One of the factors thought to be causing hospital emergency room (ER) crowding is excessive use of the ER by the uninsured, who may lack access to other sources of care. This is a particular concern in Texas. We completed a survey in Houston/Harris County, Texas, addressing whether the uninsured are high users of the ER, and the role of financial concerns in choosing a venue for care. We found no evidence that the uninsured were higher users of the ER. Financial and insurance concerns discouraged ER use. Emergency room use was higher for Black/Non-Hispanics and those with a new medical condition. The findings provide support for ER diversion strategies that focus on providing high quality primary care and urgent care center alternatives to the ER, particularly in the Black/ Non-Hispanic community.