ANALYSIS: The map shows just how many Texans rely on ACA health insurance and how deeply those subsidies shape what coverage looks like across the state. In rural counties, ACA enrollment makes up a significant share of how people get insured. In many of those places, subsidies are doing a lot of heavy lifting to keep monthly premiums within reach.
South Texas stands out in particular. In counties like Starr, Dimmit, and Maverick, which sit close together along the border, double-digit enrollment rates are common. In Starr County, more than 26 percent of the population is enrolled in an ACA plan, and nearly one in three people are still uninsured. Dimmit and Maverick counties show the same pattern with high enrollment, high uninsured rates, and steep reductions in premiums because of subsidies.
That same story plays out across much of rural Texas. In county after county, ACA coverage is not a side option. It is a major part of the local health insurance landscape. And the subsidies that make those plans affordable are not just helpful. They are essential. In some places, subsidies reduce premiums by more than 90 percent. That kind of support is what makes coverage possible for thousands of Texans.
We see a similar pattern in East Texas. Counties like Gregg, Angelina, Cherokee, and Anderson have double-digit enrollment rates, with many others close behind. Across a group of 20 East Texas counties, the average ACA enrollment rate is about 12.5 percent. In Gregg County alone, 15 percent of the population is enrolled, and premiums drop by 95 percent with subsidies. In Angelina County, 13 percent are covered through the ACA, and premiums are reduced by 96 percent. These counties tend to have higher-than-average uninsured rates and rely on ACA coverage as a critical source of insurance in areas where access to employer-sponsored plans may be limited.
In the state’s largest urban counties—Harris, Dallas, Bexar, Tarrant, and Travis—ACA enrollment looks different in scale but not in importance. On average, about 11.6 percent of the population in these counties is enrolled in ACA plans. While that percentage is slightly lower than in some rural areas, the total number of people enrolled is much higher. Harris County alone has nearly 690,000 people covered through the ACA. Dallas County has more than 318,000, and Bexar County has more than 234,000. These are communities where ACA subsidies help a huge number of families afford insurance that might otherwise be out of reach.