Texas ACA Enrollment Shock: First Decline Since 2019
The participation rate of Texans paying their first-month premium under the Affordable Care Act (ACA) decreased by 4% this year, marking the first decline since 2019. Data from the Centers for Medicare and Medicaid Services (CMS) highlights the impact of expiring federal tax credits that had previously lowered insurance costs for many enrollees.
Despite a rise in ACA enrollments earlier this year, the number of Texans who finalized their coverage by paying the initial premium fell from 3.42 million in 2025 to 3.28 million in 2026. This decrease represents the most significant drop documented by CMS for Texas since such records began. Justin Lo from KFF commented on the reduction, noting a previous record growth in enrollment during the period of the enhanced premium tax credit.
Nonetheless, Texas's performance was stronger than most states, with a national decrease in effectuated ACA enrollment reaching 12% year-over-year. Charles Miller from Texas 2036 attributed this trend to the expiration of enhanced federal subsidies, while highlighting Texas's comparatively favorable outcome.
Though the 4% drop in Texas aligns with a national trend, it is less severe than in other states. CMS data indicated enrollment decreased in 49 states, but Texas reported one of the lower declines, with only Connecticut, Idaho, Massachusetts, and Pennsylvania experiencing smaller reductions.
Enrollment Shifts and Premium Influences
Texas's substantial ACA expansion was notable before the tax credit expiration, driven by the state's lack of Medicaid expansion, which made the ACA marketplace a primary option for low-income individuals. This led to enrollment growth from about 1.3 million in 2021 to nearly 4 million in 2025 during the peak of subsidies.
In 2025, 86% of enrollees effectuated their plans by February, whereas in 2026, only 79% did so, resulting in approximately 900,000 Texans losing coverage. Additionally, plan preferences shifted, with Texans moving from silver plans to bronze and gold options due to cost changes following the tax credit expiration.
Regulatory efforts to align premiums, particularly for silver plans, may have helped stabilize Texas’s ACA market. Despite premium hikes, ACA plan holders in Texas face some of the lowest premiums nationwide, easing financial burdens on the predominantly lower-income demographic.