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

A new Forbes Advisor study shedding light on Americans' top financial worries has revealed Texas has the fifth highest health care 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 health care costs in 2024.

Factors include the average annual deductibles and premiums for employees using single and family coverage through employer-provided health insurances and the percentage of adults who chose not to see a health care provider due to costs within the last year, among 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 health care. 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 health care.

"Unexpected medical bills and the cost of health care 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 health care 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 health care costs across the U.S.

"In some states, residents face much steeper health care 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 health care 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 health care 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 health care 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 Hampshire
  • No. 10 – Louisiana

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

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This article originally ran on CultureMap.

Nurses deserve all the love. Photo by Patty Brito on Unsplash

Texas earns healthy rating as 2nd best state for nurses, Forbes says

health care heroes

With a global pandemic in the rearview and an aging workforce reaching retirement in larger proportions, strong healthcare is becoming increasingly crucial in the United States.

Nurses are in great demand throughout the nation and can make significant impacts in a state like Texas, which was just named the No. 2 best state for nurses in a study by Forbes Advisor.

Texas currently employs more than 231,000 nurses, the second-highest number in the country behind California's 325,620 nurses. Florida rounds out the top three with more than 197,000 nurses employed.

There are several factors to keep in mind when considering a career as a nurse, but one has been in a lot of recent discourse: the salary. The Bureau of Labor Statistics (BLS) says nurses in the U.S. earn a median salary of $81,220 per year. While healthcare company Trusted Health places a Texas nurse's annual salary at $74,540 - lower than places like Florida and California, adjusted cost of living can make Texas more attractive.

"Salary is a significant factor in any professional’s career decisions, but it’s not the only one to weigh when deciding where to work," the report's author wrote. "You should also consider job availability, economic demand, and licensing processes before settling on a place to grow your career."

Regarding job availability, Projections Central estimates there will be a demand for more than 16,000 nursing positions in Texas between 2020 and 2030 - the second-best job outlook in the U.S.

Texas is also part of the Nurse Licensure Compact (NLC), which can help nurses transfer their licenses from other states.

"NLC members grant RNs multi-state licenses, which allow them to practice in any NLC-participating state without jumping through the hoops of meeting a new state’s specific licensing guidelines," the report says. "NLC nurses can offer their skills to another compact state in the event of a crisis and provide telehealth services across compact states."

The full report can be found on forbes.com.

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This article originally ran on CultureMap.

Houston's not so hot for remote workers, as it turns out. thumbor.forbes.com

Houston caught slacking in Forbes study on best cities for remote workers

WFH woes

With many companies encouraging — or commanding — that remote workers return to the office in 2023, more and more Americans are seeking employment opportunities that will give them the freedom to work from elsewhere.

Houston is (remotely) clocking in as the No. 49 best city for remote workers in 2023, according to a study by Forbes Advisor. The study examined 100 U.S. cities and metro areas, and ranked them based on the earning potential of remote workers, internet access, lifestyle amenities, worker friendliness, living costs, and more.

The Bayou City did get some points for providing a quality lifestyle, the report found. Of the cities with the best access to arts, entertainment, and dining establishments, Houston came in No. 8 — outpaced slightly by No. 4 Dallas-Fort Worth.

"Remote work saves workers time and money on commuting and office clothing, while keeping their morale and productivity levels high," the report said. "Ideally, you’d live in a place with an affordable cost of living, high earning potential, reliable internet connection, low taxes, a low unemployment rate, and various entertainment options."

Out of All of Texas, only one region makes the top 10. San Antonio-New Braunfels, Texas, snagged the No. 6 spot. Here's yhe top 10 U.S. metro areas for remote workers are:

  • No. 1 – Miami-Fort Lauderdale-West Palm Beach, Florida
  • No. 2 – Indianapolis-Carmel-Anderson, Indiana
  • No. 3 – Omaha-Council Bluffs, Nebraska-Iowa
  • No. 4 – Tulsa, Oklahoma
  • No. 5 – Detroit-Warren-Dearborn, Michigan
  • No. 6 – San Antonio-New Braunfels, Texas
  • No. 7 – Jacksonville, Florida
  • No. 8 – Tampa-St. Petersburg-Clearwater, Florida
  • No. 9 – Tuscon, Arizona
  • No. 10 – Cleveland-Elyria, Ohio

Houston ranks in dead last when compared to the other Texas cities in the top 50. Behind San Antonio is Dallas-Fort Worth-Arlington, ranked No. 15 nationally. Austin-Round Rock ranks as the third overall best metro area in Texas for remote workers at No. 39.

