(#2) Texas

While Texas continues to lead the nation in attracting workers, those workers are finding a broad array of challenges when they get there. The Lone Star State has America’s highest rate of people without health insurance at 16.7%, according to the United Health Foundation, more than twice the national average. More than 17% of Texas adults said they had to forgo a doctor visit that they needed in the past year because of the cost. Even those who do have health insurance can have trouble finding a doctor. The state finishes dead last in primary care physicians per capita.

In May, Republican Gov. Greg Abbott announced $56 million in federal grants to rural hospitals. “We will deliver state-of-the-art treatment for everyone who calls Texas home,” the governor said in a statement. Some 31 million people call Texas home, so the grants amount to about $1.80 apiece, or about $350,000 for each of the state’s nearly 160 rural hospitals.

2026 Quality of Life score: 78 out of 290 points (Top States grade: F)

Strengths: Childcare, Air Quality

Weaknesses: Health, Crime, Inclusiveness, Worker Protections, Reproductive Rights