This year, seven of the 10 most-promising life science companies are based in Houston. Photo courtesy of Rice Alliance

Rice University played host this week to the 12th annual Texas Life Science Forum, where life science leaders and startup founders could network, learn and present pitches on their solutions to a wide array of health-related issues.

Hosted by Rice Alliance for Technology and Entrepreneurship and BioHouston on November 7, the event brought together more than 600 attendees for a series of keynote speakers and panels. This year, 45 early-stage therapeutic, diagnostic, medical device and digital health companies—many of which are based in Houston—also pitched their concepts.

Fort Worth-based AyuVis Research walked away from the event with the two top recognitions: The Michael E. DeBakey Memorial Life Science Award and the People's Choice Award. The company, which has developed a small molecule immunotherapy targeting bronchopulmonary dysplasia (BPD) in preterm neonates and other respiratory disorders. The company is raising a $20 million Series A round to support its clinical development and is slated to pitch at IGNITE Health’s Fire Pitch 2023 today, November 9, at the Ion.

Each year the Rice Alliance and BioHouston also name its 10 most promising life science companies, selected by investors—seven out of 10 of which are based in Houston. This year's selection included the following companies, in alphabetical order:

  • 7 Hills Pharma: This Houston-based clinical stage immunotherapy company has developed the concept of allosteric activation of integrins to facilitate cell adhesion and promote immune responses. The concept has uses in preventing infection and cancer, and increasing the effectiveness of oncology drugs and infectious disease vaccines.
  • Bairitone Health: This Houston-based company is building a scalable diagnostic system for sleep apnea anatomy utilizing home-use wearable, passive Sonar technology and AI techniques.
  • Diakonos Oncology: Also based in Houston, Diakonos' Dendritic Cell Vaccine was awarded the FDA’s Fast Track designation. The clinical-stage biotech company's immunotherapies have shown early successes for hard-to-reach, aggressive cancers like Glioblastoma Multiforme.
  • Mongoose Bio: With more than 20 years of research, Mongoose specializes in T cell-based therapies for diverse solid tumors TCR-based therapies in cancer patients. The Houston-based company has developed an immunopeptidome discovery platform for TCR-based therapies in cancer patients.
  • Nandi Life Sciences: Nandi is developing antibodies for Avastin-resistant ovarian cancer, with
  • further application in breast, colorectal and lung cancer. The company is based out of Texas Medical Center Innovation.
  • NKILT Therapeutics: This Houston-based company's seed-stage cell therapy has applications in solid tumors, such as colorectal cancer, ovarian cancer, clear cell renal carcinoma, endometrial
  • cancer and more. It is developing a novel and proprietary Chimeric ILT-Receptor.
  • NuVision Biotherapies: Based in the United Kingdom, NuVision has developed and proven a treatment for dry eye disease. It's known for its Omnigen and OmniLenz products and is raising a series A to scale, take the business to profitability and exit.
  • Panakeia Technologies: Also based in the UK, Panakeia has developed an AI-based software that can provide multi-omic biomarkers in minutes. Currently this process takes days or weeks. It's RuO platform can identify 4,500 known multi-omics cancer markers.
  • Taurus Vascular: A recent spin-out of the Texas Medical Center Innovation Biodesign program, Taurus is developing a novel, catheter-based solution for treating endoleaks, which can be related to aortic aneurysms.
  • YAP Therapeutics: The only California-based company to make the cut, this preclinical-stage biotech develops genetic medicines that leverage the company’s tissue renewal and regeneration platform to reverse and cure severe diseases, including heart failure, pulmonary diseases, retinal degeneration and hearing loss.

Last year, Bairitone Health took home the DeBakey and People's Choice awards.

Want to work for one of the top startups in Houston? Some of the best in Houston are hiring. Photo by Tima Miroshnichenko from Pexels

Looking for a job? These 2023 Houston Innovation Awards finalists are hiring

calling all applicants

More than half of this year's startup finalists in the Houston Innovation Awards are hiring — who's looking for a job at one of the best startups in Houston?

When submitting their applications for the 2023 Houston Innovation Awards, which is taking place November 8 at Silver Street Studios, every startup was asked if it's hiring. Twenty-seven of the 35 startup honorees said yes, ranging from over 20 to just one positions open at each company.