Austin did great in one category — internet access — but it seems that earning potential and lifestyle amenities just couldn't keep up. for Austinites, it's all in the Wi-Fi: a remote worker's most important tool.

Austin's average internet download speed is 425.90 Megabits per second (Mbps), and when coupled with the wide variety of free Wi-Fi hotspots around the city, Austin earned No. 3 in the category for "cities with the best internet access." And we do like to take advantage of that at restaurants and bars around town.

Rounding out the ranking was El Paso at No. 46, sneaking ahead of Houston, and McAllen-Edinburg-Mission gets an honorable mention at No. 85.

The full study can be found on forbes.com.

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This article originally ran on CultureMap.

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America's first Ismaili Center set to open in Houston in December

Sneak Preview

The long-awaited Ismaili Center, Houston is set to open to the public next month. The 11-acre site has been painstakingly designed and constructed to offer indoor and outdoor public spaces for Houstonians to enjoy, connect, and engage. As the only Ismaili Center in the United States — and seventh in the world — it joins its international communities in London, Vancouver, Lisbon, Dubai, Dushanbe, and Toronto.

Nearly 20 years in the making, the Ismaili Center, Houston features a prayer hall, rotating art installations, a black box theater, a cafe, numerous social halls for weddings and other events, and nine acres of outdoor space and landscaped botanical gardens. Involved parties hope that the community will see the space as an extension of the neighboring parks along the bayou, and have included a garden entrance to the north lawn and gardens at the corner of Montrose Boulevard and Allen Parkway.

While Houston is known for its many community engagement centers, the architects and designers believe that the seamless integration of indoor and outdoor spaces sets the Ismaili Center, Houston apart from all others.

“What we know is the connections between buildings, environment, quality of life, and landscape — this is nothing new,” structural and facade engineer Hanif Kara says. “But, certainly, it’s hard to see that in other developments, particularly when they are done by developers. It’s quite difficult to find community spaces, and to see how quality of life is improved for everyone. I think we’ve all experienced that kind of hope that it will play out something like this.”

Designed by Farshid Moussavi Architecture and Nelson Byrd Woltz Landscape Architects, the remarkable 11-acre site is designed both to receive LEED Gold certification and to withstand the tests of Houston’s sometimes extreme weather conditions.

Principal architect Farshid Moussavi looks forward to seeing the Houston community utilize the space she’s worked so hard to deliver: “We’ve given the hardware to the community, now the software needs to come in. So I hope that there will be music recitals, or lectures, or book fairs, or other kinds of markets that can happen—even simultaneously. This is not an experiment, it’s the seventh in the world.”

Community welcome events are scheduled for December 12 and 13, but, until then, here are 10 features and things to know about the Ismaili Center, Houston.

What is the Ismaili Center, Houston?

“The use of the building is really meant for, or our hope, is that we are able to—on an enhanced view of what the community does today—have engagement on service projects, arts and culture, interfaith dialogue, and even just in bringing people together,” Omar Samji, Ismaili Council for the United States of America, says. “The notion of bringing people together in a place where it is easy to create connections because it’s an open space, and because it’s specifically designed to be a place where people interact and where people find commonality. Because whether you’re out in the gardens, or on the environs, or in the atrium, this enables connection.”

Who is His Highness the Aga Khan?

His Highness Prince Rahim Aga Khan V is the 50th hereditary Imam (spiritual leader) of the Shia Ismaili Muslims and a direct descendant of the Prophet Muhammad. He was educated at Philipps Academy in Andover and Brown University (Class of 1995). He became Imam in February 2025 upon the passing of his father, His Highness Prince Karim Aga Khan IV.

The Aga Khan promotes an understanding of Islam rooted in values of generosity, tolerance, pluralism, environmental stewardship, and the shared unity of humanity. He also chairs the Aga Khan Development Network (AKDN), one of the world’s largest private development agencies, which works across more than 30 countries to improve quality of life for marginalized communities regardless of faith or background.

