Texas has achieved a major milestone in healthcare enrollment—but it may be short-lived. In 2024, nearly 4 million Texans signed up for health coverage through the Affordable Care Act (ACA), the highest number since the healthcare marketplace was introduced 12 years ago. However, policy changes in a newly passed federal tax and spending bill could lead to as many as 1.7 million Texans losing their insurance—a potential healthcare crisis.

With Texas already leading the country in the number of uninsured residents, this development threatens to reverse a decade of coverage progress—and place new pressure on families, hospitals, and the broader healthcare system.