Texas Faces Ongoing Health Care Affordability Challenges

Expiration of ACA subsidies and high uninsured rates raise concerns about access to care

Published on Feb. 23, 2026

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As the enhanced Affordable Care Act subsidies expire, health care remains a major concern for Texans. While initial 2026 ACA marketplace enrollment numbers in Texas have held steady or even slightly increased, experts warn these figures may be misleading as many policyholders were likely auto-enrolled and may struggle to afford higher premiums. Texas also continues to have the highest uninsured rate in the nation, with over 1 million children lacking any health coverage.

Why it matters

The loss of ACA subsidies and Texas' decision not to expand Medicaid have exacerbated existing challenges around health care affordability and access, especially for low-income residents and families. This has significant implications for the health and financial security of Texans, as well as strains on the state's overall health care system.

The details

Recent polling found that 67% of Texans are 'very concerned' about the cost of health care, making it the top economic concern in the state. KFF projects that over 3.7 million Texans will be impacted by the loss of enhanced ACA subsidies. While initial 2026 ACA enrollment numbers in Texas have held steady or slightly increased, experts warn these figures may be misleading as many were likely auto-enrolled and may struggle to afford higher premiums. Texas is one of a handful of states that has never expanded Medicaid, contributing to it having the highest uninsured rate in the nation. A recent UnidosUS study found that in 2024, over 1 million Texas kids, or 14% of all children, lacked any health coverage.

  • In December 2025, the Texas Politics Project released a poll showing the cost of health care was the top economic concern for 67% of Texans.
  • At the end of 2025, reports warned about the rising costs of health care due to the loss of enhanced ACA subsidies.
  • Recent federal data shows nearly 4.2 million Texans enrolled in the ACA marketplace for 2026, about 5% higher than the previous year.

The players

Dr. John Carlo

Chief Executive Officer of Prism Health North Texas, an AIDS/HIV organization in Dallas, who cautions that initial ACA enrollment numbers may be misleading and that the loss of subsidies is 'exacerbating these challenges that are already here in Texas that many families are already facing.'

UnidosUS

A civil rights and advocacy organization that recently released a study showing Texas as the worst state in 'providing health care coverage for its children,' with over 1 million Texas kids lacking any health coverage in 2024.

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What they’re saying

“There's really no good way to estimate the overall impact and ramifications because it is such a complicated system to begin with.”

— Dr. John Carlo, Chief Executive Officer of Prism Health North Texas (Texas Signal)

“We know there are many adults in our community that really rely on continued coverage so they can continue good preventive health care.”

— Dr. John Carlo, Chief Executive Officer of Prism Health North Texas (Texas Signal)

The takeaway

The loss of ACA subsidies and Texas' refusal to expand Medicaid have exacerbated long-standing challenges around health care affordability and access, especially for low-income residents and families. This has significant implications for the health and financial security of Texans, as well as strains on the state's overall health care system, underscoring the need for policy solutions to address these persistent disparities.