Texas leads the nation in the portion of its population that is uninsured. A quarter of Texans have no coverage, many of them families who are considered the working poor. Texas already has one of the nation's most restrictive Medicaid programs, offering coverage only to the disabled, children and parents who earn less than $2,256 a year for a family of three. Without a Medicaid expansion, the state's working poor will continue relying on emergency rooms—the most costly treatment option—instead of primary care doctors. The Texas Hospital Association estimates that care for uninsured patients cost hospitals in the state $4.5 billion in 2010.