Analysis shows 94% of Texas ACA enrollees received help to pay premiums; More financial assistance dropped average premium to less than $100 a month

EHF’s report includes interactive map with ACA enrollment data for every county in Texas

A record number of Texans enrolled in Affordable Care Act (ACA) health insurance for 2022 thanks in large part to the greatest amount of federal financial assistance available to date to help pay for monthly premiums. That’s one of the findings of an Episcopal Health Foundation (EHF) analysis of new ACA health insurance enrollment data released by the Centers for Medicare & Medicaid Services combined with data from previous ACA enrollment periods.

More than 1.8 million Texans signed up for ACA marketplace health insurance in 2022, up 42% from 2021. That means more than 500,000 additional Texans have marketplace health insurance coverage compared to last year – the largest increase in Texas ACA enrollment since Congress passed the law in 2013.

Read the complete analysis report:

At the same time, more Texans at more income levels received federal financial assistance to help pay their ACA insurance premiums than ever before and that assistance dropped average costs by the largest amount ever. EHF’s analysis found that a record 94% of Texans who signed up for 2022 ACA plans received financial help. That federal financial assistance dropped average premium costs by 85%, lowering the average monthly price from $557 to just $86.

“These record numbers clearly show that Texans – especially low-income Texans — want and value health insurance,” says Shao-Chee Sim, EHF’s VP for Research, Innovation and Evaluation and author of the report. “And when it’s actually affordable to them, huge numbers will sign up for coverage and become repeat customers.”

During COVID-19, Congress passed the American Rescue Plan Act that expanded the eligibility requirements of the ACA health insurance marketplace for two years. It increases financial help to those already eligible for federal subsidies and expands subsidies to people earning incomes above $54,000 for individuals and $111,000 for a family of four.  In his State of Union address, President Biden has called for Congressional approval to an extension of the federal subsidies for ACA health insurance beyond this year. 

EHF’s analysis found that 73% of ACA enrollees (1.3 million Texans) were returning consumers and more than 503,000 were new enrollees – both records in Texas. As in the previous ACA enrollment periods, the vast majority (69%) of those who signed up for ACA plans earn annual incomes less than $34,000 a year for individuals and $70,000 for a family of four.

Texas lawmakers have opted not to expand Medicaid or create a similar program that would provide even more gains in health insurance coverage for low-income Texans than those seen in these latest ACA enrollment numbers. Texas remains the state with the highest uninsured rate in the nation and the most uninsured residents.

“Increased financial assistance from the American Rescue Plan Act spurred the record sign-ups across Texas, but that will be temporary if federal funding for financial assistance expires as planned at the end of the year,” Sim says. “Without Medicaid expansion, increased affordable ACA coverage options for Texans under the Build Back Better plan, or some sort of Texas-specific proposal to increase health insurance access and affordability, we’ll be right back where we started. There’s a serious risk that we’ll go from these record enrollment numbers to hundreds of thousands of Texans back to being uninsured.”


Other findings from EHF’s analysis of 2022 Texas ACA enrollees:

  • 55% are women
  • 88% live in non-rural areas
  • 25% are adults ages 55 to 64
  • 20% are adults ages 45 to 54
  • 64% selected a Silver health insurance plan

EHF’s analysis provides an overview of the experiences of the past eight ACA marketplace open enrollment periods in Texas. Data and figures presented in the report are based on analysis of 2022 data published by the Centers for Medicare & Medicaid Services (CMS) compared with data from Office of Assistant Secretary for Planning and Evaluation (ASPE) for previous open enrollment periods.