Texas, which for four years has maintained its position as the state with the highest percentage of residents without health insurance compared to all other U.S. states, further extended its gap of percentage uninsured over other states in 2011, according to Gallup polls.

In 2011, 27.6 percent of Texans lacked health insurance, exceeding the 17.1 percent uninsured nationwide proportion of uninsured by more than 10 percent, according to the most recent Gallup survey.

The survey found that in 2011, the percentage rate of uninsured residents in Texas was more than four percentage points higher than the next highest uninsured state, Mississippi. The 4.1 percentage gap between Texas and Mississippi was the largest gap measured between the first and second state uninsured rates since 2008, according to the poll.

In 2010 Texas and Mississippi had a 3.9 gap with Texas at 27.7 percent compared to Mississippi at 24.8 percent. In 2009 Texas with 27 percent uninsured had a 3.5 percentage gap compared to Oklahoma at 24.5 percent, and in 2008 there was only a 2.8 gap between Texas with a quarter of its residents uninsured compared to 22.2 percent of uninsured Mississippians.

In contrast Massachusetts, which has been ranked first for percentage of insured for the past four years, is still the state with the lowest percentage of uninsured at 4.9 percent, followed by Vermont at 8.6 percent, Hawaii at 9.1 percent, Connecticut, Minnesota, and Wisconsin, states that all had uninsured rates below 10 percent in 2011.

Southern and western states were typically places with the highest percentage of uninsured residents, and the lowest percentage of residents lacking health insurance were generally located in the eastern of upper Midwest of the U.S., with Hawaii being the only exception.

Texas’ consistently high uninsured rates may be due to the state’s large Hispanic population, a demographic that has significantly high uninsured rates, according to Gallup.

Massachusetts' low uninsured rates may have come after the 2006 state’s health care insurance reform law under Governor Mitt Romney which required that nearly every state resident had to have a state-government-regulated minimum level of insurance coverage and the state provided free health care insurance for people who weren’t eligible for Medicaid and making less than 150 percent of the federal poverty level.

Gallup noted that in 2008, no U.S. states have shown a consistent, year-to-year decrease in the number of uninsured, but the percentage of uninsured at the national level, based on year to year increments, has increased from 14.8 percent in 2008 to 17.1 percent in 2011.

President Obama’s much debated healthcare reform, which was passed in 2010, strives to reduce the percentage of uninsured Americans nationwide. Legal battles over the reform are still to come before the plan can be successfully implemented. The U.S. Supreme Court is set to hear arguments later this month, and a final court ruling is expected by late June.