Fifteen of Houston Innovation Awards finalists share the best advice they've given or received. Photo via Getty Images

The startup journey is a long and winding road, and there's many ways to navigate it. Fifteen of this year's finalists have shared what their most valuable startup advice for their fellow Houston founders.

From the importance of mentorship to tips for female and BIPOC founders, these pearls of wisdom come directly from a selection of finalists across a handful of categories, including DEI Champion, BIPOC-Owned Business, Female-Owned Business, and Mentor of the Year.

Read these excerpts of advice from Houston's innovation community's top startup founders and supporters.

Click here to secure your tickets to the November 8 event where we'll name the 2023 Houston Innovation Awards winners.

"Be comfortable with asking for and accepting help. This journey is a marathon, not a sprint, but helping yourself with supportive people around is critical." — Cameron Carter of Rosarium Health, a BIPOC-Owned Business finalist

"Underrepresented founders often have trouble asking for what they want or deserve. ... Don't be scared to ask for what you want, or what you believe you deserve." — Pedro Silva of Milkify, a BIPOC-Owned Business finalist

"It's not 'fake it' until you make it. It's 'take it' until you make it. Be proud to be you." — Pamela Singh of CaseCTRL, a BIPOC-Owned Business finalist

"When starting a company, remember it’s a game of attrition. The best way to last longer than your nearest neighbor is to find your tribe." — Aaron Fitzgerald of Mars Materials, a BIPOC-Owned Business finalist

"Know your worth and add tax. Choose your partners wisely — at home and work. Invest in the best stock you own: YOU." — Katie Mehnert of ALLY Energy, a Female-Owned Business finalist

"Whatever battle you're fighting now that no one knows about — go ahead and WIN the war." — Shoshi Kaganovsky of Feelit Technologies, a Female-Owned Business finalist

"My advice would be to find truly effective mentors who are willing to open up their network for you. It doesn't matter if the mentors are men or women — what matters is that they genuinely care about your professional success and who you are as a person." — Tatiana Fofanova of Koda Healthcare, a Female-Owned Business finalist

"Remember...There are a BILLION ways to apply sunscreen, but no matter how you apply it, it ALL protects you from the sun. Like sunscreen, there are infinite ways to succeed in the startup world. Trust your gut, stick to your vision, and keep trying until you find what works for you. ... Your purpose and vision should be your North Star, guiding decisions in team-building, coaching, and creating a company culture. Stick to that purpose—it's what will drive you through the rollercoaster of entrepreneurship." — Emily Cisek of The Postage, a Female-Owned Business finalist

"First and foremost, embrace your uniqueness. As a woman of color, you bring a distinctive perspective to the table. Your background is not just a part of who you are; it's a strength that sets you apart in a male-dominated industry. ... Resilience is your greatest ally. Challenges will arise, and it's okay to acknowledge them. What matters most is how you respond. Each obstacle is an opportunity for growth and learning. ... Lastly, trust yourself. You are not just running a business; you are shaping a narrative of empowerment and change." — Ghazal Qureshi of UpBrainery Technologies, a Female-Owned Business finalist

"Figure out, learn, and understand your mission inside and out and use it to make all your major business (and sometimes personal) decisions." — LaGina R Harris, founder and CEO of The Us Space and Mentor of the Year finalist

"Know your value and continue advocating for inclusion." — Janice Tran of Kanin Energy, a BIPOC-Owned Business finalist

"Be your true, authentic self. There are going to be some people that like what you are doing, and there's going to be some people that don't, but the biggest thing is being true to who you are, and that's always going to flourish more than being who someone else wants you to be." — Muriel Foster, director of gBETA Houston and Mentor of the Year finalist

"Until you hire someone, you are the one wearing the product manager hat. You've got to love the problem more than the solution." — Wade Pinder, founder of Product Houston and Mentor of the Year finalist

"Be the person your younger self needed. Representation really does matter. Be a listening ear, share your lessons, and allow people to blossom under your leadership." — Michelle Ngome, founder and president of the African American Marketing Association and DEI Champion finalist

"Embrace your unique perspective as a source of strength and innovation. ... In Houston's dynamic startup scene, your presence and contributions as a traditionally marginalized founder or investor are essential for driving innovation and diversity. By staying resilient, seeking support, and advocating for inclusivity, you can navigate the entrepreneurial journey and make a lasting impact on both your business and the broader community." — Jessica Adebiyi, diversity and professional development director at Womble Bond Dickinson and DEI Champion finalist

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.

Ghazal Qureshi's Houston-based startup has advanced to the semifinal round of a prestigious national competition. Photo courtesy of Idea Lab Kids

Houston-based educational startup secures seed funding, advances to next round in prestigious competition

Funding futures

A Houston startup has advanced to the semifinal round of an inaugural competition focused on promoting educational technology for K-12 students.

