Texas has experienced a 4% drop in the number of people who paid for the first month of their Affordable Care Act (ACA) coverage, according to new data from the Centers for Medicare and Medicaid Services. This decline marks the state’s first year-over-year decrease in ACA enrollment since 2019.

ACA Enrollment in Texas

The number of Texans who effectuated their ACA coverage, meaning they activated their coverage by paying their first month’s premium, fell from 3.42 million in 2025 to 3.28 million in 2026. This decrease is attributed to the expiration of tax credits that had subsidized premium costs for most enrollees.

Despite this drop, Texas has fared better than most states, with a 4% decline compared to a 12% national decline in year-over-year February effectuated enrollment. Experts attribute this to the state’s regulation around pricing of silver plans, which has kept bronze and gold plan prices lower.

The ACA enrollment growth in Texas had surged in recent years, particularly after the expansion of tax credits in 2021. However, with the expiration of these credits, many enrollees have seen their premiums increase, leading to a decline in effectuated enrollment.

According to Justin Lo, a senior researcher for the national health policy group KFF, the drop in enrollment is not surprising, given the expiration of the enhanced subsidies. Charles Miller, director of health and economic mobility policy at Texas 2036, noted that the story is ‘pretty good for Texas’ compared to other states, despite the overall direction being down.

Original reporting: Texas Tribune (HLL/CB) — read the source article.