An American flag flies with the Texas state flag outside the Texas State Capitol building in Austin, Texas, U.S. Photographer: David Paul Morris/Bloomberg© 2017 Bloomberg Finance LP

Nearly 20% of Texans under the age of 65 don’t have health insurance and most of them are working, according to a new analysis that could further pressure that state’s policymakers and politicians to expand Medicaid coverage for the poor.

Texas has 4.7 million uninsured, the most people of any other U.S. state without medical coverage under age 65 , according to a new report on the state’s uninsured by the Urban Institute that is sponsored by Episcopal Health Foundation.

“Many are Texans who work full time in stores, wait tables, build homes, or care for Texas toddlers, but they still don’t have access to affordable health insurance,” Episcopal Health Foundation CEO Elena Marks said.

The report comes as an increasing number of states that have been led by Republican governors or GOP-controlled legislatures consider expanding Medicaid under the Affordable Care Act via ballot initiative to circumvent lawmakers who have balked at the idea. Last month, voters in Nebraska, Idaho and Utah voted overwhelmingly to expand Medicaid by public referendum.

The Fairness Project, which spent $6 million to support ballot measures that won in last month’s midterm elections, said it’s evaluating the political and regulatory climate of the 14 remaining states yet to expand Medicaid under the ACA.

If Texas lawmakers expanded Medicaid “or came up with an alternative plan to offer health insurance to low-income adults earning up to $35,000 for a family of four,” the Urban Institute report estimates 1.2 million uninsured in the state “currently ineligible for assistance would be made eligible for free or very low cost coverage.”

But Texas Republicans who control state government have remained opposed to Medicaid expansion and no ballot initiative has emerged there.

“Without policy changes, it’s likely that the number and share of uninsured Texans will increase with time,” Linda Blumberg of the Urban Institute’s Health Policy Center said in a statement accompanying the report she co-authored. “With health costs continuing to increase, it will make coverage less affordable for low-and middle-income residents and put more financial pressure on state government and healthcare providers.”

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An American flag flies with the Texas state flag outside the Texas State Capitol building in Austin, Texas, U.S. Photographer: David Paul Morris/Bloomberg© 2017 Bloomberg Finance LP

Nearly 20% of Texans under the age of 65 don’t have health insurance and most of them are working, according to a new analysis that could further pressure that state’s policymakers and politicians to expand Medicaid coverage for the poor.

Texas has 4.7 million uninsured, the most people of any other U.S. state without medical coverage under age 65 , according to a new report on the state’s uninsured by the Urban Institute that is sponsored by Episcopal Health Foundation.

“Many are Texans who work full time in stores, wait tables, build homes, or care for Texas toddlers, but they still don’t have access to affordable health insurance,” Episcopal Health Foundation CEO Elena Marks said.

The report comes as an increasing number of states that have been led by Republican governors or GOP-controlled legislatures consider expanding Medicaid under the Affordable Care Act via ballot initiative to circumvent lawmakers who have balked at the idea. Last month, voters in Nebraska, Idaho and Utah voted overwhelmingly to expand Medicaid by public referendum.

The Fairness Project, which spent $6 million to support ballot measures that won in last month’s midterm elections, said it’s evaluating the political and regulatory climate of the 14 remaining states yet to expand Medicaid under the ACA.

If Texas lawmakers expanded Medicaid “or came up with an alternative plan to offer health insurance to low-income adults earning up to $35,000 for a family of four,” the Urban Institute report estimates 1.2 million uninsured in the state “currently ineligible for assistance would be made eligible for free or very low cost coverage.”

But Texas Republicans who control state government have remained opposed to Medicaid expansion and no ballot initiative has emerged there.

“Without policy changes, it’s likely that the number and share of uninsured Texans will increase with time,” Linda Blumberg of the Urban Institute’s Health Policy Center said in a statement accompanying the report she co-authored. “With health costs continuing to increase, it will make coverage less affordable for low-and middle-income residents and put more financial pressure on state government and healthcare providers.”

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Texas’ Uninsured Rate Hits 19% As GOP Snubs Medicaid Expansion – Forbes