Texans are entering 2026 facing a new round of health-care sticker shock after Congress let the Affordable Care Act’s enhanced premium tax credits expire on Jan. 1, a change expected to push many ACA Marketplace customers into sharply higher monthly premiums. Nationally, KFF estimates subsidized enrollees would pay about 114% more on average in 2026 than in 2025.
The timing collides with already rising health-care prices in Texas. Employer-sponsored insurance — which covers roughly half the U.S. population — averaged $26,993 a year for family coverage in 2025, up 6% from the prior year, according to KFF’s annual survey.
Texas policy analysts note that figure is roughly one-third of Texas’ median household income, squeezing wages and hiring as more compensation is diverted to benefits.
Even insured Texans report going without care: a Texas 2036 analysis, drawing on polling, found 56% of Texans with insurance said they skipped care because of cost.
Meanwhile, Texas continues to post the nation’s highest uninsured rate — about 16.7% in 2024, according to groups citing U.S. Census data — heightening the risk that premium spikes will translate into more people dropping coverage.
Prescription drugs are another pressure point. Large employers increasingly cite prescription spending as a major driver of premium growth, and insurers have pointed to fast-rising costs tied in part to blockbuster GLP-1 weight-loss drugs.
In Texas, the Department of State Health Services runs a drug price disclosure program tracking medications with steep increases, including drugs costing more than $100 for a one-month supply that jump 15% or more year over year.
South Texas may be among the hardest hit: in the Rio Grande Valley, nearly all ACA enrollees receive premium tax credits, and many paid $10 or less per month in 2025, according to a Texas Tribune analysis.
Guest:
Charles Miller is the Director of Health and Economic Mobility Policy at Texas 2036.
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This episode will be recorded on Thursday, January 7, 2026, at 12:00 p.m.
