E-Paper
Are 1.7 million Texans facing threat of losing health coverage? Here's what we know
This year, almost 4 million Texans signed up for ACA health plans, the most ever since the program started 12 years ago.
Health policy experts state that as many as 1.7 million Texans might lose their health coverage due to changes to the ACA marketplace from a recently passed Republican tax and spending bill. The impact could be significant, especially since Texas has the largest uninsured population in the nation, according to The Texas Tribune.
This year, almost 4 million Texans signed up for ACA health plans, the most ever since the program started 12 years ago. But with the Biden-era premium discounts ending and changes in the new GOP bill, Texas might witness a big rise in the number of uninsured people
This could also result in higher insurance costs for everyone, more unpaid hospital bills, and more problems in the overall health insurance system, according to experts.
Also Read: Who could lose Medicaid? Trump's ‘big, beautiful bill’ threatens health insurance of millions
Texas didn’t expand Medicaid, unlike most other states
Texas didn’t expand Medicaid like 40 other states, so a lot of lower-income people here have turned to the ACA for health coverage. The uninsured rate in Texas dropped from about 24% in 2010 to 17% in 2023, mostly because of ACA sign-ups.
This year, nearly 4 million Texans enrolled in ACA plans. About 2.5 million of them earn between $32,150 and $48,225 a year for a family of four, just above the poverty line. In states that expanded Medicaid, people with those incomes would qualify for that program. But in Texas, the ACA helped fill that gap.
Most people on Medicaid in Texas are kids. For low-income adults, it’s much harder to qualify. They usually have to be pregnant, disabled, over 65, or a parent making less than $300 a month for a family of four.
Cynthia Cox, who studies the ACA at the nonprofit KFF, said these changes could lead to the biggest drop in coverage since the law first passed.
Cox said, “I think back to the Great Recession, when a lot of people lost their jobs and thus lost their job-based health insurance coverage. This is going to be more than that.”
Also Read: Los Angeles fires could be the costliest disaster in US history; to cost nearly $150 billion
About 200K Texans could lose Medicaid
Most of the talk around the Republican tax and spending bill has been about the cuts to Medicaid, especially the new work requirements. But those changes won’t hit Texas as hard since the state never expanded Medicaid in the first place. KFF estimates about 200000 Texans could lose Medicaid, but that’s less than in many other states.
What will hit harder are the changes to the ACA marketplace. The bill makes it tougher for people to sign up. It ends automatic renewals, adds more paperwork to prove income, and cuts the open enrollment period down to just one month. Starting in 2026, people who make under 150% of the federal poverty level will no longer be able to enroll year-round.
Bill blocks immigrants from getting insurance
The bill also blocks some immigrants, including DACA recipients, refugees, people with Temporary Protected Status, and asylees, from getting insurance through the ACA marketplace.
Most Texans with marketplace plans get help paying their premiums. In 2025, 95% of them received income-based tax credits to lower their monthly costs. And over 1.4 million, about 36% automatically renewed their plans, according to the Centers for Medicare and Medicaid.
