Health Insurers Seek 20% Premium Increase in Texas under ACA

Health Insurers Seek 20% Premium Increase in Texas under ACA

M Hasan    5:00 PM   

Rising Premiums and Uncertain Future for Texas ACA Market

Health insurance companies in Texas have submitted proposals for an average 24% increase in premiums for Affordable Care Act (ACA) plans in 2026. This significant rise could destabilize the marketplace, potentially leading to more individuals opting for less or no coverage. The proposed hikes are far steeper than the 3.8% average increase seen last year, marking a major shift in the health insurance landscape.

The data from KFF indicates that this could be the largest rate hike since 2018, when premiums increased by 35%. That year, insurers considered Congress' attempts to repeal the ACA and President Donald Trump's executive order ending subsidies for low-income individuals. Since then, premium increases have remained relatively modest, with no more than a 4% rise in any given year.

Growth of the ACA Marketplace in Texas

Despite these challenges, the ACA has seen substantial growth in Texas. Nearly 4 million Texans enrolled in ACA plans for 2025, a record high in a state with the nation’s highest uninsured rate. Enrollment has tripled since 2020, largely due to expanded tax credits that helped lower monthly premiums for many users.

This expansion has had a measurable impact on health care trends in Texas. Enrollment grew from 1.3 million in 2021 to nearly 4 million in 2025. The average post-subsidy monthly premium paid by Texans dropped from $136 in 2018 to $50 in 2024. While the uninsured rate remains the highest in the country, it has decreased from 23% in 2012 to 16.3% in 2023.

The ACA marketplace in Texas now offers more options than ever. The number of insurers operating in the individual marketplace has increased from eight in 2020 to 15 today. This competition has led to more choices for consumers, with 114 counties now offering at least four insurance options. Only seven counties, all near the Oklahoma border, still have just one insurer.

Challenges Ahead: Expiring Tax Credits and Rising Costs

However, these gains may be at risk due to the expiration of key tax credits at the end of the year. Insurers have cited rising medical costs and increased use of health services as reasons for their proposed rate hikes. Blake Hutson, vice president of public affairs at the Texas Association of Health Plans, described the situation as a "perfect storm" involving increasing medical costs, the loss of tax credits, and a less healthy risk pool.

The premium tax credits, expanded through the American Rescue Plan Act and the Inflation Reduction Act, currently benefit 83% of Texans who purchase coverage through the ACA. These credits are based on income and help reduce monthly premiums. However, they will expire at the end of 2025, making those earning over $62,600 ineligible for subsidies. This change could significantly impact those earning under 150% of the federal poverty level, who currently pay little or nothing for coverage.

KFF projects that premiums for those using ACA tax credits could rise by an average of 115% or $456 per year. Insurance brokers like Michelle McLaren warn that this could lead to higher uninsured rates and a contraction of the ACA marketplace, particularly affecting rural areas, lower-income individuals, and the elderly.

Impact on Major Insurers

Several major insurers have already submitted rate requests for 2026. BlueCrossBlueShield, the largest insurer in Texas, is asking for an average 39% increase in individual plan premiums. United Healthcare is requesting a 23% average increase, while Celtic Insurance Company and Superior HealthPlan are proposing 41% and 36% increases, respectively.

These hikes are driven by factors such as rising medical costs, increased use of services, and the expiration of tax credits. For example, United Healthcare explicitly cited the loss of enhanced tax credits in its filing. The company also noted higher provider reimbursement rates and the use of expensive new technologies.

The Risk of a Shrinking Marketplace

Analysts worry that if subsidies expire, healthier individuals may drop their coverage, leaving a sicker and more expensive risk pool. This could lead to further premium increases and potentially force some insurers to exit the market, as happened in 2016 when premiums rose sharply and several insurers left Texas.

The average monthly premium for Texans with ACA coverage after subsidies is $57, while the benchmark silver plan costs around $489. Federal law requires insurers to spend at least 80% of premiums on medical costs and quality improvement efforts. If this ratio falls below 80%, rebates must be issued to enrollees.

