Expiration of Enhanced ACA Tax Credits Threatens Texas Health Coverage

Texas faces a critical challenge as enhanced federal premium tax credits that help nearly one million Texans afford health insurance premiums under the Affordable Care Act (ACA) are set to expire unless Congress intervenes. The lapse of these subsidies would particularly impact Texas more severely than any other state, with premiums projected to increase by approximately 115%, compared to a 75% national average. This surge would disproportionately affect older adults and middle-income families, pushing some toward becoming uninsured and delaying necessary preventive and routine care, which can lead to adverse health outcomes and increased reliance on emergency services. The expiration poses broader systemic risks, including a rise in uncompensated care that burdens hospitals and healthcare providers, ultimately driving up costs across the healthcare system. Hospitals in Texas already absorb billions annually in such care, and the loss of subsidies would exacerbate financial strains, potentially triggering higher insurance premiums for employers, reduced payments to physician practices, and increased local tax pressures to sustain hospital services. Rural and border regions are particularly vulnerable, given their higher rates of ACA Marketplace enrollment, with significant coverage losses anticipated in major metropolitan areas like Travis, Harris, Dallas, Tarrant, and Bexar counties. The policy debate extends beyond partisan lines as the enhanced credits represent a market-based mechanism enabling working families to access private insurance plans of their choice, supporting continuity of care and health equity. Health care industry leaders in Texas, including the Texas Medical Association, Texas Hospital Association, and Texas Association of Health Plans, are advocating for Congress to extend these tax credits, maintain program simplicity and integrity, and enhance support for underserved rural and border communities. Without legislative action by the end of 2025, the affordability and accessibility of health insurance for millions of Texans are at serious risk, with significant implications for public health and the financial stability of the state's healthcare infrastructure.