Health policy experts warn that up to 1.7 million Texans could lose their health coverage following changes to the ACA marketplace prompted by a recently passed Republican tax and spending bill. This potential decline in insurance coverage could have serious ramifications, especially considering that Texas has the largest uninsured population in the nation, as highlighted by The Texas Tribune.
Record Enrollment in ACA Health Plans
This year, nearly 4 million Texans signed up for ACA health plans, marking the highest enrollment since the program began 12 years ago. However, with the expiration of Biden-era premium discounts and the changes introduced by the new GOP bill, Texas could face a significant rise in the number of uninsured individuals.
Experts indicate that this shift may lead to higher insurance costs for everyone, increased unpaid hospital bills, and destabilization in the overall health insurance system.
Texas and Medicaid Expansion
Unlike 40 other states, Texas did not expand Medicaid, driving many low-income residents to depend on the ACA for health coverage. The uninsured rate in Texas dropped from approximately 24% in 2010 to 17% in 2023, primarily due to ACA sign-ups.
Among the nearly 4 million individuals enrolled in ACA plans, about 2.5 million earn between $32,150 and $48,225 a year for a family of four, placing them just above the poverty line. In states that expanded Medicaid, individuals with these incomes would qualify for that program; in Texas, the ACA effectively filled that gap.
Challenges for Low-Income Adults
Most of those on Medicaid in Texas are children, while low-income adults face harsher qualification criteria. They typically must be pregnant, disabled, over 65, or parents making less than $300 per month for a family of four.
Cynthia Cox, a researcher at the nonprofit KFF, warned that these recent changes could lead to the most significant drop in coverage since the ACA was enacted. “I think back to the Great Recession when a lot of people lost their jobs and, consequently, their job-based health insurance coverage. This is going to be more than that,” she stated.
Potential Loss of Medicaid Coverage
While much of the discussion surrounding the Republican tax and spending bill has focused on cuts to Medicaid, the changes will not impact Texas as severely since the state never expanded Medicaid in the first place. KFF estimates that around 200,000 Texans could lose Medicaid, but this figure is lower than in many other states.
The more alarming changes lie within the ACA marketplace, making it increasingly difficult for individuals to sign up. The bill ends automatic renewals, increases paperwork requirements to verify income, and reduces the open enrollment period to just one month. Starting in 2026, individuals earning under 150% of the federal poverty level will no longer be eligible for year-round enrollment.
Impact on Immigrant Coverage
The bill also imposes restrictions preventing certain immigrants, including DACA recipients, refugees, and individuals with Temporary Protected Status, from obtaining insurance through the ACA marketplace.
Currently, most Texans who have marketplace plans receive assistance to help pay their premiums. By 2025, 95% of individuals utilized income-based tax credits to lower their monthly costs, with over 1.4 million (approximately 36%) automatically renewing their plans, according to the Centers for Medicare and Medicaid Services.
Conclusion
As the implications of the newly passed Republican tax and spending bill unfold, the potential loss of ACA coverage poses a significant risk to millions of Texans. The need for transparent communication and support for affected individuals will be crucial as the state navigates these changes in its healthcare landscape.
