Millions of Texans could be out thousands of dollars with a single trip to the doctor.

The Episcopal Health Foundation released a report that shows Texas has the most people without health insurance in the entire U.S.

Researchers found that 19 percent of Texans, or 4.6 million people, are uninsured in the state.

In addition to the statewide report, researchers provide detailed characteristics of the uninsured broken down by counties and county groups across Texas.

In Bosque, Fall, Freestone, Hill, Limestone, McLennan and Navarro Counties, researchers estimate that 18 percent of people under age 65 don’t have health insurance.

The report finds that 64 percent of the region’s uninsured were in working families and 69 percent were in families consisting entirely of U.S. citizens.

60-year-old Gerald Renfrow and his 15-year-old dog, Oscar, live in Waco. It's not easy for either of them to get around.

"Pretty much every step I take, hurts," Renfrow said.

Seven years ago, Renfrow was riding his motorcycle when another driver blew through a stop sign.

The accident landed him in the hospital where he was mended back together with hardware. He's been living with chronic pain ever since.

"She ran over my hands," Renfrow said. "Shattered my knee, there's basically no cartilage there anymore, ripped my pelvis open."

Renfrow was hurting but continued to work as a handyman trimming trees and building cabinets after his accident.

Two years ago, the pain became unbearable and he had to stop working. He's been uninsured ever since.

"I can't work now and it's driving me nuts," Renfrow said. "I can't stand up for very long, I can't sit down for very long. I can't hold onto my tools anymore."

Without insurance, he's not able to afford a knee transplant or further treatment to improve his quality of life.

Dr. Jackson Griggs works at the Family Health Center in Waco.

He said the Family Health Center sees the majority of uninsured patients in McLennan County, including Renfrow.

"I've been taking care of patients for 15 years, seen a lot of patients without insurance," Griggs said. "Probably one in five of my patients have no form of insurance."

Griggs explained that the Family Health Center has the budget to provide primary care at a low cost, but it gets more difficult when patients need more extensive services.

"He is really absolutely unable to work because of the pain," Griggs said. "In order to make the diagnosis we need some imaging, an MRI, but he can't afford that."

Renfrow feels like he's stuck in a vicious circle. He's trying to get on disability, but they won't approve him unless he has the paperwork he needs to prove his pain.

"They want me to get more tests," Renfrow said. "I can't do it right now. I don't have much of a choice, I can't afford it."

Renfrow isn't sure if he'll get the help he needs, but he hopes his situation shows others why it's so important to be prepared.

"I'll be honest with you, at first, I didn't really bother with it much because my health wasn't that bad," Renfrow said. "But it's getting to the point where I can hardly get around."

Researchers with the Episcopal Health Foundation estimate that 15 percent of the uninsured under the age of 65 in Texas are eligible for Medicaid or CHIP health insurance.

However, if Texas lawmakers expanded Medicaid or came up with an alternative plan to offer health insurance to low-income adults, earning up to $35,000 for a family of four, researchers estimate that 1.2 million uninsured Texans currently ineligible for assistance would be made eligible for free or very low-cost coverage.

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