Texas Faces Devastating Consequences if Affordable Care Act Enhanced Tax Credits Expire

Strategic Insights -

Texas is poised to be severely impacted if the Affordable Care Act's enhanced tax credits, a key point of contention in the ongoing federal government shutdown, expire at the end of the year. With the nation's highest rate of people without health insurance, Texas is particularly vulnerable to the potential loss of coverage. Health policy experts warn that without the tax credits, the uninsured rate in Texas is likely to rise significantly after having fallen in recent years.

Key Takeaways:

  • Texas has the highest rate of people without health insurance in the nation, with over 1 million Texans standing to lose health coverage if the tax credits expire.
  • Without the enhanced tax credits, premiums for the average family would increase by about $2,000 per year for over 3 million Texans who rely on the tax credits.
  • Enhanced premium tax credits were introduced under the American Rescue Plan Act of 2021, and the Inflation Reduction Act of 2022 extended them through this year, but they are set to expire.
  • Texas has seen record marketplace enrollment in recent years, with signups more than tripling since 2020, the highest enrollment growth of any state during that time.
  • Health policy experts say enrollment growth has helped reduce the state's uninsured rate, with 20% of Texans under 65 being uninsured in 2020 compared to 18.6% in 2023.
  • Lynn Cowles, director of health and food justice at the nonprofit Every Texan, noted that Bexar County has seen a 165% increase in enrollment from 2015 to 2025, with nearly 250,000 people now having marketplace coverage.
  • The state's decision not to expand Medicaid has led to many low-income adults having marketplace coverage, with nearly 23 million Americans enrolled in insurance through the marketplace.

Statistics:

  • Texas has nearly 20% of Texans under 65 without insurance (Census Bureau, 2020).
  • The uninsured rate in Texas fell to 18.6% in 2023 (Census Bureau, 2023).
  • Over 1 million Texans stand to lose health coverage if the tax credits expire (Lynn Cowles, Every Texan).
  • Premiums for the average family would increase by about $2,000 per year for over 3 million Texans who rely on the tax credits (Lynn Cowles, Every Texan).
  • Almost 250,000 people in Bexar County now have marketplace coverage, a 165% increase from 2015 (Lynn Cowles, Every Texan).

Sources:

  • Axios. (2024, December 4). Local San Antonio: Open enrollment health insurance, Texas uninsured.
  • Axios. (2025, October 6). Government shutdown politics, Affordable Care Act.
  • Congressional Budget Office. (2025, September). Health Care Costs, 2026-2035.
  • Every Texan. (n.d.). Lynn Cowles.
  • Commonwealth Fund. (n.d.). About Us.
  • KFF. (n.d.). Enrollment Growth in the ACA Marketplaces.
  • Census Bureau. (2020). Health Insurance Coverage: Early Estimates from the National Health Interview Survey, January-June 2020.
  • Census Bureau. (2023). Health Insurance Coverage: Early Estimates from the National Health Interview Survey, January-June 2023.
  • Tinyurl. (n.d.). 59pj7tuf.