Individual Health Insurance Enrollments Drop in Texas Following Changes to ACA Market Plans
By Phil West

Patient enrollment in the national individual health insurance market – largely driven by Affordable Care Act (ACA) Marketplace plans – fell by 18% between June 2025 and June 2026, per a new KFF study.

From February 2025 to February 2026, per KFF’s state-by-state analysis, active enrollment in ACA Marketplace plans in Texas fell 4%, meaning nearly 150,000 individuals did not renew their coverage or enroll in another marketplace plan.

The Texas Medical Association foresees an increase in the state’s number of uninsured. Marcial Oquendo Rincon, MD, chair of TMA’s Council on Socioeconomics, predicts significant effects for patients, physicians, practices, and hospitals.

“People are going to be able to get some insurance plans, but they’re not going to be the traditional [major medical] plans” that provide comprehensive coverage, the Dallas pediatrician said. “It will never be as good as the coverage that you would get with ACA, so people will have access to maybe primary care, but they will lose access to specialty medicine, emergency services, and hospitalization … which is going to be a big, big hit if they actually need to use those services. That’s going to be a problem for health care.”

KFF projects that more than 4.6 million Americans lost coverage through their individual health insurance marketplace plans between June 2025 and June 2026. Those individuals and their families now have to find coverage through an employer, qualify for Medicare, Medicaid, or CHIP, buy another form of coverage, or go without.

“The enrollment decline coincides with the expiration of the enhanced premium tax credits and other policy changes that are expected to reduce enrollment,” KFF noted in its study findings.

The pressure is unlikely to ease soon. Marketplace insurers have proposed a median premium increase of 15% in 2027, and several carriers have announced plan cancellations – a combination that could push enrollment lower still.

The share of working-age U.S. adults without health insurance rose from 8.9% in 2024 to 11.2% in 2026, per the Commonwealth Fund’s latest Biennial Health Insurance Survey. 

TMA testified in September on behalf of Medicaid beneficiaries and physicians and continues to advocate for Texas Health and Human Service Commission funding to support Texans.

“Those that cannot [qualify for Medicaid] will still have medical needs and are going to end up in our hospital systems unable to pay for the services, and those are going to be paid by the taxpayers,” Dr. Oquendo said.

Read Texas Medicine Today's previous health insurance reporting.