The number of Texans who paid for the first month of their Affordable Care Act coverage dropped 4% this year, the state’s first year-over-year decline since 2019, according to a first nationwide glimpse at how coverage through the federal marketplace is shaking out this year.
Texas was one of a handful of states to increase its ACA enrollment at the beginning of the year, a surprising data point in the wake of the expiration of tax credits that had subsidized premium costs for most enrollees.
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The Centers for Medicare and Medicaid Services has released new provisional data on those who “effectuated” their coverage, which means enrollees who have activated their coverage, usually by paying their first month’s premium in February. That data shows that Texas’ effectuated ACA population fell from 3.42 million 2025 to 3.28 million in 2026 after the credit expiration and subsequent higher premiums.
That 4% year-over-year decrease is the first drop in the effectuated population in Texas since 2019, when the ACA population was a third of what it is today, and the state’s largest numeric decline since the CMS began tracking the figure.
“We saw record growth in ACA enrollment when there was an enhanced premium tax credit,” said Justin Lo, a senior researcher for national health policy group KFF. “This is the first time we’ve seen a decrease in the enrollment.”
But Texas, which has more ACA enrollees than any state but Florida, has still fared better in 2026 than most states. The national decline in year-over-year February effectuated enrollment was 12%.
On that benchmark, “the story is pretty good for Texas, compared to other states,” said Charles Miller, director of health and economic mobility policy at nonpartisan think tank Texas 2036.
“The overall direction is down,” Miller said. “We did lose effectuated enrollment year-over-year. That’s not terribly surprising, given the expiration of the enhanced subsidies at the federal level. And I think what the positive story is is how well Texas did on that measure compared to other states.”
CMS data from February showed that year-over-year effectuated enrollment declined in 49 states, but was less steep in Texas than in most other states. Only Connecticut, Idaho, Massachusetts and Pennsylvania had a smaller drop, by percentage, than Texas. And neighboring New Mexico, which used state funds to replace the expired federal subsidies, was the only state to experience growth in its ACA population.
Congress expanded the ACA tax credits in 2021 during the Biden administration, capping the amount ACA enrollees could pay towards their premiums and expanded eligibility for the subsidies. This had allowed millions to qualify for health insurance plans that had low or no-cost premiums through the federal marketplace. As a result, ACA enrollment surged — particularly in Texas, which is among a small number of states to never expand Medicaid to people earning more than 100% of the federal poverty limit. Because that low-income population cannot access Medicaid in Texas, the ACA marketplace became a popular source of coverage.
The issue became a massive political sticking point last fall as the expiration date loomed. Senate Democrats blocked annual government funding from passing to attempt to pressure Republicans into a tax credit extension deal, triggering a lengthy government shutdown. While the U.S. House ultimately passed a subsidy extension, supported by all Democrats and 17 Republicans, a Democratic bill in the Senate to similarly extend the tax credits for three years fell short of the 60 votes needed for passage, earning the support of all 47 Democrats but just four Republicans.
ACA enrollment grew from about 1.3 million Texans in 2021 to nearly 4 million in 2025, the last year of the enhanced subsidies, and experienced a record high this year of 4.17 million during open enrollment.
But each year, the number of enrollees who effectuate coverage by making a payment is smaller than those who initially sign up. In 2025, for example, while about 3.97 million Texans enrolled in an ACA plan, only 3.42 million — or 86% of enrollees — effectuated their coverage that February.
This year, 79% of enrollees effectuated their coverage, meaning that nearly 900,000 of the 4.17 million Texans who selected Affordable Care Act plans during open enrollment had canceled their plan or not paid after the first premium payment deadline.
Most ACA enrollees are eligible for a three-month grace period to catch up on premium payments before insurers can terminate their plans.
While this year’s effectuation rate, the lowest in nine years, is less rosy for Texas, it is hard to understand the full impact because the CMS has not yet released specifics about the non-effectuating population, including whether or not they had been auto-enrolled or any regional or income characteristics.
Expiration of the enhanced tax credits spiked premiums for silver plans and mostly eliminated silver plans where enrollees owed $0 toward their premiums. Miller speculated that people who auto-enrolled and then saw that their plans were no longer free could be driving the drop-off between the enrollment and effectuation figures, but said more detailed CMS data is needed to know for sure.
“You can imagine a scenario where last year, [someone] had been enrolled in a $0 premium [plan] that made great sense for them,” Miller said. “They didn’t take any action during the open enrollment period. So they were passively re-enrolled in that plan, and that plan, because the enhanced subsidies expired, now has a premium that is greater than $0 — and they just never made that payment.”
Beyond the drop, CMS open enrollment data also showed changes in Texas’ plan selection mix, presumably reflecting cost changes brought on by the tax credit expiration. There are four metal tiers — bronze, silver, gold and platinum — for ACA coverage plans, which each have different cost-sharing plans. Bronze plans have lower monthly premiums but higher deductibles, while gold and platinum plans have higher premiums but lower out-of-pocket costs for enrollees when they receive care.
The size of tax credits is calculated using a benchmark silver plan, which is typically the most popular metal tier, especially among people who qualify for tax credits.
The CMS’ open enrollment data showed that enrollees were more likely than in years past to select a bronze or gold plan, reflecting the expiration of the tax credits. Silver plans had been the most popular selection in Texas each year until 2026, when it fell to third behind gold, which is now 41% of selections, and bronze, at 31%.
“There was a migration away, in plan selections, from silver towards bronze and gold,” Miller said. “And that was concentrated in people who actively selected a plan — people who were first-time market entrants or went back and actively re-enrolled.”
The percentage of ACA enrollees on bronze plans rose from 18% of plan selections in Texas in 2025 to 31% in 2026.
Experts said Texas’ relatively small year-over-year drop in its effectuated population likely owes to regulation around pricing of silver plans, a policy referred to as premium alignment. This has kept bronze and gold plan prices lower, and maintained the lower-income nature of ACA enrollees in Texas. Texas passed a premium alignment law in 2022, and subsequently saw a spike in gold plan selection.
And while Texas’ monthly average per person premium rose from $57 during 2025 open enrollment to $89 this year post-subsidy, ACA enrollees in the state pay the lowest premiums in the nation, according to a KFF analysis of CMS data.
“One [reason] is behavior change — people, instead of buying silver plans, did drop down to lower coverage bronze plans,” Lo said. “We see that in Texas specifically…also, the marketplace population in Texas skews lower-income. This is not a Medicaid expansion state, and so a lot of the people that are signed up for ACA plans in Texas still do get some subsidy.”
Disclosure: Charles Miller and Texas 2036 have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in The Texas Tribune’s journalism. Find a complete list of them here.