Rural Texas Is Losing Affordable Care Access Coverage Even as Statewide Enrollment Rises

Rural Texas is experiencing declining Affordable Care Act (ACA) enrollment despite statewide increases, with exurban counties seeing a 5% drop. Nationally, ACA Marketplace enrollments fell by over one million in 2026 due to higher costs after enhanced tax credits expired, pushing average monthly premiums up 58% and deductibles over $1,000. Rural areas face heightened challenges, including shifts to lower-tier plans or dropping coverage altogether.