Texas Dropped 140,000 ACA Enrollees in One Year
Texas lost 140,000 Affordable Care Act enrollees between February 2025 and February 2026, the state’s first year-over-year decline since 2019. The Centers for Medicare and Medicaid Services released provisional data showing Texas’ effectuated enrollment fell from 3.42 million to 3.28 million after enhanced premium tax credits expired at the end of 2025. Effectuated enrollment means people who activated their coverage by paying their first month’s premium.
The tax credits, which subsidized premium costs for most enrollees, expired after Congress did not extend them. Without the credits, premiums rose and hundreds of thousands of Texans stopped paying.
140,000 Texans who dropped ACA coverage between February 2025 and February 2026, the largest single-year numeric decline since CMS began tracking the figure.
Texas Fared Better Than Most States, But Still Lost Ground
The national year-over-year drop in February effectuated enrollment was 12%. Texas fell 4%, which means the state performed better than the national average but still recorded its steepest numeric loss on record.
“We saw record growth in ACA enrollment when there was an enhanced premium tax credit. This is the first time we’ve seen a decrease in the enrollment.”
Justin Lo, Senior Researcher, KFF, 2026
Texas has more ACA enrollees than any state except Florida. That scale matters: a 4% drop in Texas translates to more people losing coverage in raw numbers than a larger percentage drop in a smaller state.
Charles Miller, director of health and economic mobility policy at Texas 2036, told the Texas Tribune that while Texas outperformed other states, “the overall direction is down.”
Who Lost Coverage and Why It Matters
The enhanced tax credits, first enacted under the American Rescue Plan in 2021 and extended through 2025, had made ACA premiums free or near-free for low- and moderate-income households. Their expiration meant many enrollees faced premium increases of hundreds of dollars per month.
Texas has not expanded Medicaid under the ACA. That means people who cannot afford ACA premiums without the credits often have no fallback public coverage option. Texans earning below the federal poverty level do not qualify for either Medicaid or ACA subsidies in a non-expansion state, leaving them in the coverage gap.
What You Can Do Now
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Call your U.S. senators at (202) 224-3121 and tell them to restore enhanced ACA premium tax credits. Ask specifically for reinstatement of the credits that expired in December 2025. The coverage drop is already accelerating.
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Contact the Senate Finance Committee, which controls tax credit legislation, at (202) 224-4515. Tell them that 140,000 Texans lost coverage in a single year and that Texas has not expanded Medicaid, leaving no safety net for those priced out of the marketplace.
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Tell your U.S. House member that Texas recorded its worst ACA enrollment drop on record. Find your representative’s direct line at house.gov/representatives/find-your-representative.
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Check eligibility for remaining subsidies at healthcare.gov. Lower-income Texans may still qualify for income-based subsidies even without the enhanced credits. Open enrollment runs November through January.
Sources
Texas Tribune: Texas ACA Enrollment Drops 4% After Tax Credit Expiration KFF: ACA Marketplace Enrollment and Premium Tax Credit Data CMS: Effectuated Enrollment Snapshot Data 2026 KFF: The Coverage Gap in Non-Medicaid Expansion States Texas 2036: Health and Economic Mobility Policy Research