Click here to secure your tickets to see which of these growing startups win.

Here's a look at which of the top startups in Houston are seeking new team members.

Double-digit growth

When it comes to the awards finalists looking to scale their team by 10 or more new hires, five finalists are growing rapidly.

Medical practice software platform RepeatMD, fresh off a $40 million raise — which included participation from Houston-based Mercury — is reportedly growing its team. The company, which has 115 employees already, is looking for over 20 new hires.

Female-owned business Feelit Technologies, which is using nanotechnology for preventive maintenance to eliminate leaks, fires and explosions, increase safety and reduce downtime, has 50 employees, and only three of which are in Houston – for now. The company hopes to grow its team by 12 to 15 employees in Houston alone.

Square Robot, an energy industry-focused robotics company that recently grew its presence in Houston, is hiring 10 to 30 new team members. It has 24 employees already in Houston.

Solugen, an alternative chemicals business, has around 140 of its 200 employees in Houston. The company, which has raised over $600 million to date, is hiring an additional 10 to 15 new hires.

Additionally, Blue People, also a finalist in last year's awards, is hiring 25 new employees. The company was founded in 2015 in Mexico and relocated its primary operations to Houston in 2020. Blue People, which develops software innovation for its clients, has over 150 employees — 10 of whom, including C-level executives, are based in Houston. Some of the company's new hires will be based in town.

Steady growth

Four Houston startups are hiring within the six to 10 team member range — all with fairly significant employee counts already.

A finalist in last year's awards too, Venus Aerospace, a hypersonics company on track to fly reusable hypersonic flight platforms by 2024, is again growing its team. With 48 on-site employees and 23 working remotely, Venus's team will add another five to 10 employees.

Syzygy Plasmonics, a deep decarbonization company that builds chemical reactors designed to use light instead of combustion to produce valuable chemicals like hydrogen and sustainable fuels, has 112 employees in Houston and plans to hire another eight to its team.

Lastly, Fervo Energy, which recently raised $10 million, has 63 full-time employees (34 in Houston, 29 outside of Houston) and looking to hire seven more.

Seeking selectively

The following awards finalists are looking to grow their teams by just a handful or so — between one and five — of new hires:

  • ALLY Energy, helping energy companies and climate startups find, develop, and retain great talent.
  • CaseCTRL, an AI-powered surgery scheduling and coordination software for optimized procedures.
  • CellChorus, using AI to evaluate immune cell function and performance to improve the development and delivery of therapeutics.
  • FluxWorks, making frictionless gearboxes for missions in any environment.
  • Helix Earth Technologies, decarbonizing the built environment and heavy industry.
  • Hope Biosciences, a clinical stage biotechnology company focused on the development and delivery of adult stem cell based therapeutics.
  • Innovapptive, empowering the deskless workers in operations, maintenance and warehouses by unlocking the power of SAP through mobility.
  • INOVUES, re-energizing building facades through its non-invasive window retrofit innovations, making building smarter, greener, and healthier for a better and sustainable future.
  • Koda Health, , a tech-enabled care coordination service to improve serious illness care planning and drive savings for value-based care at scale.
  • Molecule, an energy/commodity trading risk management software that provides users with an efficient, reliable, responsive platform for managing trade risk.
  • Rhythm Energy, 100 percent renewable electricity service for residential customers in Texas.
  • Starling Medical, bringing the future of a proactive and predictive home-based healthcare system to patients today through passive AI powered at home urine screening.
  • Taurus Vascular, pioneering a new era of aortic aneurysm treatment by developing minimally invasive catheter solutions to drive better long-term patient outcomes.
  • Tierra Climate, decarbonizing the power grid faster by helping grid-scale batteries monetize their environmental benefits and change their operational behavior to abate more carbon.
  • UpBrainery Technologies, an innovative educational technology company that provides personalized and adaptive learning experiences to learners
  • Utility Global, a technology company converting a range of waste gases into sustainable hydrogen and syngas.
  • Voyager Portal, helping commodity shippers identify root causes of demurrage, reduce risk and streamline the entire fixture process.

