Open enrollment for the Affordable Care Act opens next week, running to Jan. 15 of next year. And rates are expected to rise again in 2027, as insurers have proposed higher premiums, potentially affecting nearly 3.3 million Texans (as of February) enrolled in ACA marketplace plans in 2026, according to the Centers for Medicare & Medicaid Services.
Nationwide, insurers are proposing a median increase of about 15% in monthly premiums for ACA plans in 2027, according to the Peterson Center on Healthcare and KFF, nonprofit partners that monitor the nation’s healthcare system. In Texas, the median increase is 13.1%. If finalized, the increases would mark the second consecutive year of double-digit hikes, following a finalized median premium increase of 20% for 2026, according to the nonprofit partners.
Researchers at Georgetown University attribute the premium increases to several political and economic factors, specifically the expiration of enhanced premium tax credits that subsidized ACA plans for 22 million people in 2025. Congress introduced the enhanced tax credits in 2021 to mitigate coverage gaps during the pandemic. Those funds expired in 2025 after the longest government shutdown in U.S. history, when Democrats said they wouldn’t reopen the government unless Republicans kept the ACA subsidies in place.
The expiration of enhanced tax credits coincides with inflation, medical labor shortages, rising pharmaceutical costs, and changes in claim severity that drive up monthly premiums, according to the Peterson Center on Healthcare and KFF report.
Nationally, about 3 million fewer people had ACA insurance plans in February 2026 than in February 2025, a drop health experts attribute to the loss of enhanced tax credits, according to AP.
As more people go without insurance, healthcare costs rise for everyone else, especially at hospitals, said Ashleigh Alvarez, senior program manager of Foundation Communities’ Prosper Health Coverage program. The program has provided free healthcare enrollment assistance since 2014, helping over 65,000 Texans find affordable insurance.
“The gap of people who are uninsured in our country is going to increase significantly.”
Ashleigh Alvarez, senior program manager at Foundation Communities
“That [rise in cost is] because of all the uninsured people and the healthcare providers trying to find some balance to recoup expenses,” Alvarez said. “It all falls on people who have insurance, which isn’t fair. However, if people were able to be eligible for these premium tax credits to help them pay for insurance … then that would remove the additional risk of more uninsured people.”
Alvarez said that even after the enhanced tax credits expired, subsidies for ACA insurance still exist for those who qualify. Individuals and households are eligible for ACA tax credits if they make between 100% and 400% of the federal poverty line. For an individual, that’s between $15,960 and $63,840 of annual income. Alvarez mentioned the importance of filing taxes annually to ensure eligibility for ACA tax credits.
“If people have not filed taxes in past years, the marketplace can deny them the ability to enroll in a marketplace plan for 2027,” Alvarez said. “A lot of people don’t realize that the IRS and healthcare.gov talk to each other.”
Alvarez also pointed to recent federal policy changes affecting eligibility for premium tax credits based on immigration status. Starting next year, only green card holders, certain immigrants from Haiti and Cuba, and immigrants from three small North Pacific nations are eligible for premium tax credits, alongside U.S. citizens.
Alvarez said that means all other immigration statuses won’t qualify for government subsidies: refugees, asylum seekers, visa holders. Without those subsidies, she said many immigrants may opt out of health insurance, driving up costs for everyone else.
“Anyone who doesn’t have citizenship or lawful permanent residence is not going to be eligible for premium tax credits through the marketplace anymore,” Alvarez said. “Because they’re not eligible … that is going to mean that they’re not able to afford insurance through the marketplace anymore. The gap of people who are uninsured in our country is going to increase significantly.”
Alvarez said premium increases will negatively affect people who don’t qualify for federal tax credits to subsidize their ACA plan. She said she assisted a couple during ACA open enrollment last year who had a $50 monthly premium in 2025.
“Then last year, when they came in, it had increased to several hundred dollars for their marketplace plan every month,” Alvarez said. “When we’re talking about cost of living, especially here in Austin, it’s already a challenge in and of itself.”
Beyond Foundation Communities, Alvarez said many local organizations offer financial aid to pay for health premiums, including Health Alliance for Austin Musicians, Good Work Austin, and RAISE Texas. Foundation Communities also provides resource lists of local clinics for uninsured or underinsured individuals, offering dental, vision and sexual healthcare services.
“We’re at least going to be able to provide them [with] those additional resources,” Alvarez said, “so that they can still have access to healthcare even without having health insurance.”
This article appears in October 30 • 2026.
