Enrollment in the federal health insurance marketplace begins next month, and advocates warn uncertainty and confusion around policy changes could affect millions of Texans who depend on it for coverage.
Federal lawmakers over a push to extend the enhanced premium tax credits designed to make Affordable Care Act marketplace coverage more affordable. The enhanced credits are set to expire at the end of the year, which would more than double premiums for 2026 plans.
鈥淎t this point, we're so close to open enrollment that if Congress does extend tax credits at this moment, which they absolutely should, then there will be a mad dash to try to figure out how the infrastructure of healthcare.gov will work,鈥� said Lynn Cowles, director of health and food justice at the advocacy group Every Texan. 鈥淚ssuers would likely not readjust their rates at that point.鈥�
Cowles isn鈥檛 just worried about how the back-and-forth from the federal government makes an already difficult process even more confusing. During the 2025 open enrollment period, nearly auto-enrolled in Marketplace plans 鈥� accounting for 44% of returning consumers.
鈥淚n a lot these cases, people have rolled over plans with $0 monthly premiums,鈥� Cowles said.
Those people may have never opened a premium statement because there wasn鈥檛 a bill for them to pay, and they may not be expecting a new bill in January, she said. Then, they may get kicked off their plans for non-payment.
ACA enrollment in Texas has more than tripled over the last decade 鈥� driven largely by expanded subsidies introduced in 2021. The loss of those subsidies could cost up to 1.5 million Texans coverage, according to a .
Cowles recommends working with to find a plan that works.
If coverage is too expensive, she said people should be aware of local safety net providers and clinics. That includes or FQHCs, , and hospitals with .
Texas already has the worst uninsured rate in the country, and Cowles said she鈥檚 worried about how this 鈥渦nprecedented鈥� uncertainty will affect enrollees. She also said as the uninsured population increases, it will likely increase costs for everyone as people forgo less expensive preventive care and rely on emergency rooms.
Cowles said open enrollment has happened during a government shutdown before, including during the program鈥檚 first year.
鈥淓ven in 2013, when the thing was rolling out, we still had clear understandings then of鈥hat the tax credits were going to look like for people,鈥� Cowles said. 鈥淲e had stable numbers then, and we don't have those right now.鈥�
Cowles said it鈥檚 difficult for people enrolled to keep up with all the information and news surrounding the Marketplace right now. But for those paying attention, she said it鈥檚 another example of people being left behind by lawmakers.
鈥淭he government shutdown is another representation of the variability and the fluctuation that's happening right now across all sectors of government and public life,鈥� Cowles said.
Abigail Ruhman is 四虎影院鈥檚 health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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