This week's roundup of Houston innovators includes Erik Ibarra of Magnolia Fund, Matthew Kuhn of Taurus Vascular, and Libby Covington of The Craig Group. Photos courtesy

3 Houston innovators to know this week

who's who

Editor's note: In this week's roundup of Houston innovators to know, I'm introducing you to three local innovators across industries — from investment to biodesign — recently making headlines in Houston innovation.

Erik Ibarra, founder of Magnolia Fund

Erik Ibarra's latest venture is to give agency to residents in the neighborhood he grew up in. Photo courtesy

For years, Erik Ibarra has watched Houston's East End — La Segunda Barrio — evolve. Now, with tons of construction in the works, he's got a plan for a business that will tap into existing residents to give them ownership of their community.

Ibarra started Magnolia Fund, a mission-driven investment fund dedicated to enriching the East End community and preserving the neighborhood's culture and history. Ibarra, who has lived in the area the majority of his life, says on the Houston Innovators Podcast, that he's looking to turn residents into investors.

"Over the years, I've felt like there's so much development going on. But, the people from the neighborhood are very often just passive — they don't get a chance to benefit from or think about how they could participate in these new developments," Ibarra says. "The neighborhood is very close to my heart, and, about a year ago, I realized I wanted to do something about this." Read more.

Matthew Kuhn, co-founder of Taurus Vascular

A new innovation out of the Texas Medical Center's Biodesign Program is enhancing efficacy of a life-saving aortic aneurysm rupture procedure. Photo courtesy

As part of the current class of the TMC Innovation Biodesign Program, fellows Matthew Kuhn and his co-founder Melanie Lowther were tasked with creating a biomedical company in a year. The founders came up with Taurus Vascular, a medical device company that improves efficacy of abdominal aortic aneurysms treatment.

“It used to be if you had a AAA, you had a gnarly procedure,” Kuhn tells InnovationMap, which included a large incision across the abdomen. The standard treatment, endovascular aneurysm repair, or EVAR, eliminated that, but its problem is that it often results in endoleaks. As many as 20 percent of patients need another EVAR within five years.

Taurus Vascular’s technology improves on EVAR by placing a self-deploying stent to create a drainage pathway between the high-pressure aneurysm sac and a low-pressure nearby vein — mitigating the adverse impact of endoleaks that would otherwise cause the aneurysm to continue to grow. The simple solution will allow patients to live longer, healthier lives after their procedure. Read more.

Libby Covington, partner at The Craig Group

Houston expert shares how to use your data to improve your marketing efforts. Photo courtesy

Data can be hard to tap into when you're working within B2B sales, writes Libby Covington in a guest column for InnovationMap.

"When focusing on revenue growth in business to business companies, analyzing data to develop and optimize strategies is one of the biggest factors in sales and marketing success," she writes. "However, the process of evaluating B2B data differs significantly from that of B2C, or business to consumer. B2C analysis is often straightforward, focusing on consumer behavior and e-commerce transactions."

In her column, Covington shares her advice on navigating this process. Read more.

A new innovation out of the Texas Medical Center's Biodesign Program is enhancing efficacy of a life-saving aortic aneurysm rupture procedure. Photo via Getty Images

Houston biodesign innovators ready to spin out startup with life-saving vascular tech

heartbreak healers

Yes, you can die of a broken heart — although it's not in the hyperbolic way you might be thinking. Fewer than 20 percent of people who have an aortic aneurysm rupture survive the event. But aortic aneurysms can be treated if they’re caught before they burst. A new Houston company is devoted to a novel solution to helping patients with abdominal aortic aneurysms (AAA).

That company is Taurus Vascular. As part of the current class of the TMC Innovation Biodesign Program, fellows Matthew Kuhn and Melanie Lowther were tasked with creating a biomedical company in a year. The founders started their journey last August. At the end of this month, they'll be kicked out of the nest, Kuhn tells InnovationMap. Taurus is also in Rice University's 2023 cohort of OwlSpark, an ongoing summer program for startups founders from the Rice community.

Kuhn is a biomedical engineer who just scored his forty-fifth patent. The CEO says that he hit it off quickly with his co-founder and COO, Lowther, former director entrepreneurship and innovation at Texas Children’s Hospital.

