1.7 million Texans could lose health coverage under expiring tax credits, ACA changes in GOP megabill

WASHINGTON — Up to 1.7 million Texans are expected to lose their health insurance through coming changes to the Affordable Care Act marketplace under Republicans’ tax and spending megabill, according to an analysis by health policy experts — a serious blow to a state health care system already strained by the highest uninsured rate in the nation.

Nearly 4 million Texans signed up for ACA health plans this year, a high-water mark in the marketplace’s 12-year history. But between the looming expiration of Biden-era enhanced premium tax credits — which lower out-of-pocket costs for people with marketplace coverage — and changes in the recently passed GOP megabill, the state’s uninsured population is expected to spike.

The effects could reverberate across the health care landscape, with higher premiums, more financial strain on hospitals and destabilized insurance marketplaces, experts said.

Because Texas never expanded Medicaid to people earning above the federal poverty level — as 40 other states have done — the ACA marketplace has been an enormous driver of coverage, particularly among lower-income people. Texas’ uninsured rate fell from 23.7 percent in 2010 to 17.4 percent by 2023, with ACA enrollment contributing significantly.

https://www.texastribune.org/2025/07/18/texas-health-coverage-loss-trump-gop-megabill-affordable-care-act/