Millions of Texans still qualify for free health coverage
This is a preview of our Texas 2036 newsletter with what you need to know about the upcoming ACA open enrollment coverage and how millions still qualify for free health coverage. To receive this weekly look at our work, sign up here.
2026 Health Coverage: What Texans Can Expect
Open enrollment for Affordable Care Act (ACA) coverage begins Nov. 1, and Texans could face the steepest premium hikes in 15 years, triggered partly by the expiration of COVID-era temporary ACA subsidies.
These numbers might grab headlines but they don’t tell the full story: many Texans, especially lower-income families and older adults, will still qualify for free or inexpensive plans. And it’s up to us to get the word out.
What subsidies are set to expire?
In 2021, Congress boosted federal subsidies for ACA plans and removed the income cap on eligibility as part of its COVID response.
The Inflation Reduction Act of 2022 extended those subsidies, but they are scheduled to end in 2025. The reality is that some Texans — particularly at higher income levels — should brace for higher prices.
Source: Baker Institute
📈 Did you know? By 2025, Texans’ enrollment in ACA marketplace plans increased to nearly 4 million receiving coverage, a more than fivefold increase over the past 12 open enrollment periods.
However, Texas’ uninsured rate continues to lead the nation, with 16.7% reporting not having coverage in 2024. That’s the highest rate seen in two years, reversing a downward trend that began post-COVID.
Many still qualify for low-cost, free coverage
The expiration of these supplemental ACA subsidies doesn’t change this basic fact. Millions of Texans remain eligible for affordable options.
Source: The Paragon Institute
While 2026 ACA premiums aren’t final, national modeling from the Paragon Institute indicates $0-premium options will persist for enrollees at 100–150% of federal poverty level, with older adults potentially qualifying at higher incomes.
Separately, Texas 2036’s analysis shows over half of Texas marketplace enrollees earn between 100-150% of the federal poverty level. These findings suggest many Texans in these ranges will almost certainly continue to see $0-premium plans even if temporary subsidies expire.
Texas 2036’s “Who Are the Uninsured?”
Source: Texas 2036’s “Who are the Uninsured?”
Our “Who Are the Uninsured?” study found that nearly 2 million of the state’s roughly 5 million uninsured individuals qualified for entirely free plans through Medicaid, CHIP and ACA plans. Even more qualify for heavily subsidized plans.
📋 Why aren’t more Texans signing up for these free plans? Our report found that, in large part, it’s due to a perception issue. Too many Texans think a plan is more expensive that it is in reality.
Texans have better options than other states
In fact, thanks to laws like 2021’s SB 1296 and follow-up actions by state policymakers, Texans find themselves better positioned than anywhere else in the country to find an affordable plan on the ACA Marketplace and will likely be able to find free plans at higher income levels than residents of other states.
Did you know? According to estimates, state actions directly led to an increase of 250,000 Texans enrolling in affordable health plans in 2023 alone!
Tackling the larger health care affordability issue
Rising costs of health care, though, are increasing pressure on both employers and employees, with premium increases outpacing paychecks.
And while many may continue to enjoy low-cost coverage through federal ACA subsidies, long-term systemic and sustainable affordability within the larger health care system requires structural reform.
That requires tackling health care industry consolidation among providers and insurers as well as addressing the lack of competition in Texas health markets.
Why we’re studying Texas health care markets
At Texas 2036, we know lasting health care solutions start with facts. That is why we launched a first-of-its-kind study to uncover why Texans go without coverage and to highlight the reforms needed to change that story.
With support, we can keep digging into the data, track how the market is evolving, and advance smart reforms that put affordable health care within reach for families across Texas.