Texans defy expectations with ACA enrollment
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Texans' enrollment in Affordable Care Act health insurance is exceeding the expectations of health policy experts who worried it would plummet when enhanced federal subsidies expired.
Why it matters: Texas has the highest rate of uninsured people in the nation.
Driving the news: Thursday is the last day to sign up for a marketplace plan.
The big picture: The ACA enhanced tax credits, introduced during the COVID pandemic, expired at the end of 2025. They were the main sticking point in the federal government shutdown last fall.
- Experts warned that without the subsidies, Texas' uninsured rate could rise as people faced increased premium costs.
The latest: More than 4.1 million Texans enrolled in an ACA plan as of Jan. 3, per Centers for Medicare & Medicaid Services data released Monday. That's about a 6.5% increase over the same time last year.
- Texas is outpacing enrollments nationwide, which dipped by about 834,000 signups, or 3.5%, when compared to the same time frame.
Yes, but: The data does not specify how many Texans are new to the marketplace, were automatically re-enrolled or selected new coverage plans.
What they're saying: Premium costs are rising, but the impact on many people isn't as big as some suspected, says Charles Miller, director of health and economic mobility policy at Texas 2036, a policy research nonprofit.
- People tend to think marketplace plans will be more expensive than they actually are, which causes them to not even consider enrolling, Miller tells Axios.
State of play: A 2021 Texas state law made bronze and gold ACA plans more affordable than before, Miller says, in an effort to match a plan's price to how generous its coverage is.
- For example, some low-income Texans were previously on a $0 silver plan. While that plan will no longer be free, they could instead access a $0 bronze or gold plan.
By the numbers: Every Texas enrollee earning at or below 200% of the federal poverty level — about $60,000 for a family of four and $30,000 for a single person — can sign up for at least one marketplace plan with a $0 premium for 2026, per Texas 2036.
- That's a little over 3 million Texans.
Zoom in: In Bexar County, a single 40-year-old person earning about $39,000 can still find plans ranging from $50 to $274 per month, per Texas 2036 estimates shared with Axios.
Reality check: Those who will be most impacted by the subsidy expiration earn more than 400% of the federal poverty level (about $60,000 for a single person or $125,000 for a family of four). They make up about 3.5% of Texas' ACA enrollment, Miller says.
- Miller says that anyone newly uninsured in 2026 can check health care prices in advance, look over itemized bills and consider a hospital's charity care policy.
The bottom line: "With the subsidies expiring, plans are getting more expensive," Miller says. "We just want to make sure that people … are aware that affordable options still exist."