The scale

The center stretches across an 11-acre site along Montrose Boulevard, from West Dallas to Allen Parkway. The physical building is 150,000 square feet, leaving nine acres for garden spaces on both the north and south sides of the building. The south side of the property is more formal, with gardens and community spaces that flank an 80-foot reflection pool and other water features. The gardens on the north side of the building are more informal, but densely planted and vast.

Photo by Iwan Baan

The creation

The development of the Ismaili Center was led by the Ismaili Council. It was initiated by His Highness Prince Karim Aga Khan IV (1936-2025), and completed under the leadership of his eldest son, Prince Rahim Aga Khan V.

The project was designed and constructed by a team of both local and international firms. Farshid Moussavi Architecture joined forces with structural and facade engineer Hanif Kara, co-founder and creative director of AKT II. DLR Group is the architect and engineer of record, while contractor McCarthy Building Companies built the project. Thomas Woltz, senior principal and owner of landscape architecture firm Nelson Byrd Woltz, along with principal Jeff Aten taking lead on the nine acres of garden space. The project is targeting LEED Gold certification.

The focus on native Texas plants and trees

The center will be recognized as a leading cultural asset for the City of Houston, complementing nearby institutions such as The Menil Collection, Rothko Chapel, Asia Society Texas, and the Museum of Fine Arts, Houston. While the surrounding gardens will add to the other notable Nelson Byrd Woltz projects within close proximity at Memorial Park, Rothko Chapel, and Rice University.

“We’ve been building massive projects in Houston for 12 years,” Woltz says. “We know the horticultural community in the region, and we did a deep, deep dive in ecological research to understand ‘What are the native plants of whatever region?’ It’s just baked into our process. Right when we are starting any project in Houston—right to the river. Look at the soils, ‘What are the plants appropriate to that place?’ Its solar aspect, its humidity, it’s moisture in soils, the shadow of the building.

But then, this idea of taking a section across the state of Texas, so that each of those distinct ecological regions is represented by one of the terraced gardens — so it’s very clear. It’s a diagram of the state of Texas and all of its native plants. This is functioning like a botanic garden and a repository for biodiversity — this is work in service.”

The eco-friendly exterior

The exterior of the building is clad in stone, a durable material with low embodied carbon. The stone cladding is a rainscreen over in-situ ‘fair-faced’ concrete walls, exposed on the interior to minimize additional material use. The concrete mix used has replaced 35-62 percent of Portland cement with fly ash and slag, reducing CO2 emissions by roughly 30 percent compared to standard mixes. The exterior stone rainscreen uses smaller tiles to increase the stone yield, utilizing 20-25 percent more of the irregular blocks they are cut from. This reduction in waste has also lent itself to crafting the cladding in a unique way.

The tessellation of the stone pieces changes across the building's surfaces to create different patterns on different sides of the buildings and at the corners. Relief stone tiles are used to add texture to the facades.

The space for outdoor events

The north-facing botanical gardens that will accommodate the 200-year flood plain offer a 27 foot gradient toward the building. This allowed for various levels of seating and gathering areas that culminate at an elevated terrace that will act as a stage for various events such as plays and concerts. Attendees can stretch out and enjoy the shows from an extensive lawn area that is surrounded by dense gardens of native trees and plants.

The black box theater

A 2,600-square-foot black box multipurpose space which seats 125 people is found on the second floor of the building’s west wing. It can host public events, such as exhibitions, film screenings, theatrical performances, music recitals, and other artistic programs throughout the year. It will also serve as a flexible space for teaching and learning. With acoustic isolation to surrounding spaces and the mechanical mezzanine above, it is designed to operate simultaneously without disrupting other events in the building. Design includes an upper-level control room, pipe grid, and flexible drapery and seating configurations to allow for a wide variety of programming.

The cafe

The center’s café is a 1,600-square-foot, double-height space located in the west wing (Montrose side) that opens onto an enormous terrace, offering visitors the option to enjoy their coffee or food outdoors. The terrace near the cafe is lined by an exterior wall and long, trough-style fountains that aid in noise reduction from Montrose Boulevard. The second-floor wall overlooking the Café is fully glazed, creating visual connection with the levels above.

