Texas experiences 4% drop in Affordable Care Act enrollment

The national effectuated enrollment dropped from its peak of 22.5 million in August 2025 to 19.2 million in February 2026, approximately a 15% decrease, according to CMS data. The office of the assistant secretary for planning and evaluation for the U.S. Department of Health and Human Services estimates that a large portion of the decline in enrollment is due to the removal of improper or phantom enrollees.

“What all of this drills down to is that when the program is not ‘free,’ people don't want it,” Brittany Madni, a senior fellow for fiscal policy at National Taxpayers Union, told The Center Square. “The whole thing is revealed to be expensive for the taxpayer and not a good deal for the patient. So that's why we're seeing a massive drop off.”

As part of the American Rescue Plan, the Biden administration implemented additional COVID-19 credit subsidies, on top of already existing standard ACA premium tax credits, in 2021. This meant that individuals who had an income above 400% of the federal poverty line, received COVID-related healthcare relief. These COVID subsidies were intended to be temporary and serve as a short-term emergency effort, according to Madni.

The 4% decrease in Texas includes both populations of people above and below the 400% federal poverty line threshold.

In 2025, the average monthly effectuated enrollment in Texas was 3.64 million. Ninety-seven percent of this population received some sort of advanced premium tax credit. The average premium cost facing members prior to the application of premium tax credits was $562. After premium tax credits were applied, the average cost facing individuals was $44, according to CMS data. 

In 2020, prior to the implementation of the COVID credits, the average monthly effectuated enrollment in Texas was 1 million and 91% of enrollees received premium tax credits.

The looming expiration of the COVID-19 subsidies in December, contributed to a 43-day government shutdown in October and November as Republicans and Democrats disagreed on whether to reduce or extend the subsidies. 

The Biden-era COVID credits expired on Dec. 31, 2025. The standard ACA premium tax credits remain in effect.

“Despite the loss of the enhanced premium tax credits, almost half (49%) of consumers signing up for 2026 Marketplace coverage in Texas and 27% nationally have premium payments of less than $10 a month because of the remaining premium tax credits,” Justin Lo, KFF senior researcher for the Program on the ACA, told the Center Square via email. KFF is an independent source for health policy research, polling and journalism.

The ACA premium tax credits, and expansion in the form of enhanced COVID relief credits, function as subsidies paid directly to insurance companies, rather than to individuals, according to Madni.

“Families are making a decision that perhaps ACA plans are not cost effective for them. You're revealing not even the true cost of this coverage, but a less subsidized, albeit still subsidized, cost of coverage through this ACA regime,” Madni said. “People who aren't taking up those plans are choosing to do so because they're seeing more of the actual cost of that coverage, and that coverage doesn't go as far because the cost of healthcare itself is also higher.” 

“This has been a trend for quite a while. We've seen that people really only take up plans when they cost $0 or are extremely low,” Madni further added. 

Under the COVID-19 credit, there was a high number of zero dollar entries into the marketplace, according to Madni, who noted the U.S. government is already saddled with more than $39 trillion of debt.

The expiration of the COVID-19 credits have saved taxpayers billions of dollars, according to Madni.

"An immediate permanent extension of the enhanced Obamacare COVID subsidy, including debt service costs for the added spending, would likely increase the deficit by about $455 billion. That would put taxpayers on the hook for nearly an additional half a trillion dollars for the next decade — all for a so-called temporary program pretending to help patients but instead funneling money directly to insurance companies,” Madni said. “This is just a way to paper over the unattractive, unaffordable coverage offered by ACA plans while taxpayers continue to pay the price and patients continue to lack quality care.”

The expiring enhanced tax credits have also led to a trend of individuals enrolling in plans with higher deductibles. The average deductible in the ACA Marketplaces grew by over $1000 per person, a 37% increase, from $2,759 to $3,786, Lo said.   

According to Every Texan, an advocacy organization that spoke in favor of the enhanced tax credits, the impact of the expiring government subsidies will be felt in a few years.

“In five to ten years, we’ll start seeing the tragic consequences of uninsurance, including people with advanced diagnoses for cancer, diabetes, and other conditions that went untreated or undiagnosed without access to affordable, preventive, primary, and specialist care today,” Lynn Cowles, Every Texan director of health and food justice, told The Center Square, answering questions by email.  

Texas, which already has the highest current rate of uninsurance, will face even higher rates of uninsurance and will lose a significant number of jobs as a result of the enhanced tax credits expiring, Cowles said. “With fewer federal tax credit dollars paying for people to have health insurance and health care in Texas, hospitals and clinics will have to lay off staff to meet tightening budgets."

Cowles called for universal healthcare to be adopted.

“Congress should pass universal healthcare to provide basic health care services for all U.S. residents. Barring that necessary and eventual policy shift, Congress must pass an extension of the Enhanced Advanced Premium Tax Credits immediately to return coverage numbers to the trends we were seeing before the EAPTCs expired,” Cowles said. 

Madni said if a future administration wanted to implement similar tax credits to the COVID credits or even move toward universal healthcare, taxpayers would be on the hook for significant expenses, upward of a trillion dollars.