Health Care Remains A Major Concern For Texans
At least in the early part of 2026, enrollment in the ACA marketplace in Texas held steady, with even a slight uptick. But those numbers may be deceiving.
Nearly two months into 2026, health care remains an acute concern for Texans in all parts of the state. In December 2025, the Texas Politics Project released an expansive poll that showed the cost of health care became the top economic concern for Texans. In fact, 67 percent of Texans in the poll reported they were “very concerned” about the cost of health care.
That finding was likely not a surprise for the pollsters. At the end of 2025, there were plenty of stories warning about the rising costs of health care due to the loss of enhanced Affordable Care Act subsidies. In Texas, KFF, a nonpartisan health policy organization, projected that over 3.7 million Texans would be impacted by those lost subsidies.
At least in the early part of 2026, enrollment in the ACA marketplace in Texas has held steady, with even a slight uptick. Recent data from the federal government shows that nearly 4.2 million Texans enrolled in the ACA marketplace for 2026, which is about 5 percent higher than the previous year.
According to KFF Health News, ACA sign-ups around the country dropped, but a few states (like Texas) saw people selecting plans jump. KFF indicates that these initial numbers are just a partial part of the health care story. Many of the policyholders were likely auto-enrolled, and it remains to be seen if they will continue to pay increased premiums.
Dr. John Carlo, the Chief Executive Officer of Prism Health North Texas, an AIDS/HIV organization in Dallas, is also noting that these first waves of numbers may be deceptive. In a conversation with Texas Signal, Dr. Carlo elaborated on the complexity of calculating health care costs and access for Texans.
Dr. Carlo stressed caution with reading too much into early survey assessments. “There’s really no good way to estimate the overall impact and ramifications because it is such a complicated system to begin with.”
Texas is just one of a handful of states that has never expanded Medicaid. That has contributed to the state’s distinction as having the highest uninsured rate in the nation. And for Dr. Carlo, the premium subsidies going away is “exacerbating these challenges that are already here in Texas that many families are already facing.”
Strains on the health care system are also top of mind for Dr. Carlo, who oversees a center that offers comprehensive services. Many adults with chronic illnesses rely upon community health centers. If somebody were to experience a loss of coverage through an ACA plan, does that mean they would need to forfeit medication? “We know there are many adults in our community that really rely on continued coverage so they can continue good preventive health care.”
As the effects of increased subsidies do start to take shape in Texas, there are still further challenges in the entire health care landscape. Earlier this month, the civil rights and advocacy organization UnidosUS released their latest study showing Texas as the worst state in “providing health care coverage for its children.”
In 2024, more than one million Texas kids, or about 14 percent of all children, lacked any health coverage. Their polling also showed that health care was the second most important economic concern for Latinos in the state, just behind inflation and rising costs.
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