The prayer hall

The prayer hall is 12,240 square feet, featuring a unique structural system of seven interlocking squares, formed from steel beams spanning the 115-by-115-foot open space. These beams are clad in concrete to enhance durability, beneath which lies a two-layer perforated aluminum ceiling with integrated diffused lighting. Its intricate pattern recalls the traditional jālī screens of Islamic architecture creating a soft, seemingly infinite ceiling effect, adding to the serenity of the prayer hall.

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A version of this article first appeared on CultureMap.com

Intuitive Machines to buy satellite maker Lanteris for $800 million

space deal

Houston-based aerospace company Intuitive Machines has agreed to buy satellite manufacturer Lanteris Space Systems for $800 million from private equity firm Advent International.

Intuitive Machines co-founder, president and CEO Steve Altemus said the combined revenue of his company and Palo Alto, California-based Lanteris exceeded $850 million as of Sept. 30, and their backlog of orders totaled $920 million.

Until recently, Lanteris operated as Maxar Space Systems. Its origins date back to 1957.

The deal—comprising $450 million in cash and $350 million in Class A shares of Intuitive Machines stock—is expected to close in the first quarter of 2026.

The acquisition “marks the moment Intuitive Machines transitions from a lunar company to a multi-domain space [company], setting the pace for how the industry’s next generation will operate,” Altemus said.

Altemus said the acquisition would enable Intuitive Machines to better compete for Earth orbit, lunar, Mars and deep space projects. Among the opportunities that would open up thanks to the Lanteris deal are the proposed Golden Dome missile defense system and a large lunar lander capable of carrying astronauts, he said.

“The new Intuitive Machines will combine rapid innovation and precision spacecraft production to meet the growing demand for responsive, high-reliability space infrastructure and services,” Altemus said.

Intuitive Machines, founded in 2013, develops lunar landers and provides aerospace services. In 2024, it became the first U.S. company to land a spacecraft on the moon in half a century.

Altemus said Intuitive Machines is already building three satellites for NASA’s near-space network, and it might upsize two more satellites now that it plans to buy Lanteris.

Aside from satellites, Lanteris is developing the power and propulsion element for NASA’s Gateway, a lunar orbiting command module that will support Artemis missions and deep space exploration.


Lanteris was a division of Maxar Technologies, which Advent and minority investor British Columbia Investment Management took private in a 2023 deal valued at $6.4 billion

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Meet 6 mentors who are helping the Houston startup scene flourish

meet the finalists

Few founders launch successful startups alone — experienced and insightful mentors often play an integral role in helping the business and its founders thrive.

The Houston startup community is home to many mentors who are willing to lend an ear and share advice to help entrepreneurs meet their goals.

The Mentor of the Year category in our 2025 Houston Innovation Awards will honor an individual like this, who dedicates their time and expertise to guide and support budding entrepreneurs. The award is presented by Houston City College Northwest.

Below, meet the six finalists for the 2025 award. They support promising startups in the medical tech, digital health, clean energy and hardware sectors.

Then, join us at the Houston Innovation Awards this Thursday, Nov. 13 at Greentown Labs, when the winner will be unveiled. The event is just days away, so secure your seats now.

Anil Shetty, InformAI

Anil Shetty serves as president and chief medical officer for biotech company Ferronova and chief innovation officer for InformAI. He's mentored numerous medical device and digital health companies at seed or Series A, including Pathex, Neurostasis, Vivifi Medical and many others. He mentors through organizations like Capital Factory, TMC Biodesign, UT Venture Mentoring, UTMB Innovation and Rice's Global Medical Innovation program.

"Being a mentor means empowering early-stage innovators to shape, test, and refine their ideas with clarity and purpose," Shetty says. "I’m driven by the opportunity to help them think strategically and pivot early before resources are wasted. At this critical stage, most founders lack the financial means to bring on seasoned experts and often haven’t yet gained real-world exposure. Mentorship allows me to fill that gap, offering guidance that accelerates their learning curve and increases the chances of meaningful, sustainable impact."

