Texas has the 5th highest health care costs in the nation, Forbes says

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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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Houston ranks among world’s top 30 emerging startup ecosystems

Startup Status

Long known as the Energy Capital of the World, Houston also ranks among the world’s top 30 emerging startup ecosystems, according to a new report.

The report from Startup Genome, a research and advisory organization, doesn’t assign a specific numeric ranking to Houston’s startup ecosystem. Rather, it puts Houston in the ranking range of 21 to 30 for emerging ecosystems. Startup Genome weighed factors such as early-stage funding, performance and talent to identify the top emerging ecosystems.

Houston also gained notice for being one of the world’s 20 emerging ecosystems with at least four unicorn startups in the past 10 years. Houston and nine other ecosystems each had four unicorns.

According to StartupBlink, a startup research platform, Houston’s startup ecosystem grew 24 percent in 2025, with over 1,300 startups and total startup funding exceeding $808 million. StartupBlink places Houston at No. 46 among the world’s top 100 startup ecosystems.

In a recent post on LinkedIn, David Horsup, executive in residence at the Rice Alliance Clean Energy Accelerator, wrote that Houston “has all the ingredients to be wildly successful if it stays true to its differentiated pillars that drive the economy — energy, medical, and aerospace.”

Mumbai topped Startup Genome’s list of emerging ecosystems, followed by Istanbul, Madrid, Salt Lake City-Provo and Barcelona. After Salt Lake City-Provo, the top U.S. ecosystems were Phoenix, Detroit, Minneapolis and Las Vegas.

Silicon Valley led Startup Genome’s ranking of the world’s top established ecosystems, followed by New York City, London, Tel Aviv and Boston. Austin landed at No. 18 in this category and Dallas at No. 27.

“For much of the past decade, this report has chronicled the welcome dispersion of opportunity beyond the traditional hubs,” Startup Genome writes. “That trend has not died — but it has been complicated. Capital and scale are consolidating once more, particularly in the United States, and the gap between leading and emerging ecosystems is widening.”

KBR names C-suite duo to lead $5.3B government services spinoff

new leaders

In advance of the spinoff of its Mission Technology Solutions unit, Houston-based KBR has made two C-suite hires for the new business.

Michael LaRouche is coming aboard as president and CEO of the spinoff, currently called SpinCo, on Sept. 26. Nicholas Veasey is joining as executive vice president and chief financial officer on July 1.

“Michael and Nick bring a highly complementary combination of operational leadership, financial expertise, and mission-driven experience, and together they will accelerate our impact for stakeholders,” Stuart Bradie, chairman, president and CEO of publicly traded KBR, said in a news release.

LaRouche currently is CEO of Serco North America, a Herndon, Virginia-based government services contractor. Veasey most recently was CFO of MAG Aerospace, a Fairfax, Virginia-based defense contractor.

SpinCo, a government services contractor, will launch with more than $5.3 billion in annual revenue and 20,000 employees. KBR’s total headcount is around 36,000. Branding for SpinCo, including a formal name, will be revealed in July.

“SpinCo is positioned as a top-tier provider of differentiated technology solutions, anchored by deep mission expertise, global scale, and a relentless commitment to delivering for our customers,” LaRouche says.

After the spinoff, the slimmed-down KBR will focus on its Sustainable Technology Solutions business, a provider of energy and industrial technology that generated $2.5 billion in revenue in 2025. Bradie will remain chairman, president and CEO of the business.

Both SpinCo and the new KBR will be public companies. The spinoff is scheduled to be completed in January.

Experts: Houston's VC ecosystem has set the foundation — now we need scale

guest column

Fervo Energy went public earlier this summer. The Houston geothermal company priced its IPO at $27 per share, raised $1.89 billion, and opened the next morning at a market capitalization north of $10 billion. By most measures, it is the largest venture-backed cleantech IPO in history and an unambiguous win for Houston. It’s also a useful moment to look at where Houston's venture ecosystem stands and where it can go. The highlight: Houston's venture ecosystem has real foundations and, with increased company formation activity, can grow into the scale our city's ambitions deserve.

A Houston energy story in the national recovery

The recent uptick in Houston venture activity follows national trends. U.S. venture deal count contracted roughly 22 percent from its 2021 peak through 2024 before rebounding to about 16,700 rounds in 2025. Houston's 23 percent increase in VC funding from 2023 to 2024 is part of a national recovery of comparable magnitude over the same time window.

