Texans Face the Harshest Consequences with Loss of Health Insurance Discounts
By Annie Spilman, Executive Director, Texans for Affordable Healthcare
When it comes to healthcare costs, Texans are already experiencing a crisis. We lead the nation in prescription drug spending, the cost of medical care and ER visits continues to balloon, and almost four in ten Texans report skipping doses of their medication or delaying medical procedures because of costs. Making matters worse, we also lead the nation in our rate of uninsured residents. Roughly one in six Texans—nearly five million people—lack health coverage, double the national average. But in recent years, that number has begun to improve. Thanks to enhanced Affordable Care Act (ACA) premium tax credits, more Texans—especially gig workers, small-business employees, and the self-employed—were finally able to afford coverage.
That fragile progress is now at risk of vanishing. Unless Congress acts, the enhanced tax credits will expire at the end of 2025, and Texas stands to be punished more than any other state.
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Why Texas Is Hit the Hardest
In most other states, people who lose access to subsidies can fall back on Medicaid. Texas chose a different path, relying on a private-market approach instead of expanding Medicaid. That means low-income Texans who lose subsidies have nowhere else to go. When these enhanced credits disappear, they won’t just face higher premiums—they’ll face outright loss of coverage.
The Fallout by the Numbers
Texans received about $1.5 billion in enhanced subsidies in 2024—a lifeline that kept coverage within reach for over 3 million.
If those credits expire, premiums are projected to rise by 75% or more.
Nationally, up to 4 million Americans could lose coverage. More than 1 million of them—over a quarter—will be Texans.
Here at home, that could mean a 27% jump in the uninsured rate, erasing recent gains.
California, by comparison, would see just 174,000 people lose coverage—a fraction of the impact Texas faces.
Who Will Be Hurt
Those hit hardest by the expiration are the very Texans who power our economy.
Gig workers and contractors who don’t get job-based insurance.
Self-employed Texans—from freelance designers to ranchers—who rely on marketplace plans.
Small-business employees, whose employers can’t afford to provide group coverage, which makes individual subsidies not only critical but necessary.
These are hardworking Texans who finally had a foothold in the health system. If enhanced credits expire, they’ll be priced out again.
The Bottom Line
Texas has made progress in reducing its uninsured rate. Letting these subsidies lapse would reverse that progress overnight. And because our state chose a private-market approach instead of Medicaid expansion, Texans don’t have the same fallback other states enjoy. That’s why our state is poised to shoulder more than a quarter of the national coverage losses.
This is not about politics—it’s about fairness. Texans work just as hard as people in other states, yet we’re set to be penalized more severely simply because of where we live.
Congress must act quickly to extend the enhanced premium tax credits. The health and economic stability of more than a million Texans depend on it.