Matthew Kuhn and Melanie Lowther co-founded Taurus Vascular as TMC Biodesign fellows. Photos via taurusvascular.com

Members of the Biodesign Program are paid a livable stipend to devote themselves fully to creating a pioneering company. Kuhn says that he became interested in finding a more effective way to heal AAAs during his four and a half years as a project leader at the Center for Device Innovation at the Texas Medical Center.

“It was ripe for innovation and we landed on a concept of some merit,” he says.

The current standard of care for AAAs is EVAR, or endovascular aneurysm repair, in which a surgeon inserts a stent to relieve pressure on the aneurysm.

“It used to be if you had a AAA, you had a gnarly procedure,” he says, which included a large incision across the abdomen. EVAR eliminated that, but its problem is that it often results in endoleaks. As many as 20 percent of patients need another EVAR within five years.

Taurus Vascular’s technology improves on EVAR by placing a self-deploying stent to create a drainage pathway between the high-pressure aneurysm sac and a low-pressure nearby vein — mitigating the adverse impact of endoleaks that would otherwise cause the aneurysm to continue to grow. The simple solution will allow patients to live longer, healthier lives after their procedure.

Kuhn says that being in Houston has been and will continue to be instrumental in his company’s success. Part of that, of course, is his relatively cosseted status as a founder in the Innovation Biodesign Program. But he says that the industry as a whole has become almost like a family.

“It feels very different from startup life for other industries where it feels competitive,” he explains. "You have to be a little crazy to start a medical device company and there’s a sense that we’re all in the same boat. People are so generous with their time to share resources. I feels like I have 100 co-founders."

Following the end of Taurus Vascular’s time in the program that helped conceived it, its founders will remain in the same building, continuing to work to support their technology. The next step is raising a seed round that will pay for the company’s chronic animal studies. Because Taurus Vascular is producing a Class III medical device, its approval process to get to market is the most stringent the FDA has.

The goal is to be commercial by 2030, says Kuhn. By then, Taurus Vascular will have healed many a heart.

Four Houston accelerators will be working together this summer to advance nearly 30 university-associated startups. Photo via UH.edu

Houston universities reveal teams for summer accelerators

bayou startups

The University of Houston and Rice University have announced the cohorts for their summer accelerators that advance university-founded startups and small businesses.

The two schools run four programs in tandem with each other every summer for about a decade. There are nearly 30 companies this year being accelerated across the four programs, which are:

  • Rice's OwlSpark is focused on early-stage startup teams.
  • UH's RED Labs is focused on early-stage startup teams.
  • Rice's BlueLaunch is focused on non-tech small businesses.
  • UH's RED Launch is focused on non-tech small businesses.

"A very cool part of the program is that we partner every summer with Rice University's OwlSpark and Blue Launch," says Liana Gonzalez-Schulenberg, managing director of RED Labs. "It creates this really incredible network across the universities and allows both schools to bolster and benefit from each other.

"We share staff, we share mentors, we share speakers, we co-host the demo day, and we even share the catering bill," she continues. "It's a really special part of the program that I think has brought endless value to the founders, the universities, and Houston."

The 12-week program takes each of the teams — all of which have a university-affiliated founder, from undergrad to faculty — through key programming and mentorship. The final event includes a pitch day, called the Bayou Startup Showcase, where all of the companies share their business plans they've created through the program.

“I’m excited to support these new ventures with highly curated offerings and rich mentorship, propelling them to commercial success,” said Jessica Fleenor, managing director of BlueLaunch and OwlSpark. "We have built a long-standing culture of advocacy and collaboration, and look forward to upholding that in our largest cohort to date."

The selected companies for the four programs are as follows.

RED Labs (cohort 11)

  • We Felt It 3-D prints customized modifications to mobility devices like canes, walkers, and wheelchairs that maximizes comfort during use.
  • Zoop makes nutrition easy, clean and sustainable smoothie premixes which can be consumed anywhere and anytime by just mixing it with any of the preferred mixer (Water, Vegan milk, Milk, etc.)
  • Orbit is an application that allows users to understand the stock market through practice and training.
  • Team X is creating a company around nanoporous membrane technologies that recovers metals from wastewater and brine.

