By Michael J. Darrouzet, John Hawkins, and Jamie Dudensing
This opinion-editorial first appeared in the Austin American-Statesman on Dec. 4, 2025.
America’s longest government shutdown may be over, but many
Texans' health coverage is still in jeopardy.
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 reach. Without the subsidies, access to
physician 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.
Lawmakers must realize what’s at stake by not firming up a
deal that keeps the credits in place: higher health care costs, poorer health
outcomes and further destabilization of our health system.
Alternative ideas, such as 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. Renewing the credits is also the classically
conservative, fiscally responsible thing to do.
Almost 4 million Texans are insured through ACA Marketplace
plans. 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 premiums would 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 will spike for families simply trying to
keep their same coverage. 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.
By Michael J. Darrouzet, executive vice president and CEO
of the Texas Medical Association; John Hawkins, president and CEO of the Texas
Hospital Association; and Jamie Dudensing, president and CEO of the Texas
Association of Health Plans.