Republican Bill Targets ACA Protections, Millions in Texas Could Lose Coverage

As many as 1.7 million Texans are projected to lose their health insurance under sweeping changes to the Affordable Care Act (ACA) included in a Republican-led tax and spending bill. The rollback of key federal subsidies and stricter enrollment requirements come as Texas already leads the nation with the highest uninsured rate, as first reported by The Texas Tribune.

“With the passage of the One Big Beautiful Bill, we now have the tools to strengthen these vital programs for generations to come,” said Robert F. Kennedy Jr.

Nearly 4 million Texans enrolled in ACA plans this year, a record-high, largely driven by enhanced premium tax credits enacted during the Biden administration. Those credits, which reduced monthly costs for millions, are set to expire at the end of 2025. Without them, coverage costs will surge, particularly for low- and middle-income families, and over 1.1 million Texans could lose their plans solely due to the loss of these subsidies.

Texas has not expanded Medicaid eligibility under the ACA, leaving many low-income adults dependent on marketplace plans. About 2.5 million Texas enrollees earn between 100% and 150% of the federal poverty level. The ACA has served as a critical gap-filler for these individuals, who would otherwise qualify for Medicaid in most other states.

“The whole bill is just designed to dismantle these health programs by getting people to disenroll in them, which then makes the entire system less functional,” said Lynn Cowles, the health and food justice director at Every Texan.

The newly passed federal bill also introduces significant administrative barriers to coverage. It ends automatic renewal, shortens the open enrollment window to one month, and increases documentation requirements. Additionally, beginning in 2026, year-round enrollment for people earning under 150% of the poverty level will be eliminated, and many lawfully present immigrants— including DACA recipients, asylees, people with Temporary Protected Status and refugees— will be excluded from the ACA marketplace.

“I think back to the Great Recession, when a lot of people lost their jobs and thus lost their job-based health insurance coverage,” said Cynthia Cox, director of KFF’s ACA Program, which analyzed the state-level impact of Trump’s megabill. “This is going to be more than that,” she added.

Experts warn the combined impact of these changes could destabilize the insurance market, increase financial pressure on hospitals, and reduce health care access across Texas. With over half of marketplace enrollees currently paying less than $10 a month, any spike in premiums could push thousands to drop their coverage entirely, further widening the state’s already troubling insurance gap.