UpBrainery, an immersive educational technology platform that customizes lessons for students, received $20,000 in seed funding from the U.S. National Science Foundation’s Visionary Interdisciplinary Teams Advancing Learning (VITAL) prize challenge. The $6 million prize challenge is cosponsored by the Bill & Melinda Gates Foundation, Schmidt Futures, and the Walton Family Foundation.

“This incredible achievement reflects our commitment to pushing the boundaries of knowledge and technology,” UpBrainery states in a LinkedIn announcement.

In addition to the seed money, UpBrainery will be partnered with a mentor to help them improve the logistics of their exploratory learning and AI aided platform, with a focus on developing their minimum viable prototype.

“As we progress to the semifinal round, we remain committed to our mission. This recognition from the NSF further fuels our passion to continue pushing the boundaries and finding new ways to make a positive impact on society,” UpBrainery's LinkedIn post continues.

CEO and team leader Ghazal Qureshi, who was recently nominated for Forbes’ “50 Over 50: Impact” list, founded the career and technical education centered app in 2020. Offering online courses from the basics of culinary skills to sportscode gaming and programming, UpBrainery aims to spark students’ curiosity with the ultimate goal of helping them uncover their future career paths. Last year, Qureshi was named to Entrepreneur Magazine's 2022 Women of Influence list.

Upbrainery is among 54 teams that reached the semifinal round of the VITAL prize challenge, successfully emerging from the initial discovery round of which there were 100 teams. One other Texas-based startup moved forward to the semifinals, FabuLingua, an Austin based startup that employs science-based language learning tools in its mobile game for kids.

The final round of the competition will consist of 18 teams, all of which will be eligible for an additional $50,000 in seed funding. Three first place winning teams of the final round will each receive another $250,000 in seed funding.

Upbrainery recently joined a Houston-based accelerator, Softeq Ventures, earlier this year.

When it comes to innovation within education, trivia has a role to play, says this Houston edtech startup founder. Photo via Getty Images

Houston founder on the power of trivia when it comes to reliable education

guest column

Recently, our focus shifted towards quizzing — how to assess knowledge and retain information in the most innovative way possible. Personally, we are not in favor of low-level questions that simply rely on cramming, as they block away creativity. The primary motivation of traditional learning is punitive with high demands of simply, making the students read the content.

Castrophying effective learning with poor teaching methods has caused a stir of poor performance despite raging talent, the students perform badly. The question is why? Is quizzing not the proper assessment tool? Before we jump onto the bandwagon, let's understand the power of effective learning.

Effective learning and trivia

Using technological, societal, and cultural trends to upgrade from traditional white-board methods towards evolving modern technology is what leads to effective learning. With UpBrainery, we focus on technological advancements that personalize the experience to meet the unique needs and preferences of individual learners. The goal is to combine different strategies and approaches, including personalized learning, collaborative learning, multimodal learning, and accessible learning. These approaches may incorporate a variety of tools and technologies, such as adaptive learning platforms, online collaboration tools, virtual and augmented reality, and assistive technologies for learners with disabilities.

That being said, trivia can certainly be a valuable addition to a well-rounded learning approach. It can help learners stay engaged and motivated, while also stimulating memory, attention, creativity, and learning transfer. In the future, we may see more innovative and interactive forms of trivia-based learning, as well as new tools and technologies for supporting cognitive development and effective learning in a variety of contexts. How cool will that be?

Trivia and cognitive processes

Cognition refers to the mental processes involved in acquiring, processing, and using knowledge. Trivia can be a fun and engaging way to help individuals improve their memory skills.

By learning and recalling new facts, individuals can strengthen their ability to store and retrieve information, which can support learning and problem-solving in other areas. It helps individuals improve their attention skills by requiring them to focus on new information and recall it quickly. This can be particularly helpful for individuals with attention deficit disorders or other challenges that make it difficult to stay focused for extended periods of time.

Furthermore, it stimulates creativity by encouraging individuals to think outside the box and come up with new ways of connecting and interpreting information. By exploring new facts and ideas, individuals can develop their ability to generate new insights and solutions to problems. Finally, trivia can help individuals transfer learning from one context to another. By learning new facts and ideas in a trivia context, individuals can develop their ability to apply that knowledge in other areas of their lives, such as work or school.

Overall, while trivia may not be a complete substitute for other learning methods, it can be a valuable tool for supporting and enhancing learning in a variety of contexts.

Trivia in classroom

Through research and incorporating trivia as a source of effective learning, we have gathered a few ways how to support learning in different contexts:

1. Classroom learning: Trivia can be used to support classroom learning by introducing interesting and unusual facts that relate to the topic being studied. For example, if students are learning about the solar system, a teacher could share trivia facts about each planet to help students remember key characteristics.

2. Online learning: Trivia can be used in online learning environments to add an element of fun and engagement to the material. For example, an online course on history could include trivia quizzes at the end of each module to help learners reinforce their understanding and test their knowledge.

