More Texans have signed up for ACA health coverage despite expiring subsidies and falling national enrollment

The Jan. 3 snapshot, though incomplete, indicates a stabler marketplace and less coverage loss than many experts and insurers feared.

More Texans have signed up for health insurance through the Affordable Care Act marketplace compared to last year — despite the expiration of federal subsidies to lower the costs of premiums.

As of Jan. 3, nearly two weeks before open enrollment closes on Thursday, 4.11 million Texans had selected a plan through the ACA marketplace, according to data released Monday from the Centers for Medicare and Medicaid Services. During all of 2025 open enrollment, nearly 3.97 million Texans enrolled in an ACA plan. At a similar point in the enrollment period in 2025, about 3.86 million Texans had enrolled, meaning ACA plan selection is up 6.5%.

Through Jan. 3, Texas was one of only six states to surpass its 2025 enrollment total, with overall national enrollment lagging last year by 3% as health policy experts widely warned the expiring subsidies would nudge people to drop coverage. The 2026 enrollment figure would be a new record for the state, which has set a record for ACA sign-ups every year since 2021.

But health care experts caution that the preliminary figures show an incomplete picture of how many people ultimately maintain coverage once they receive a premium bill.

The data does not break down how many of the 4.11 million Texans were automatically re-enrolled in their plans, returned to the ACA marketplace but made a new selection — possibly opting for less generous plans — or were new to the marketplace. The report covers those who made a plan selection, including re-enrollments, but does not yet specify enrollees who have “effectuated” their coverage by making a payment.

Data about enrollees’ income and what metal level they selected — which determines how generous plans are — is forthcoming.

Experts caution that Texans automatically re-enrolled in plans may not realize their premium payments have risen, and could end up dropping coverage. And some experts predict that while enrollment overall may be stable, Texans may have opted for less generous plan coverage than before.

But the Jan. 3 snapshot, though incomplete, indicates a healthier marketplace and less coverage loss than many experts and insurers feared.

Charles Miller, a senior policy adviser at nonpartisan think tank Texas 2036, cautioned that more data is needed to fully assess Texas’ ACA population, but that the plan selection number exceeding last year’s total is a positive sign.

“The underlying thing that we noticed — which is that there are affordable options out there — is something that is being noticed by lots of Texans,” Miller said. “So that is good news.”

Health care experts had predicted significant coverage loss in Texas and around the country due to the expiration of enhanced ACA tax credits. Created by congressional Democrats in 2021, these subsidies, paid directly to insurers, capped the amount that ACA enrollees could pay toward their premiums and expanded the pool of people eligible to claim subsidies. As a result, millions of Texans were able to enroll in insurance plans through the ACA marketplace with low or no cost premiums.

But those enhanced subsidies expired at the end of 2025, despite a lengthy government shutdown in which Democrats tried to pressure Republicans into reaching a deal on extending the subsidies. The House of Representatives has since passed a three-year clean extension of the tax credits, with 17 Republicans voting with all Democrats in favor of the bill, but faces long odds in the Senate. A bipartisan group of senators are working towards a compromise deal, but have yet to reach a framework.

The number of Texans who enrolled in ACA coverage, as in previous years, is second only to Florida. Both states never expanded Medicaid to people earning more than 100% of the federal poverty limit, driving ACA uptake high among low-income people who would qualify for government health coverage in other states.

Since 2020, the ACA population has grown at least 13% each year, jumping as high as 44.5% between 2023 and 2024.

While Texas’ ACA enrollment still grew in 2026 and could grow further during the last two weeks of open enrollment, the Jan. 3 figure would represent the smallest year-over-year increase, by percent, since 2020, before the tax credits were enhanced.

The majority of Texans who enrolled in ACA coverage last year reported incomes at or below 150% of the federal poverty level — $48,225 for a four-person household — and are still eligible for the smaller version of the tax credit. Many Texans are still eligible for low or no-cost plans, though they may be at different coverage levels.

Miller theorized that Texas’ premium alignment bill, passed on a bipartisan basis in the Legislature in 2021, may have kept the cost of gold and bronze plans down and the state’s plan selection figure up. Premium subsidies are priced based on the cost of silver plan premiums.

“That bill functionally made our bronze and gold plans more affordable, relatively speaking, than a lot of other states,” Miller said. “That is certainly a plausible explanation of why our enrollment would continue to trend higher, while we might see lower enrollment in other states.”

Open enrollment ends Jan. 15.

Source: Gabby Birenbaum, DATA REPORTING BY Dan Keemahill, The Texas Tribune

Photo Credit: The Titus Regional Medical Center in Mount Pleasant administers an antibody infusion procedure on Aug. 19, 2021. Shelby Tauber

The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.

More Texans have signed up for ACA health coverage despite expiring subsidies and falling national enrollment

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