Jason Ethier, EnergyTech Nexus

Jason Ethier is the founding partner of EnergyTech Nexus, through which he has mentored numerous startups and Innovation Awards finalists, including Geokiln, Energy AI Solutions, Capwell Services and Corrolytics. He founded Dynamo Micropower in 2011 and served as its president and CEO. He later co-founded Greentown Labs in Massachusetts and helped bring the accelerator to Houston.

"Being a mentor means using my experience to help founders see a clearer path to success. I’ve spent years navigating the ups and downs of building companies, struggling with cash flow, and making all the mistakes; mentoring gives me the chance to share those lessons and show entrepreneurs the shortcuts I wish I’d known earlier," Ethier says. "At Energytech Nexus, that role goes beyond just helping individual founders — it’s about creating a flywheel effect for Houston’s entire innovation ecosystem."

Jeremy Pitts, Activate Houston

Jeremy Pitts serves as managing director of Activate Houston, which launched in Houston last year. He was one of the founders of Greentown Labs in the Boston area and served in a leadership role for the organization between 2011 and 2015. Through Activate, he has mentored numerous impactful startups and Innovation Awards finalists, including Solidec, Coflux Purification, Bairitone Health, Newfound Materials, Deep Anchor Solutions and others.

"Being a mentor to me is very much about supporting the person in whatever they need. Oftentimes that means supporting the business—providing guidance and advice, feedback, introductions, etc," But just as important is recognizing the person and helping them with whatever challenges they are going through ... Sometimes they need a hype man to tell them how awesome they are and that they can go do whatever hard thing they need to do. Sometimes they just need an empathetic listener who can relate to how hard these things are. Being there for the person and supporting them on their journey is key to my mentorship style."

Joe Alapat, Liongard

Joe Alapat founded and serves as chief strategy officer at Houston software company Liongard and chief information officer at Empact IT, which he also owns. He mentors through Founder Fridays Houston Group, Software Day by Mercury Fund, SUPERGirls SHINE Foundation, Cup of Joey and at the Ion. He's worked with founders of FlowCare, STEAM OnDemand, Lokum and many other early stage startups.

"Being a mentor to me means unleashing an individual’s 10x—their purpose, their ikigai (a Japanese concept that speaks to a person’s reason for being)," Alapat says. "Mentoring founders in the Houston community of early stage, high-growth startups is an honor for me. I get to live vicariously through a founder’s vision of the future. Once they show me that compelling vision, I’m drawn to bring the future forward with them so the vision becomes reality with a sense of urgency."

Neal Dikeman, Energy Transition Ventures

Neal Dikeman serves as partner at early stage venture fund Energy Transition Ventures, executive in residence at Greentown Labs, and offices in and supports Rice Nexus at the Ion. He mentors startups, like Geokiln, personally. He also mentored Helix Earth through Greentown Labs. The company went on to win in the Smart Cities, Transportation & Sustainability contest at SXSW earlier this year. Dikeman has helped launch several successful startups himself, most recently serving on the board of directors for Resilient Power Systems, which was acquired by Eaton Corp for $150 million.

"Founders have to find their own path, and most founders need a safe space where they can discuss hard truths outside of being 'on' in sales mode with their team or board or investors, to let them be able to work on their business, not just in it," Dikeman says.

Nisha Desai, Intention

Nisha Desai serves as CEO of investment firm Intention and mentors through Greentown Labs, TEX-E, Open Minds, the Rice Alliance Clean Energy Accelerator, Avatar Innovations and The Greenhouse. She currently works with founders from Solidec, Deep Anchor Solutions, CLS Wind and several other local startups, several of which have been nominated for Innovation Awards this year. She's served a board member for Greentown Labs since 2021.

"When I first started mentoring, I viewed my role as someone who was supposed to prevent the founder from making bad decisions. Now, I see my role as a mentor as enabling the founder to develop their own decision-making capability," Desai says. "Sometimes that means giving them the space to make decisions that might be good, that might be bad, but that they can be accountable for. At the end of the day, being a mentor is like being granted a place on the founder's leadership development journey, and it's a privilege I'm grateful for."

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The Houston Innovation Awards program is sponsored by Houston City College Northwest, Houston Powder Coaters, FLIGHT by Yuengling, and more to be announced soon. For sponsorship opportunities, please contact sales@innovationmap.com.