By: TAHP | Monday, October 6, 2025

The big picture: If Congress fails to extend enhanced premium tax credits, monthly health insurance costs will more than double. That would leave over 1 million Texans without health insurance, the largest coverage loss of any state.

• Over 1 million Texans could lose coverage, roughly 26% of total U.S. losses in this scenario.
• The state’s uninsured rate would jump from 16% to 20% — the steepest increase nationwide.
• For those families who remain insured, average premiums would rise by about $2,000 per year.

Why Texas is uniquely vulnerable: Unlike many states, Texas has not expanded Medicaid, so families rely on tax credits to make coverage affordable, just like employers rely on tax support for job-based coverage. Without this tax relief, premiums double overnight, and Texans are forced to drop coverage. Doctors and hospitals are left with unpaid bills, creating the largest coverage losses in the nation and the biggest increase in uncompensated care.

Texas Hospitals and Doctors take the hit: Texas providers would absorb $1.5 billion in new uncompensated care, climbing from $6.8 billion to $8.3 billion, the largest increase in uncompensated care costs in the country.

• That’s a shocking 20% of the total increased uncompensated care nationally, falling on Texas alone.
• Texas hospitals report billions in unreimbursed charity care and Medicaid shortfall costs each year.
• Unpaid costs don’t disappear — they get shifted as cost burdens to insured patients, higher premiums, and increased pressure on local governments.

Rural areas especially vulnerable: 24 rural hospitals in Texas have closed — the most in the nation — leaving many counties with no hospital at all. Loss of coverage is expected to hit these areas the hardest, further straining rural Texas.

Texas tie-in: In Texas, where 73% of the uninsured are employed and less than 27% of small employers offer coverage, the ripple effects of more uninsured people are felt not just in hospital corridors, but in community budgets, taxes, and economic growth.

Bottom line: Unless Congress acts, Texas will bear a disproportionate share of the fallout. The state isn’t just projected to lose the most insured people — it will also carry the heaviest uncompensated care burden, threatening hospital survival and undermining community health across the state.

Learn more: Check out TAHP’s full presentation and one pager diving into the data and impact on Texans. Also, read our recent complete coverage explaining how coverage will soon become unaffordable for Texans.