Not all CMS data is telling the same story when it comes to ACA enrollment in Texas.
As of January, nearly 4.2 million Texans had selected ACA plans for 2026, up from nearly 4 million in 2025. That marked the largest enrollment increase of any state.
A previous KFF analysis found Texas had the highest uninsured rate in the country at 19.2%, almost double the national rate of 9.8%, in 2024.
Leading up to 2026, nonpartisan think tank “Texas 2036” expected a slight ACA enrollment dip. While President Donald Trump’s administration has been touting integrity efforts as shaping enrollment figures, the expiration of enhanced subsidies at the end of 2025 has also been a major factor. Healthier people could opt out of coverage when facing steeper premiums, straining insurers’ risk pools.
Fast forward to the recent release of February data: It turns out the expectations were pretty spot on.
Texas’ effectuated enrollment was under 3.3 million in February 2026, down 4% year over year. In January 2026, effectuated enrollment was 3.6 million.
Effectuated enrollment depends on whether an enrollee paid their premium for the month — or they have a zero-dollar premium — and have an active policy. Plan selections, however, take place before these payments. This pool can include people who chose a plan, were automatically re-enrolled or got put into a suggested alternative plan.
In essence, plan selections show who originally enrolled, while effectuated enrollment shows who actually stuck around. Effectuated enrollment for February is reviewed after the premium payment grace period, according to KFF.
Before the release of effectuated enrollment data, a Texas Association of Health Plans spokesperson told Becker’s that enrollees often shifted to bronze plans with reduced benefits. That could leave them facing higher out-of-pocket costs when they need care. Silver-loading is another policy component shaping Texas’ enrollment, where insurers account for the cost of federally required cost-sharing reductions by increasing premiums for silver-tier plans.
Overall, national effectuated enrollment was down 2.6 million in February 2026 compared to the same month in 2025. Effectuated enrollment has generally increased in recent years, with 2026 disrupting the pattern.
The one standout state, New Mexico, likely does not come as a surprise. For February 2026, effectuated enrollment was 80,047, up more than 14% from the same time in 2025. Every other state saw a drop in enrollment in 2026 compared to 2025. New Mexico completely replaced the subsidies, with the governor and lawmakers allocating an additional $17.3 million toward premiums during an October special legislative session. Even based on early 2026 data, New Mexico logged record-high enrollment, as well. In other words, backfilling those subsidies gave New Mexicans less reason to drop coverage.
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