Texas families saw their health insurance premiums soar 40 percent in five years — 10 times faster than their incomes increased, according to a report being released today by a national foundation that promotes health care improvement.

Nationally, Texas ranked third — behind Oklahoma and Idaho — in premium increases from 2001 to 2005, according to the report on employer-offered insurance by the Robert Wood Johnson Foundation in Princeton, N.J.

At the same time, Texas ranked No. 1 in the percentage of residents without insurance. In 2005-06, that figure was 27 percent. The state had 5.5 million of the nation's 47 million uninsured people.

Health care advocates said they were not surprised by the relationship between high health insurance premiums and a high number of uninsured people. But they said they found the difference between the growth of insurance premiums and the increase in the state's median incomeover the same period — 4 percent — to be alarming.

"These are horrifying numbers," said Regina Rogoff, executive director of People's Community Clinic, which treats uninsured people in the Austin area. "This is, for many people, the bottom line of the crisis of the uninsured in Texas. The costs don't go away."

People without coverage often get expensive emergency room care, and those costs get passed on as higher premiums to people with insurance, Rogoff and others said.

Taxpayers also share the tab when hospitals and governments do more to help the uninsured, said Clarke Heidrick, a member of the Travis County Healthcare District board.

"For people at the lower-income jobs, it's just not affordable" to buy health insurance, said Heidrick, who has proposed a regional, low-cost health insurance program for small-business workers.

"Some people call that the vicious cycle," Rogoff said. "They joke that someday there will be one person who's insured paying a trillion dollars for health care. Health care can't exist without someone paying the tab."

The foundation's report — Squeezed: How Costs for Insuring Families are Outpacing Income — prepared by University of Minnesota researchers, didn't study why premiums increased almost 30 percent nationally, to an average of $10,728 in 2005 from 2001. In Texas, premiums jumped from an average of $8,255 to $11,533.

"This study makes plain what every working parent knows — that providing insurance coverage takes a bigger bite from the family budget every year," said Dr. Risa Lavizzo-Mourey, president and CEO of the foundation.

Factors that drive higher costs include expensive medical technology, less healthy lifestyles and an aging population, said Brian Quinn, a program officer at the foundation.

The foundation did not examine insurance company profits, he said. The Texas Department of Insurance did not have that data readily available Monday afternoon but noted that premiums doubled from 1997 to 2004.

"Health care insurance companies are not making a fortune," but like any business, they deserve a profit, said Carolyn Goodwin, president of the Texas Association of Health Underwriters.

Texans want health care on demand, which has resulted in an investment in new technology by hospitals across the state, Goodwin said.

Another reason costs are increasing is that 60 percent of uninsured Texans who are eligible for government-assisted programs are not receiving the help, she said.

"Without getting too political, I think the programs don't have the appropriate outreach," she said.