Texas ACA Enrollment Decline Post-COVID Subsidies

Texas experienced a significant 4% decline in Affordable Care Act (ACA) Marketplace enrollments following the conclusion of additional COVID-19 subsidies. These subsidies, introduced during the Biden administration, ended in December 2025. As of February 2026, enrollment numbers have dropped to 3.28 million, down from 3.42 million in the previous year. Nationally, ACA enrollments faced a 15% decrease, illustrating the subsidies' widespread financial impact.

The U.S. Department of Health and Human Services cites the removal of improper or ineligible enrollees as a contributor to this decline. Fiscal policy expert Brittany Madni emphasizes the end of these program subsidies significantly affects taxpayer costs and patient expenses. The cessation prompts a critical evaluation of ACA plans' cost-effectiveness, especially among Texas households across income levels.

In a 2021 effort to provide temporary relief, the American Rescue Plan introduced additional subsidies alongside existing ACA premium tax credits. These provisions helped individuals earning above 400% of the federal poverty line. Despite the expiration of these enhanced subsidies, Texas saw variance in the financial impact across different income brackets.

During 2025, an overwhelming 97% of ACA enrollees in Texas benefited from advanced premium tax credits. Without these credits, the average premium was $562, but it was significantly reduced to $44 with credit application, according to CMS. In 2026, despite the reduction in premium tax credits, 49% of Texan enrollees face monthly premiums under $10, a continuation of tax credit benefits, albeit adjusted.

The expiration leads to many opting for plans with higher deductibles, averaging a 37% increase nationally to $3,786. Lynn Cowles of Every Texan warns this could drive up uninsured rates in Texas, potentially complicating healthcare access. She advocates for universal healthcare to mitigate these issues, forecasting necessary staffing adjustments in healthcare facilities due to reduced federal support.

Madni cautions that reintroducing similar subsidies or adopting comprehensive healthcare reforms risks imposing trillion-dollar burdens on taxpayers. This fiscal challenge underscores a critical juncture in balancing regulatory policies and sustainable health coverage solutions.