OwlSpark (cohort 11)

  • Terradote will manufacture cost-competitive, petroleum-free chemicals using captured carbon dioxide, methane and renewable bio-based materials.
  • Biomethanator’s biofilm bioreactors utilize biomethanation to convert industrial-waste carbon dioxide to methane, which can be used as fuel or in other industrial applications.
  • TaurusVascular is developing a minimally invasive catheter for addressing the most pressing complication of endovascular aortic aneurysm repair: endoleaks.
  • Voythos offers a mobile physician companion that monitors electronic medical records, prompting action and initiating care workflows.
  • AiKYNETIX is developing a video analytics platform for human motion insights, focusing on a mobile running lab for runners and coaches.
  • AllStars is building an affect-sensitive educational tool for self-studying and blended classroom learning.
  • EurekaHub is developing a marketplace where data and research scientists can publish, manage, share and revise analytical models for data sets across diverse applications.
  • ScoutBetter is an end-to-end recruiting platform that connects students with corporate campuses and provides recruiters access to university talent.

RED Launch (cohort 2)

  • CurioSweets is a vegan dessert brand that provides wholesale desserts and services including: consultation; recipe development; and contract baking of their product.
  • SpaceCityVinyl is a vehicle wrapping business that offers a quick and non permanent color change of vehicles.
  • Venus by Design is a handmade jewelry company
  • First Byte Digital consulting firm that helps mom and pop restaurants and non-profits establish a robust online presence by offering a wide range of digital conversion services.
  • 2tinys designs, prints, and cuts stickers with the plan of expanding into art prints and stationery items.
  • Lacey's Art paints dog portrait artwork. They partner with shelters to find models (and provide some help to getting the dog adopted), and then sells the prints.

BlueLaunch (cohort 2)

  • Archway Family Medicine provides medical care to patients through a monthly membership model known as direct primary care.
  • rdy helps communities recover from disasters faster and more equitably by working with local organizations to plan for them.
  • 610Smokehouse is a mobile food service and catering company that serves “Texan Fusion,” a unique cuisine that combines traditional Texas barbecue with diverse Houston food.
  • SerendipityPicnic is a unique picnic with all the goodies and essentials wrapped in a beautiful, lightweight, easy-to-carry and reusable “BlanKIT.”
  • La Mer Macaron offers an assortment of homemade French macarons.
  • TenTwelve provides residential construction and remodeling services.
  • DHA America customizes, designs and sells powder-coated and galvanized fence panels, posts and accessories.
  • All About Baby provides bespoke tableware for babies transitioning to solid foods.
  • MeowPlanet is opening a cat lounge.

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CultureMap Emails are Awesome

Texas Space Commission launches, Houston execs named to leadership

future of space

Governor Greg Abbott announced the Texas Space Commission, naming its inaugural board of directors and Texas Aerospace Research and Space Economy Consortium Executive Committee.

The announcement came at NASA's Johnson Space Center, and the governor was joined by Speaker Dade Phelan, Representative Greg Bonnen, Representative Dennis Paul, NASA's Johnson Space Center Director Vanessa Wyche, and various aerospace industry leaders.

According to a news release, the Texas Space Commission will aim to strengthen commercial, civil, and military aerospace activity by promoting innovation in space exploration and commercial aerospace opportunities, which will include the integration of space, aeronautics, and aviation industries as part of the Texas economy.

The Commission will be governed by a nine-member board of directors. The board will also administer the legislatively created Space Exploration and Aeronautics Research Fund to provide grants to eligible entities.

“Texas is home to trailblazers and innovators, and we have a rich history of traversing the final frontier: space,” Lieutenant Governor Dan Patrick says in a news release. “Texas is and will continue to be the epicenter for the space industry across the globe, and I have total confidence that my appointees to the Texas Space Commission Board of Directors and the Texas Aerospace Research and Space Economy Consortium Executive Committee will ensure the Texas space industry remains an international powerhouse for cutting-edge space innovation.”

