Texas ACA Marketplace Enrollment Falls 4% — Its First Decline Since 2019 — as Enhanced Subsidies Expire; ~900K Never Effectuated
New CMS data show Texas's effectuated ACA Marketplace enrollment fell from 3.42 million (2025) to 3.28 million (2026) — the state's first year-over-year decline since 2019 — after the enhanced premium tax credits expired December 31, 2025 and the average per-person premium rose from about $57 to $89 per month. Nearly 900,000 of the 4.17 million Texans who selected a 2026 plan never paid for coverage.
Because Texas has not expanded Medicaid, the Marketplace is the primary coverage path for low-income adults above the poverty line, so a Marketplace contraction pushes more uninsured patients onto FQHC sliding-fee schedules and uncompensated-care rolls.
Key takeaways
- Texas's effectuated Marketplace enrollment fell 3.42M → 3.28M (−4%), the first decline since 2019, after enhanced subsidies expired.
- With no Medicaid expansion, subsidy loss falls straight onto FQHCs as more low-income Texans become uninsured.
Primary source
KSAT / The Texas Tribune (CMS data)Source packet
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FQHC Talent. (2026, July 9). Texas ACA Marketplace Enrollment Falls 4% — Its First Decline Since 2019 — as Enhanced Subsidies Expire; ~900K Never Effectuated. Primary source: KSAT / The Texas Tribune (CMS data). Retrieved July 21, 2026, from https://www.fqhctalent.com/intel/tx-aca-marketplace-enrollment-decline-4pct-2026
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