Texas emerged as a standout in the 2026 ACA open enrollment period, attracting about 206,000 new enrollees — the highest in the country — according to preliminary data published Jan. 28 by CMS. Meanwhile, nationwide enrollment fell to nearly 23 million from 24.2 million.
The 5% growth may come as a surprise, considering the fallout of the expired ACA enhanced subsidies, which could particularly weigh on states that have not expanded Medicaid, like Texas.
Becker’s spoke with Oscar Health Vice President Breck Garrett, who oversees the company’s Texas market, and the Texas Association of Health Plans, to better understand what prompted the gains — even as states with similar policy landscapes, such as Florida, lagged on enrollment.
One major factor driving growth: Shifts to bronze and low- or no-premium plans, especially as Texans faced sticker shock in the wake of the enhanced tax credit expiration.
“When people went to sign up for coverage, they looked at their options, and they saw the higher prices. Instead of dropping coverage altogether, they selected plans with lower benefits, so they went from gold down to bronze plans or silver down to bronze plans,” a TAHP spokesperson said. “The effect of that is that people just have less coverage, so they have more out-of-pocket costs when they do end up needing care.”
A KFF analysis this past November found Texas’ average lowest-cost bronze-tier monthly premium for 2026 was $426, falling into the lower half of state averages.
Mr. Garrett said most Texans at 200% of the federal poverty level had access to zero-premium plans. He emphasized collaboration with agents and brokers to ensure consumers were informed of affordable options.
“We did see members shift, buy down, to the zero-dollar plans, but it kept them insured and kept them in the market,” he said.
When asked about morbidity concerns, Mr. Garrett cited Oscar’s condition-specific plans, such as menopause-oriented HelloMeno, that offer zero-premium benefits before deductibles.
“The morbidity within the bronze metallic level could shift over time and shift this year,” he said. “[These specialized plans] are also kind of unique to the individual market. In a group health plan, you really wouldn’t be able to do that because you have to underwrite the risk of the group. But in an individual plan, where it’s one giant risk pool, you can do these kinds of things.”
Silver-loading, when insurers place the price of cost-sharing reductions onto silver-tier plan premiums, is another policy factor in Texas.
“It effectively allows people to get a little bit more subsidy to buy a plan on the exchange,” the TAHP spokesperson said.
As a non-expansion state, Texans also have limited last-resort options. States that have expanded Medicaid allow almost all adults with incomes up to 138% of the federal poverty level to get coverage.
“That leaves a bigger chunk of people in the state that don’t have access to another option outside of the Healthcare.gov marketplace,” the TAHP spokesperson said. “Texas doesn’t really give Medicaid to working adults no matter how low their income is.”