TARSEC will independently identify research opportunities that will assist the state’s position in aeronautics research and development, astronautics, space commercialization, and space flight infrastructure. It also plans to fuel the integration of space, aeronautics, astronautics, and aviation industries into the Texas economy. TARSEC will be governed by an executive committee and will be composed of representatives of each higher education institution in the state.

“Since its very inception, NASA’s Johnson Space Center has been home to manned spaceflight, propelling Texas as the national leader in the U.S. space program,” Abbott says during the announcement. “It was at Rice University where President John F. Kennedy announced that the U.S. would put a man on the moon—not because it was easy, but because it was hard.

"Now, with the Texas Space Commission, our great state will have a group that is responsible for dreaming and achieving the next generation of human exploration in space," he continues. "Texas is the launchpad for Mars, innovating the technology that will colonize humanity’s first new planet. As we look into the future of space, one thing is clear: those who reach for the stars do so from the great state of Texas. I look forward to working with the Texas Space Commission, and I thank the Texas Legislature for partnering with industry and higher education institutions to secure the future of Texas' robust space industry."

The Houston-area board of directors appointees included:

  • Gwen Griffin, chief executive officer of the Griffin Communications Group
  • John Shannon, vice president of Exploration Systems at the Boeing Company
  • Sarah "Sassie" Duggleby, co-founder and CEO of Venus Aerospace
  • Kirk Shireman, vice president of Lunar Exploration Campaigns at Lockheed Martin
  • Dr. Nancy Currie-Gregg, director of the Texas A&M Space Institute

Additionally, a few Houstonians were named to the TARSEC committee, including:

  • Stephanie Murphy, CEO and executive chairman of Aegis Aerospace
  • Matt Ondler, president and former chief technology officer at Axiom Space
  • Jack “2fish” Fischer, vice president of production and operations at Intuitive Machines
  • Brian Freedman, president of the Bay Area Houston Economic Partnership and vice chairman of Wellby Financial
  • David Alexander, professor of physics and astronomy and director of the Rice Space Institute at Rice University

To see the full list of appointed board and committee members, along with their extended bios, click here.

City of Houston approves $13M for new security tech at renovated IAH​ terminal

hi, tech

A new terminal currently under construction at George Bush Intercontinental Airport just got the green light for new security technology.

This week, Houston City Council unanimously approved the funding for the new Mickey Leland International Terminal's security equipment. The Mickey Leland International Terminal Project is part of the $1.43 billion IAH Terminal Redevelopment Program, or ITRP, which is expected to be completed by early next year.

This new IAH International Terminal will feature an International Central Processor, or ICP, with state-of-the-art technology in a 17-lane security checkpoint — among the largest in the country — as well as ticket counters and baggage claim.

“Houston Airports strives to get passengers through TSA Security in 20 minutes or less. Today, we meet that goal at Bush Airport more than 90 percent of the time,” Jim Szczesniak, director of aviation for Houston Airports, says in a news release. “This investment in innovative technology will enhance our efficiency and ensure that our passengers have a world-class experience each time they visit our airports.”

Going through security at IAH is about to be smoother sailing. Rendering courtesy of Houston Airports

The funding approval came from two ordinances, and the first one appropriates $11.8 million from the Airports Improvement Fund to buy, service, install, and train staff on nine new automated screening lanes, called Scarabee Checkpoint Property Screening Systems, or CPSS.

Per the news release, each of these CCPS automated lanes "is capable of screening more than 100 additional people and bags/hour than existing equipment used today." Currently, Terminal D's TSA is using eight CPSS Lanes, so the additional nine lanes will bring the total to 17 lanes of security.

The other appropriates another $1.2 million from the Airports Improvement Fund to buy, install, maintain, and train staff on six new Advanced Imaging Technology Quick Personnel Security Scanners.

The new scanners, which don't require the traveler to raise their arms, "is capable of screening more than 100 additional people/hour than existing equipment used today," per the release.

“These new security screening machines are faster, have fewer false alarms and have improved detection rates, which creates a safer experience for our passengers and airlines,” Federal Security Director for TSA at IAH Juan Sanchez adds.

The Mickey Leland International Terminal originally opened in 1990 and is currently under renovation. Rendering courtesy of Houston Airports

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

dollar signs

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.