The energy sector is where Houston exhibits unique trends—and where the story turns clearly positive. (Houston's strong health and space sectors deserve their own separate consideration.) By deal count, energy-related rounds have accounted for 15 to 20 percent of Houston activity, roughly consistent over the past few years.

By capital, energy's share surged from about 14 percent in 2023 to over 60 percent in 2025, driven by a small number of large Houston-headquartered rounds, primarily in geothermal and related technologies. Fervo is the obvious anchor, but Sage Geosystems, Quaise Energy, Zeta Energy, Vaulted Deep, Applied Carbon and Mariana Minerals have all closed meaningful rounds. Houston is concentrated and accelerating as an energy capital market, an invaluable position to build upon.

From foundation to scale

The institutional pieces are in place. Greentown Labs, Activate, the Ion and others have built sector-specialized infrastructure most cities would struggle to assemble. Fervo itself is an alum of both Activate and Greentown Labs. Mercury Fund closed its $160 million Fund V, its largest ever. Houston Angel Network, GOOSE Capital, Fathom Fund, and broader pre-seed and seed capital coverage are here. The Houston $10 million-plus Series A list now includes 40 rounds since 2021, which break roughly into two eras. While 2021 to 2022 was biotech-heavy, with companies like Sporos Bioventures, RadioMedix, Cellenkos and Coya Therapeutics, 2024 to 2025 has tilted clearly toward energy, climate, and critical minerals, with Vaulted Deep, Applied Carbon, Mariana Minerals, Sage Geosystems and Ignis H2 Energy among them.

What’s less developed is the volume of seed-stage companies flowing into that capital. Imagine a dozen more Fervos coming out of that infrastructure over the next decade, each generating jobs, recycled founder capital, and the next wave of operators and angel investors. That is the kind of opportunity Houston has within reach if we build the company-formation pipeline to feed it. To be relevant on the national stage as a venture market, and to drive an economy the size of Houston's into the 2030s, the city needs to be doing closer to 20 Series A rounds per month rather than per year. That throughput implies roughly 1,000 seed rounds per year, feeding the funnel at a 20 percent to 30 percent graduation rate. Reaching such throughput depends on how many new founders Houston produces and how quickly our innovation ecosystem can help them achieve lift-off.

Houston in context

The comparative picture brings the scaling challenge into focus. Between 2021 and 2024, Houston-area startups closed between 126 and 153 disclosed venture rounds per year, against a national count between 9,854 and 14,125. That places Houston at a little over 1 percent of the U.S. deal count. For comparison, Austin ran about three times Houston's deal count each year.

At the Series A level, Houston closed between 12 and 24 rounds in any given year. The median Houston Series A across the period was about $10.7 million, compared with $15.4 million in San Francisco. Houston founders are raising fewer and smaller Series A rounds than founders in peer metros, which points directly to where Houston has the most room to grow.

The unicorn picture tells the same story. From 2021 through 2025, the U.S. produced 590 venture-backed unicorns. Four were Houston-based: Solugen and Axiom Space in 2021, Cart.com in 2023, and Fervo Energy in 2024. Adding HighRadius from 2020 brings Houston's all-time total to five. Austin added 19 over the same five-year window. The path from here is to make Houston's entries on lists like these less the exception and more the rule.

Where this leads

Houston has a real opportunity to become the deepest, most credible energy and climate capital market in the country, with the company formation, talent and operator density to support it. The data shows the foundation is already in place. Fervo, Solugen and the growing roster of energy-adjacent Series A graduates are proof. Fervo's IPO is the first of what should be many. Houston has not had a venture-backed cleantech liquidity event of this scale before, and the city now has one to reference, recruit against and build on. With increased company formation at the seed and pre-seed stages, a Fervo-scale outcome need not be a generational event in Houston, but instead, it can become part of a chain reaction powering the city's economy.

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Stephanie T. Schmidt, PhD, is the founder of a stealth startup, a Venture Fellow at Energy Transition Ventures, and an Executive MBA candidate at Rice University's Jones Graduate School of Business. Lawson Gow is the Chief Operating Officer of Greentown Labs. The full Houston VC landscape report is available at Energy Transition Ventures and CleanTech.Org.

Sources: Crunchbase, PitchBook-NVCA, Carta
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