripping the threads and losing one pedal completely."

In addition to the rigorous physical demand on the writer, he also faced mental roadblocks.

"The biggest mental challenge was the lead-up to the trip, both the painstaking planning and the very real fear of dying,” he says “By the time we got on the water, that stress and fear lifted, and it was all about making the most of a beautiful experience."

Avrel Seale Austin author Seale's stroke couldn't keep him from nature.Photo by Daniel Cavazos

Published by TCU press in the fall of 2023, The River Nuts came out after that year's submission deadline for the Texas Book Festival. Since then he’s also written The Hewetts: An American Saga in the Age of Vaudeville, Circuses, and Bands, a wild historical account spanning four generations of a family of self-made entertainers.

"I've written 12 books over the last 25 years, and this is definitely the highlight of my career so far," he points out. "Hopefully it will open even more doors for me. I'm tickled to death."

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Austinite who kayaked 86 miles with one arm has Texas Book Fest debut