Looking Ahead

With open enrollment approaching, time is running out to address these concerns. While Congress could extend the tax credits, the window for action is narrowing. As the ACA marketplace faces these challenges, the future of affordable health care in Texas remains uncertain.

The Real Story Behind Resident Doctors' Pay Before the 5-Day NHS Strike

The Real Story Behind Resident Doctors' Pay Before the 5-Day NHS Strike

M Hasan    7:08 AM   

The NHS Doctors' Pay Dispute: A Clash of Statistics and Priorities

The ongoing dispute between the British Medical Association (BMA) and the UK government over resident doctors’ pay has sparked significant controversy, with both sides using different statistical measures to justify their positions. As a result, the debate has become increasingly complex, raising questions about the accuracy of the data being used and the potential impact on the National Health Service (NHS).

Resident doctors, who are also known as junior doctors, have announced a five-day strike starting this Friday, demanding salary increases that could reach up to £20,000. They argue that these hikes are necessary due to what they describe as "pay erosion" over the past 17 years. According to the BMA, this erosion amounts to more than a 29% reduction in real terms. However, the government claims that resident doctors have already received an average pay rise of 28.9% over the last three years, including a 5.4% increase this year—making it the largest in the public sector.

The BMA’s stance is that the current pay levels do not reflect the true cost of living for doctors, particularly given the high student loan debt many face upon entering the profession. The union uses the Retail Price Index (RPI) to calculate this erosion, which they argue better reflects the everyday expenses of working people. However, the Nuffield Trust, an independent health policy think tank, found that when measured against the Consumer Price Index (CPI), the pay gap is much smaller—only 4.7% below inflation since 2008. This discrepancy highlights the importance of the inflation measure used in such calculations.

The government has criticized the use of RPI, pointing out that it was downgraded as an official national measure in 2013 due to its tendency to overstate inflation. Instead, CPI and CPIH (which includes housing costs) are now considered more accurate. Despite this, the BMA continues to defend its use of RPI, arguing that it is more relevant to the daily lives of doctors. For instance, RPI is used to set student loan repayments, car taxes, and train fare caps—factors that significantly affect the financial burden of medical professionals.

Health Secretary Wes Streeting has condemned the strikes as "shockingly irresponsible," insisting that the government will not compromise on pay. He emphasized that resources are finite and that decisions must be made with the interests of all NHS staff in mind. Streeting also pointed out that resident doctors have already received substantial pay increases under the current administration, including a 28.9% rise over three years.

Despite these efforts, the BMA remains unconvinced. In September, members voted overwhelmingly in favor of further strike action after rejecting a proposed pay deal from the government. The latest offer included a 4% uplift plus £750 in additional payments, resulting in an average pay increase of 5.4%. However, this was not enough to prevent another round of industrial action, with nearly 90% of those who voted supporting the walkout.

The consequences of the strikes are expected to be severe. A report by the Policy Exchange think-tank warned that up to 250,000 appointments could be canceled or postponed this month, costing the NHS approximately £87 million in staffing cover. Charities have also expressed concern, warning that the disruptions could lead to "significant distress, pain, and worsening health for patients."

In addition to the financial impact, there are serious safety concerns. Previous strikes by junior doctors have been linked to at least five patient deaths, according to an audit. NHS leaders have warned that the upcoming five-day walkout could put even more lives at risk.

As the debate continues, the question of how to fairly assess pay increases remains unresolved. Different inflation measures can paint vastly different pictures of real-term changes in wages, making it essential to consider multiple perspectives. The Nuffield Trust's Lucina Rolewicz emphasized the need to look at a range of baseline years and inflation measures to gain a more complete understanding of the situation.

Ultimately, the dispute underscores the challenges of balancing the needs of medical professionals with the broader responsibilities of the NHS. While the BMA argues that fair pay is crucial for retaining talent and ensuring quality care, the government maintains that resources must be allocated wisely across the entire healthcare system. The outcome of this conflict will likely have far-reaching implications for both the NHS and the wider public.