3. Study groups: Trivia can be a useful tool for study groups to review material and prepare for exams. By creating trivia questions that cover key concepts and facts, study groups can help each other reinforce their understanding and identify areas where they may need additional support.

4. Corporate training: Trivia can be used in corporate training programs to make the material more engaging and memorable. For example, a training session on customer service could include trivia questions that relate to common customer service scenarios and help employees to remember key principles and best practices.

5. Personal learning: Trivia can be a fun and engaging way to learn new information on a personal level. For example, if you are interested in a particular topic, you could challenge yourself to learn a certain number of trivia facts about it each day or week, helping you to deepen your understanding and expand your knowledge base.

With that being said...

Trivia can be a fun and engaging way to learn new facts and information across a wide range of topics. It increases student participation, improves test scores, lowers failure rates, and overall boosts overall motivation and the will to learn more. With this in mind, at UpBrainery Technologies, we focus on innovative teaching methods to make education fun rather than a burden, check out our Brainlab and get access to unlimited resources, and crash courses.

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Ghazal Qureshi is the founder and CEO of UpBrainery, a Houston-based immersive educational technology platform that taps into neuroscience research-based programs to provide adaptive learning and individualized pathways for students at home or in the classroom.

Fourteen companies are joining the spring cohort of the Softeq Venture Studio. Photo courtesy of Softeq

Spring cohort announced for Houston tech company's startup accelerator

ready to grow

A Houston tech company has announced the latest cohort of its accelerator program, bringing the total number of startups supported by the company to 63.

Softeq Development Corp., a technology services development company, named 14 new startups joining its three-month spring Softeq Venture Studio cohort.

“We are so proud of the success we have had with the Softeq Venture Studio, helping to support and secure funding for 63 startups to date through the Softeq Venture Fund," says Christopher A. Howard, founder and CEO of Softeq. "With 23 of 89 founders coming from outside of the U.S., we demonstrate Houston’s growing influence as a startup hub where entrepreneurs can find a welcoming innovation community, a strong talent base, and world-class research facilities."

The spring 2023 cohort for Softeq includes:

  • Houston-based AIM7, data intelligence platform that unlocks wearable and mHealth data to provide customized and predictive wellness solutions.
  • Avendly, based in Providence, Rhode Island, makes robotic automation for restaurants to help, not supplant humans. Its first of many products is Mixibot, an integrated back-bar cocktail vending system.
  • Founded in Austin, ClioVis, is meeting today’s content-creator students where they are and how they learn. The company provides unique experiential learning tools designed for today’s content-creator students who learn by doing, not lectures.
  • Based in Tel Aviv, Israel, Flometrica, is a digital health solution featuring "use anywhere" devices to remotely monitor and diagnose various urinary tract problems through analysis of different urine parameters.
  • Gophr, from Lake Charles, Louisiana, is a technology-driven logistics company that provides tailored and efficient delivery solutions for various industries, individuals, and businesses of all sizes.
  • Chicago-based KarChing puts cash in teens’ hands for safe driving. The only app built for parents, teens, and insurance companies that rewards drivers for phone- and distraction-free behavior behind the wheel.
  • Houston-founded Meander collects travel customer satisfaction micro-surveys as people go about their trips. The research platform rewards travelers for sharing their pics, videos, and insights.
  • MEedia, based in Sacramento, California, puts a professional press conference event in your pocket. Individuals can create broadcast-worthy interactive shareable content with just their phone.
  • MeterLeader, from Huntington Beach, California, gamifies saving energy in homes by using real-time utility data and behavioral science. We're like a Fitbit challenge for your home, but instead of steps we measure kWh, therm, and CO2 reductions.
  • Houston-based PayOnDelivery, integrates secure payment with delivery for markets like Craigslist and Facebook. It’s low-hassle, fraud-free buying and selling for peer-to-peer marketplaces.
  • Another Lake Charles business, Picasso Analytics has a platform that can reduce delays and save oil refiners and petrochem owners 10 to 15 percent on multi-million dollar turnaround events by providing a single source of truth integrating the schedule, time entry, and shop status.
  • Sarasota, Florida-based Toivoa develops software-based therapies for people with disabilities who experience mental health disorders. On track for FDA approval, the platform is prescription-based, clinically validated, and delivered on your phone.
  • UpBrainery Technologies, founded in Houston, helps students explore careers through digital experiences. AI guides their interests in career paths and credentials their achievements for employers and colleges.
  • Also from Houston, WellWorth (https://wellworthapp.com/), is a financial modeling SaaS platform that helps upstream oil and gas finance leaders improve their decision-making around raising, managing, and deploying capital.

Softeq Venture Studio launched over a year ago with its inaugural cohort in 2021, and the fund was launched last year. Since launch, Softeq has raised 80 percent of its inaugural $40 million Softeq Venture Fund and made investments in 63 startups. Softeq has also reformatted its accelerator program to include two cohort classes per year, allowing for more time to be spent with the Venture Studio and its cohort startups.

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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.