Texas ACA Enrollment Drops as Federal Subsidies Lapse

The uptake of Affordable Care Act (ACA) plans in Texas has seen a 4% decrease this year, as fewer individuals secured their first month of coverage. According to the Centers for Medicare and Medicaid Services (CMS), Texas experienced a reduction in effectuated ACA enrollments, dropping from 3.42 million in 2025 to 3.28 million in 2026. This marks the first decline of this nature for the state since 2019.

Texas initially observed an increase in ACA sign-ups at the start of the year, despite the phase-out of tax credits which helped mitigate premium costs for enrollees. Preliminary CMS data indicate that Texas fared better than the national average decline of 12% in ACA enrollees who confirmed their coverage. Charles Miller, director at Texas 2036, highlighted that Texas outperformed other states during this enrollment period.

The lapse in federal subsidies accounted for this overall decrease, but Texas saw a less significant drop compared to other states. Only four states, including New Mexico, which introduced its subsidies, experienced a less pronounced decline, with New Mexico even witnessing growth in their ACA population.

Senate negotiations last year around the extension of federal tax credits did not reach a resolution, contributing to this development. Although the U.S. House passed an extension on a bipartisan basis, the Senate bill lacked the necessary support. This affected ACA enrollment fluctuations, particularly after enhanced tax credits expired, which had been instrumental in capping premiums and expanding eligibility.

CMS data also reveal shifting trends in plan selection, with bronze and gold plans gaining popularity over silver plans for the first time. This is due to changes in cost structures and strategic state policies, like Texas's premium alignment laws that kept bronze and gold plans priced lower. Despite an average premium increase to $89 this year, Texas maintains the lowest average premiums nationally.

Industry observers, such as Justin Lo from KFF, emphasize Texas’s unique position given its decision not to expand Medicaid. This continues to funnel lower-income populations into the ACA marketplace for coverage. These enrollment patterns provide valuable insights into the impacts of policy shifts on insurance frameworks across the U.S., warranting further study.