At the end of 2025, Congress failed to extend subsidies that made health insurance more accessible for millions of Americans through the Affordable Care Act (ACA). Now, we’re starting to see the fallout of that decision, as people across the country face sudden and significant increases in their premium and deductible costs—leading many to lose their insurance coverage altogether.  

The loss of the ACA subsidies is starting to hurt many of our North Texas neighbors, at a time when other costs—including fuel and food—are spiking. In the face of these challenges, it’s important for us to work together to ensure every individual and family has access to the health resources they need to thrive.  

Why We’re Concerned About Health Insurance Changes 

Industry analysts estimate that 20% of Americans who previously had health insurance coverage through the ACA will be forced to drop their insurance this year due to rising costs, according to reporting from The New York Times. That means Texas—which already has the lowest healthcare enrollment rates in the nation—is likely to see even lower enrollment rates, as the progress of the last few years is quickly undone. 

At United Way of Metropolitan Dallas, health is one of our three focus areas—along with education and income—because we know that good health creates a foundation for every aspect of a person’s life. One of our Aspire United 2030 community goals is to increase to 96% the number of North Texans with access to affordable healthcare insurance.  

Why Cost-Saving Health Insurance Subsidies Ended 

For the last several years, enhanced subsidies made health insurance more affordable through the ACA, by increasing the amount of financial assistance available and expanding eligibility to people with higher incomes. As a result, coverage became more affordable for millions of Americans, and we saw a significant increase in health insurance enrollment nationwide. 

The impacts in Texas were especially noteworthy. Most years, our state has the lowest healthcare enrollment rates in the nation, with 21.6% of all residents not enrolled in healthcare coverage. That includes nearly 14% of Texas children, compared to 6% nationally, who are uninsured.    

Thanks to the subsidies, Texas was the No. 1 state for new ACA signups for several years in a row, in part because 97% of Texans signing up through the Marketplace received subsidies for their premiums. The average premium was $60 a month, but many people paid $10 or less after tax credits.  

Unfortunately, the ACA subsidies were scheduled to expire at the end of 2025. Despite months of debate and an extended government shutdown directly related to this issue, Congress failed to reach an agreement that would extend the policy.  

How People Are Being Affected 

With the subsidies gone, all 24 million Americans who buy their insurance through the ACA Exchange saw their costs increase at the beginning of 2026. In fact, most people’s premiums doubled, while deductibles rose more than they ever have before, by an average of $1,000, according to research by the nonpartisan nonprofit health policy organization KFF.  

Initial ACA sign-ups for 2026 plans fell by about 1.2 million people to 23.1 million people during the 2026 Open Enrollment Period, according to the Centers for Medicare and Medicaid Services. KFF estimates that as many as 5 million people who buy health insurance on the ACA marketplaces may drop their coverage this year.  

Not surprisingly, research has found that Americans are extremely concerned about healthcare costs right now. A KFF survey reported that ACA enrollees are worried about affording their monthly premiums, as well as out-of-pocket medical expenses. And already, healthcare costs are hurting people’s budgets, with 55% of ACA customers saying they are cutting back on spending for food and other household necessities. 

What This Means for North Texas 

Prior to the subsidies ending, health insurance coverage stood around 83% in the United Way of Metropolitan Dallas service area (Dallas, Collin, Rockwall and southern Denton counties). That number is poised to decrease this year, as many of our neighbors are forced out of overly expensive ACA plans.  

For our neighbors from lower-income households, increased healthcare costs will have a ripple effect. North Texans are already struggling with increased prices for food, housing and daily essentials. As health insurance premiums spike, we are likely to see an increase in food insecurity—which our neighbors are already struggling with—as well as other challenging situations like evictions.   

Meanwhile, higher premiums and loss of coverage could destabilize insurance markets nationwide and put greater strain on hospitals and the healthcare system. 

The Live United Movement Is Improving Access to Healthcare 

Now more than ever, programs that ensure greater access to health insurance are vital to the health and economic vitality of our region. When more of our neighbors have access to affordable, quality health insurance, we all benefit in the form of a stronger workforce, lower overall healthcare costs, more successful students and better life outcomes. 

To meet our goal of 96% health insurance coverage across North Texas, we must improve access to health insurance by more than 2% annually.  

The good news is that Texas’ rapid increase in ACA enrollment over the last several years indicates that people in our state want access to affordable, quality insurance. 

Our Healthcare Navigators initiative is one key to expanding healthcare access in North Texas. Our team of Navigators assists uninsured North Texans as they compare and enroll in plans through the Health Insurance Marketplace, CHIP or Medicaid.  

Navigating the Health Insurance Marketplace or applying for CHIP or Medicaid can be confusing and stressful. Many people avoid signing up for health insurance because the process is overwhelming or they have language barriers. Now that the ACA subsidies have expired, initiatives like Healthcare Navigators are vital for ensuring more North Texans can maintain their coverage while keeping costs under control.   

Importantly, our Healthcare Navigators also addressed broader family stabilization needs. Navigators routinely connected families to additional resources, including CHIP and Medicaid coverage for children and pregnant women, food assistance programs, and community-based support services. By combining health insurance enrollment with access to integrated supports, United Way strengthens long-term health stability across North Texas communities.  

Each year, our certified enrollment experts assist tens of thousands of North Texans, helping more people access the health coverage and other supports necessary to thrive. In the last year, our navigators had a significant impact on our community, fielding 21,000 client inquiries, assisting 7,680 individuals as they signed up for CHIP/Medicaid and supporting 2,316 consumers as they enrolled in a qualified health plan.  

Together, We Can Ensure Every North Texan Can Get Covered 

As many of our North Texas neighbors face rising health insurance costs and the prospect of losing their coverage altogether, we know we must unite as a community to ensure that access to healthcare continues to expand, despite the challenges we face. 

Donate to United Way now to support programs like Healthcare Navigators, which simplifies health insurance for tens of thousands of our neighbors and ensures more families get the coverage that they need to thrive.