Texas leads the nation in the proportion of its population (17 percent or 4.6 million Texans) that is uninsured. This brief examines the impacts of uninsurance in Texas. Though the Affordable Care Act (ACA) increased the state’s health insurance rate by six percentage points between 2013 and 2015, some of those gains will be reduced under replacement scenarios put forward by the GOP, making it critical to look at the consequences of uninsurance in the state.