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The looming expiration of enhanced premium tax credits is poised to dramatically increase Affordable Care Act (ACA) marketplace premiums in 2026, placing healthcare access at risk for millions, particularly in Texas – a state already grappling with the nation’s highest uninsured rate.
Texas currently leads the country with approximately 20% of its population lacking health coverage. Now, with Congress failing to extend enhanced premium tax credits, premiums for ACA marketplace plans are projected to more than double for most enrollees, impacting the 4 million Texans who rely on this coverage. Experts warn that without the subsidies that make ACA plans affordable, a significant number of individuals will be forced to forgo necessary care.
The potential impact is acutely felt by individuals like Shanice Jordan, a Dallas resident diagnosed with SLE lupus in 2003. Jordan, who relies on consistent medical care, experienced a sense of relief when the ACA expanded insurance accessibility for those with chronic conditions. “It was just such a relief off of myself and my parents’ shoulders,” she stated.
However, that relief is now threatened. Jordan’s current monthly premium of $173 is expected to jump to $942 in 2026 – more than five times the current cost – for the same plan. While she considered cheaper options, she fears losing access to the specialized doctors, medications, and treatments crucial to managing her condition.
A Difficult Choice for Families
Jordan’s situation is far from unique. Lynn Cowles, an advocate with the group Every Texan, highlights the impossible choices families are facing. “Pay $20,000 a year for your health insurance premiums or potentially pay hundreds of thousands of dollars per year if you have somebody in your family who ends up needing some major medical care. That’s the position that the government is putting people in right now,” Cowles explained.
The anxiety surrounding these potential premium hikes is palpable, with enrollees expressing fear, anger, confusion, and a sense of betrayal. Advocates warn that the loss of coverage could have devastating consequences, with some predicting a potential increase in preventable deaths.
Texas Particularly Vulnerable
Texas is anticipated to experience the fourth-largest loss of coverage nationwide, trailing only California, New York, and Florida. According to research from KFF, a health policy research organization, the majority of Texas’s coverage losses will stem from changes to the ACA, rather than alterations to Medicaid. This vulnerability is compounded by the state’s decision not to expand Medicaid, a policy choice that leaves many Texans without affordable healthcare options.
“Even in Texas, the state with the highest uninsured rate, people want insurance. People want the peace of mind that health insurance brings when it’s affordable to them,” noted Stacey Pogue, a senior research fellow with Georgetown University’s Center on Health Insurance Reforms. Approximately 95% of ACA enrollees in Texas currently rely on subsidies, and most will see those subsidies reduced or eliminated.
A National Crisis
The issue extends far beyond Texas’s borders. Over 20 million individuals nationwide utilize the ACA marketplace, and many will find themselves in a similar predicament. The full impact of these premium increases may not be felt until individuals begin to pay them alongside rising healthcare costs next year.
Despite the uncertainty, Jordan remains resolute in prioritizing her health. “We might have to forego a lot of things, but at least I have health insurance,” she said, underscoring the fundamental importance of healthcare access. Advocates and experts emphasize the urgent need for solutions to mitigate the impending crisis and ensure that affordable healthcare remains within reach for all Americans.
