How Will Healthcare Changes Impact Rundberg?

The Affordable Care Act marketplace open enrollment has ended, and early numbers show Texans signed up in record numbers this year – despite a big cost increase for many people.

4.11 million Texans signed up for plans through the ACA marketplace as of January 3, according to data released by the Centers for Medicare and Medicaid Services. That breaks previous ACA enrollment records for the state. That comes as federal subsidies expired, causing healthcare plan costs to increase for most families.

Experts say enrollment numbers could change once bills arrive for the new increased premiums, but how could this impact healthcare access in Rundberg?

Some Background

The Affordable Care Act Marketplace started with the passage of the Affordable Care Act in 2010.

The marketplace was intended to help people who fell into a health coverage gap: people who made too much money to qualify for Medicaid or CHIP, but didn’t have insurance through a workplace, could get affordable medical coverage through this new federal marketplace. States could also opt to create their own healthcare exchange. Texas is one of 30 states that relies on the federal marketplace. Laura Dagan is a researcher with Texas A&M University, and she says the marketplace had an impact on the state’s high uninsured rate.

“Here in Texas, even though we still have the highest rate of uninsured in the U.S. for non elderly folks, at about 18%, it was greatly reduced through the marketplace overall,” Dagan says.

Tax subsidies were always part of the program. Subsidies are calculated by different things like where you live and how much you make, and offer a credit to bring down your monthly healthcare plan costs. But those were expanded in 2021 in the American Rescue Plan bill. The enhanced subsidies capped how much ACA marketplace enrollees could pay towards premiums, and also expanded who could claim subsidies. The changes led to a huge spike in enrollment, according to Dague.

“Since the enhanced subsidies, marketplace enrollment in Texas has more than tripled its in 2020,” Dague says. “Last year it was around 4 million people. That's about as big as the state's Medicaid program.”

But those enhanced subsidies expired on January 1st. Congress didn’t expand them, so costs skyrocketed. For most of the open enrollment period, people didn’t know if the cost was going to change.

ACA Costs

Ashleigh Alvarez is the senior program manager for health coverage with Foundation Communities. They’ve been helping people navigate the ACA marketplace for 13 years. And she said this year has been a little different.

“This year our goal was to enroll 4000 residents,” Alvarez says. “We're over 3600 enrollees right now.”

Alvarez says the majority of their clients are lower income, and still qualify for tax subsidies that cover most of the monthly premium. But even as they neared their enrollment goal, she says less people made appointments with their teams.

“We feel that that was a big, big reason why was because people there was just so much uncertainty,” Alvarez says. “People are just kind of waiting to see how everything plays out.”

While costs may not be going up for many of Alvarez’s clients, they are increasing for many ACA enrollees in the state. A Kaiser Family Foundation study found that plans in Texas have increased by 35%. Researchers say middle income families will be hit the hardest.

“Where these premium increases are probably going to bite the most is for folks who were really close to four times the poverty level,” says Dague. “[They’re] going to be looking at $800 for a silver plan, and $500 for a bronze plan.”

That’s up from roughly $450 for similar plans when the enhanced subsidies were in place, says Dague.

But Texans still enrolled in record numbers. According to CMS data, 4.11 million Texans had signed up for ACA marketplace plans, an increase of more than 6% from last year.

The Community Impact

Nicholas Yagoda is the CEO for CommUnity Care. They are one of several healthcare providers in central Texas who provide healthcare to people without insurance. He says their patient pool has already been growing, and now they’re preparing for more.

“We've seen somewhere between 7% and 10%, population growth every year, successively for at least eight years,” Yagoda says. “Our capacity expansion is still trying to catch up to what the demand in the region is.”

Yagoda says the Rundberg clinic is one of their busiest locations, but they only see a small percentage of patients with ACA plans. But he says folks may drop off their ACA plans once the new bills come in.

“Once the subsidy rolls off, we may find that those are individuals who can no longer afford ACA plans and also don't meet requirements for Medicaid,” Yagoda says. “We expect that to be part of a transition, which we have historically worked with our close partners at Central Health to ensure access to other support services.”

Early enrollment data doesn’t show if people downgraded their ACA plans, or if they were automatically re-enrolled without knowing about the price increase.

So what’s the potential impact to Rundberg?

The 2026 enrollment snapshot doesn’t break down numbers by zip code. But the most recent numbers show that about 12% of Rundberg residents get healthcare through the ACA marketplace. That’s 6,920 people. On average, they saved about $543 through the enhanced subsidies. But that could go down now that those subsidies have expired.

But the big healthcare concern for Rundberg is how many people don’t have insurance at all. About 20% of residents are at the federal poverty level, and about 22% don’t have health insurance, according to U.S. Census data. That’s even higher than the state’s uninsured rate of 16.7%, which is one of the highest in the nation. Marketplace enrollment won’t open up again until 2027. If you don’t have coverage there are local options, including Lone Star Circle of Care, CommUnity Care, and the MAP program. Subsidies could be replaced by Congress, but Alvarez says the impact would be felt down the road.

“Basically there's a credit people would receive,” Alvarez says. “So it's not like they're going to get a check in the mail.”

Most importantly, Alvarado says know what your healthcare needs are.

“it's better, again, to know your options to make an educated decision as opposed to just rolling the dice and saying, ‘oh, I'll deal with that if I have to deal with that,’” Alvarez says.

“That's a very risky gamble.”