Rural and Exurban Texas Lose ACA Marketplace Enrollees Even as Statewide Enrollment Rises 5% — Bastrop Down 17%, Caldwell Down 10%

While Texas posted a roughly 5% statewide rise in ACA Marketplace enrollment for 2026 even as national enrollment fell, rural Texas counties saw enrollment fall more than 3% and exurban counties (metro counties where at least a third of residents live in rural-designated areas) fell about 5%, as enhanced premium tax credits expired and average monthly costs for enrollees rose 58%.

Bastrop County, just southeast of Austin, saw enrollment drop more than 17% as average monthly premiums rose about $100; Caldwell County saw a 10% drop with premiums up more than $50. Both counties already have uninsured rates above 21%, meaning the coverage loss lands directly on communities with limited local provider capacity and heavy reliance on the safety net.