San Antonio small business owners Mark and Laura Humphries and their two children have relied on the Affordable Care Act marketplace for their health insurance on and off since the program opened in 2014.
Expanded tax credits first approved in the 2021 American Rescue Plan Act and later extended through 2025 helped keep their monthly premium around $500. When Congress allowed those enhanced credits to expire at the end of last year, the couple’s premiums skyrocketed — to nearly $3,000.
“We would have had to take out a small business loan to pay for the policy,” said Laura Humphries, who works as a graphic designer.
The Humphries family is among many marketplace enrollees left looking for alternative, affordable health coverage options this year.
More than 234,000 Bexar County residents were covered under marketplace plans in 2024, according to The Century Foundation, many of them small business owners, part-time workers and early retirees who don’t have access to employer-sponsored health plans and don’t qualify for Medicare or Medicaid.
It has been especially hard on folks dealing with chronic conditions and unexpected diagnoses, according to South Texas health insurance broker Maria Lee.
“Some individuals [are] currently going through cancer treatment or diagnosis like an autoimmune disorder,” Lee said. “It could be that they just suffered a stroke or a heart attack and are in the process of rehab. It could be that they recently had a vascular episode, and they’ve lost a limb. There’s a lot of different situations that unfortunately some of my [clients] dealt with this year, and the transition period wasn’t as easy.”
Changes to the health marketplace
The majority of Americans under 65 have employer-sponsored health plans. Nearly all Americans 65 and older are covered by Medicare, often supplemented by private coverage. But for many small business owners, the self-employed and early retirees, those aren’t an option.
The health insurance marketplace was created through the Affordable Care Act, offering affordable health insurance plans through HealthCare.gov.
Originally set to expire in 2022, tax credits available to marketplace enrollees were extended and enhanced during the Biden Administration and the COVID-19 pandemic, lowering premiums further and opening up the program to even more people.
Enrollees earning over 400% of the federal poverty level ($62,600 for an individual or $128,600 for a family of four), saw the biggest premium spikes early this year as the enhanced credits expired.
Some enrollees were able to switch over to different plans in the marketplace, including Mark Humphries, who works as a commercial photographer. But the new plan is much less affordable than the family plan they had maintained for years.
Laura Humphries and her two children couldn’t find an affordable alternative in the marketplace, she said. Instead, they’re relying on temporary, private emergency plans until they can find something affordable in the long-term.
“The amount of time that I’ve had to put into this this year, that would have been a very nice job to have been paid for,” Laura Humphries said. “You get sent through a labyrinth of people with no real resolution when you finally get off the call. We feel like ping-pong balls sometimes.”
“I honestly don’t know what my daughter and I are going to do,” Laura added. “It’s very stressful.”
Lee works with South and Central Texas residents, helping them find affordable and comprehensive health coverage, meaning plans that are generally reliable in approving claims.
“The state of Texas does not have other options,” Lee said. “There are health plans available, but these are what I refer to as ‘skinny’ options. There are some plans that are close, but not comprehensive.”
Lost messaging
Many analysts expected the expiration of the enhanced premium tax credits to reduce marketplace enrollment nationwide.
Texas, however, has seen increases in enrollment, according to the latest data from January.
Over 4.1 million Texans enrolled in marketplace plans in 2026, an increase of more than 200,000 enrollees year-over-year, according to data from the Centers for Medicare and Medicaid Services. County-level data isn’t available.
Charles Miller, director of health and economic mobility policy at nonprofit think tank Texas 2036, pointed to the availability of low- to no-cost plans in the marketplace that remained available to the majority of ACA enrollees in Texas.
Miller said that although there were steep cost increases for some marketplace enrollees, this group was a relatively small portion of total enrollees. According to Texas 2036, about 75% of current enrollees, about 3.1 million Texans, had incomes below 200% of the Federal Poverty Level and have access to at least one $0–premium plan in 2026.
On top of that, there’s still a sizable population of uninsured Texans who qualify for no-cost plans under the marketplace. And efforts to get those folks signed up for free plans have continued. Miller has been working to ensure that that point isn’t overshadowed by the conversation around rising premiums.
In 2023, more than 316,000 Bexar County residents, or 16% of the county population, was uninsured, giving the county the fourth-largest uninsured population in Texas, according to U.S. Census data analyzed by Texas 2036.
Miller said that it has been a priority of his to ensure that the uninsured who qualify for marketplace insurance aren’t turned off by the headlines over rising premiums, since they likely still qualify for affordable plans.
“The enhanced subsidies expiring, that is directionally worse. It makes things more expensive,” Miller said. “What we wanted to make sure was not lost is that the vast majority of current enrollees still qualify for a free plan.”
