April began with National Public Health Week. As the month closes, Texas is turning to another health issue that deserves equal attention: affordability.

The newly announced Texas House Select Committee on Health Care Affordability is holding its first hearing on April 30 to examine the policies, decisions, and cost drivers that brought the state to this point. That is a critical and timely conversation. If Texas is going to take a serious look at affordability, the lens should extend beyond coverage, premiums, reimbursement, and administrative burden alone. 

The Chronic Disease Burden Texas is Already Carrying

A fuller affordability discussion starts with a basic question: what is driving so much illness, complexity, and cost in the first place?

In Texas, that question points directly to chronic disease. The Texas Department of State Health Services identifies chronic diseases such as heart disease, cancer, and diabetes as leading causes of death, disability, and health care cost. It also reports that in 2023, more than one-third of Texas adults and about one-fifth of children, ages 10 to 17 had obesity. These are not side issues in an affordability discussion. They are central to it.

If Texas defines affordability only by the price of care or the cost to deliver it, we are overlooking a critical part of the equation: the long-term cost of carrying preventable and poorly managed disease burden over time. That burden is already accumulating, not just in health care spending, but also in disability, lost productivity, caregiving strain, and increased reliance on high-cost services downstream. That challenge is compounded by how and where Texas spends its healthcare dollars. The 2025 Commonwealth Fund’s Texas profile shows state public health funding at $17 per person, compared with a $40 national average. Primary care also accounts for a relatively small share (~6%) of total health care spending in Texas across all payer types. At the same time, Texas has higher-than-average potentially avoidable emergency department use and preventable hospitalizations among employer-covered adults. 

Where Texas Invests

The combination of low public health funding and primary care investment with high potentially avoidable emergency department use and preventable hospitalizations matters. It suggests Texas is addressing affordability in a state with high chronic disease burden, low public health investment, and continued signs of avoidable downstream utilization.

This is where public health and primary care become especially important. They are not substitutes for insurance reform, payment reform, or delivery system redesign. But they are among the clearest tools the state has for reducing avoidable burden through earlier intervention, risk reduction, continuity, and better management of chronic conditions before they become more severe and more expensive.

That point applies statewide, and it becomes even more visible in rural communities, where affordability pressures are often compounded by longer travel distances, thinner workforce capacity, and fewer local options for prevention and ongoing health management.

A Fuller Affordability Lens for Texas

As the committee begins its work, three questions may be worth considering:

• How much of Texas’s affordability burden is tied to preventable or poorly managed chronic disease?
• Where could stronger public health and primary care capacity reduce avoidable downstream cost?
• How should Texas distinguish between the cost of buying care, the cost of delivering care, and the cost of carrying preventable illness over time?

These questions do not compete with traditional affordability concerns. They strengthen them.

What a Broader Lens Enables

Texas will not solve health care affordability by focusing only on the price of care; it must also confront the cost of preventable illness. That is not a challenge for any one sector alone; rather, it is a shared opportunity amongst policymakers, public health, primary care, hospitals, health plans, employers, academic partners, and community organizations. This is a moment to widen the lens, not to compete with existing affordability strategies, but to make them more effective and more durable. At THI, we see this as part of our shared work: helping connect data, policy, and implementation so that Texas can act with greater clarity and urgency, advancing an affordability agenda that addresses what is truly driving illness, cost, and complexity in the lives of Texans.