1 million Texans would lose health insurance under GOP budget

Texas cannot afford another million citizens without health insurance, but that's what'll happen if congressional Republicans take the affordable out of the Affordable Care Act.

Texas already has the highest uninsured rate in the nation, without Congress reducing the subsidies available to low-income people through Obamacare. Kicking a million Texans off the program will also hobble the entire U.S. health care system.

A University of Texas/Texas Politics Project Poll released Wednesday found that 88% of Texans are concerned about the rising cost of health care.

Senate Democrats have refused to fund the government until Republican lawmakers restore the subsidies. But President Donald Trump has refused to negotiate, and Democrats show no signs of budging before Healthcare.gov opens enrollment for 2026 insurance plans on Nov. 1.

"It's very clear that affordability is an important driver of health insurance coverage for consumers in Texas," Texas A&M professor and health care researcher Laura Dugue told me. "They seem to be quite price-sensitive, and the marketplace has been an important part of the reductions in insurance we've seen over the past few years."

More than 4 million Texans bought their insurance through healthcare.gov in 2025. If Congress doesn't reauthorize subsidies started during the COVID-19 pandemic, Texas' uninsured rate will rise from 16.8% to at least 20%, Dugue and co-author Benjamin Ukert found in a new research paper.

Dugue and Ukert calculated that between 665,000 and 1.45 million marketplace Texans will not renew Obamacare coverage next year. The nonpartisan Urban Institute estimates 1.8 million Texans will drop coverage, while health care think tank KFF put the number at 1.4 million.

Enrollees must be U.S. citizens or permanent residents, and there is no evidence for Republican claims that immigrants lacking permanent legal status are enrolled.

"Marketplace coverage started out pretty small in Texas, but really, really grew after the enhanced subsidies were put in place," Dugue said. "Today, about 16% of marketplace enrollees nationwide are Texans, and we're about 9% of the population."

Health insurance encourages people to see primary care physicians, get free preventative care and obtain treatment before illnesses worsen. Insurance also spreads the financial risk by pooling premiums from healthy people to help pay for the ill.

Over the summer, Republicans wanted to reduce government spending after cutting income taxes on the wealthy. The One Big Beautiful Bill Act ended COVID-era subsidies to save $350 billion over the next 10 years, but Democrats argue it's cheaper to subsidize health insurance than see hospitals close or people file bankruptcy over unpaid bills.

When hospitals and doctors get stuck with uncollectible bills, they make up the losses through higher fees. In rural areas, hospitals often reduce services or shut down when they can't recoup losses, the Center for Healthcare Quality and Payment Reform reported.

People without health coverage die younger and live less productive lives, studies show. Their lifetime earnings are also lower, penalizing their children's futures.

The cut in subsidies coincides with cuts to Medicaid, the health care program for the impoverished and disabled. Texas hospitals will suffer most from Congress slashing payments for treating indigent patients.

"The cuts for federal fiscal year 2026 alone would cost Texas safety-net hospitals around $800 million and more than $2 billion over the next three years," the Texas Hospital Association warned.

The double whammy of more uninsured and reduced safety-net funding will raise health care costs for all Texans, said Elena Marks, a senior fellow in health policy at Rice University's Baker Institute.

"The more people who are paying into the system, the more resources there are in the system to enable the system to continue chugging along," Marks told me. "So, regardless of where your insurance comes from, when the entire system suffers from a lack of resources, ultimately, we all pay for it."

While critics complain about massive fraud, Marks said there is no evidence to support the allegations. People living in rural areas, who are the most dependent on Medicaid and Obamacare subsidies, will suffer the most dramatic drop in services.

The most cost-effective way to pay for health care is to require everyone to pay what they can afford for insurance and provide preventative care.

But conservatives are more worried about someone getting a free ride than doing what makes economic sense.

Lack of insurance does not prevent illness. Making the Affordable Care Act unaffordable for a million Texans will not save taxpayers money, only change how society pays for it. Congress needs to make the COVID-era subsidies permanent; it makes sense economically, medically and morally.

Award-winning opinion writer Chris Tomlinson writes commentary about money, politics and life in Texas. Sign up for his "Tomlinson's Take" newsletter at houstonchronicle.com/tomlinsonnewsletter or expressnews.com/tomlinsonnewsletter.