Texas is one of 10 states that has not expanded Medicaid in the decade after the Affordable Care Act presented the option. Texas lags in healthcare outcomes, ranking at the bottom of health indicators and bearing the unfortunate distinction of having the highest rate of uninsured adults (24.3%) and the highest sheer number: nearly 5 million individuals. The closure of rural hospitals, which happens more frequently, costs 170 jobs and an annual payroll of $22 million.