Keep Texans Insured – for Everyone’s Health

Dec. 11, 2025

(A version of this opinion piece ran in the Dec. 5, 2025, Austin American-Statesman)

It feels a bit like running to stand still. The longest government shutdown in U.S. history is now over, but America’s health remains in limbo.

With no deal to extend federal tax credits, up to a million Texans are still at risk of losing critical subsidies that help make health insurance premiums financially within their reach. Without the subsidies, access to their physician’s care might be out of reach as well.

If Congress does not act soon to extend enhanced premium tax credits, this targeted relief that helps working Texans buy private insurance on the Affordable Care Act Marketplace will expire at the end of the year, hitting Texas harder than anywhere else in the country.

Going back to the drawing board, lawmakers must realize what’s at stake by not firming up a deal that keeps the credits alive: higher health care costs, poorer health outcomes, and further destabilization of our health system.

Alternative ideas, like shifting dollars to health savings accounts, should be highly scrutinized for unintended consequences. Any erosion of individual coverage ultimately increases health care costs for all.

The enhanced credits are a lifeline for working Texas families. Stable coverage means more consistent access to their doctors and preventive care, healthier Texans, and healthier communities.

But it’s more than that. Renewing the credits is also the classically conservative, fiscally responsible thing to do.

Almost 4 million Texans are insured through ACA Marketplace plans today. Before the enhanced premium tax credits, only a little over 1 million Texans could afford this coverage. These tax credits led to nearly 3 million more Texans gaining affordable insurance.

If the credits lapse, average out-of-pocket premium payments will spike by an estimated 115% in Texas, compared to about 75% nationally. The steepest hikes hit older adults and middle-income families who do not qualify for traditional assistance.

For a typical Texas couple in their early 60s earning about $85,000 per year, their monthly premium bills would roughly rise by more than $18,000 a year. This is an impossible price tag that few families can absorb.

Once they become uninsured, they delay preventive care; they put off seeing their doctor and getting routine screenings. They might wind up in the hospital emergency department in a health crisis.

In addition to the patient suffering, everyone across the health care system loses.

More uncompensated care doesn’t vanish. Hospitals and physicians stretch to provide free care. Costs shift across the system – ultimately straining hospitals, increasing insurance premiums for employers, and cutting already meager payments for struggling physician practices.

These costs also lead to higher local tax burdens on businesses and families to keep hospital doors open. Texas hospitals already absorb billions of dollars in uncompensated care each year. Letting the enhanced credits lapse will push those costs up for everyone.

The consequences will be felt in every community. Rural and border counties have the state’s highest rates of Marketplace enrollment and will face steep coverage losses. Texas’ five largest counties – Travis, Harris, Dallas, Tarrant and Bexar – could collectively see 350,000 or more newly uninsured.

This should not be a partisan fight. The credits help families buy private plans they choose, with networks they prefer. This is a market-based solution, not government-run coverage.

Texas health care leaders urge Congress to do three simple things before the end of 2025: extend enhanced premium tax credits, keep program integrity and enrollment simple, and prioritize technical assistance for rural and border communities.

Some will argue that Congress cannot afford this. But Texans cannot afford the alternative. Without action, premiums spike for families who made no new choices. The people most likely to be hurt are the ones who embraced private coverage when it finally became affordable.

Texas families, employers, and communities are counting on Congress to extend this tax relief to keep health coverage affordable and Texans insured and healthy.

John Hawkins is President & CEO of the Texas Hospital Association. Jamie Dudensing is President & CEO of the Texas Association of Health Plans. Michael J. Darrouzet is CEO of the Texas Medical Association.

About THA
Founded in 1930, the Texas Hospital Association is the leadership organization and principal advocate for the state’s hospitals and health care systems. Based in Austin, THA enhances its members’ abilities to improve accessibility, quality and cost-effectiveness of health care for all Texans. One of the largest hospital associations in the country, THA represents more than 85% of the state’s acute-care hospitals and health care systems, which employ some 400,000 health care professionals statewide. Learn more about THA at www.tha.org or follow THA on Twitter at http://twitter.com/texashospitals.