McALLEN — Alix Flores, 62, has jumped from different careers over the years, working with nonprofits, in corporate America, as a teacher at a Brownsville school and with the regional office of the Texas Department of State Health Services.
He wanted to make sure he was always employed so he would be covered by employer-provided health insurance.
“I always made sure that if I quit a job, I better have another one waiting already so I can continue being insured,” Flores said.
That changed with the rollout of the Affordable Care Act and he was able to take breaks between work. Now, he works part-time as a home health aide for his aging mother.
For the past two years, the Brownsville resident has paid $12 a month for health coverage. He doesn’t pay anything to visit his primary care provider and pays $10 to visit a specialist.
He also pays nothing for medication to treat his chronic condition, even though it can cost approximately $900 without insurance.
But next year, Flores’ monthly premium is jumping to $275, 23 times higher than what he’s paying now.
That’s because enhanced premium tax credits that had made it much cheaper for many more people to buy health insurance through the federal marketplace are slated to expire by the end of the year. The Rio Grande Valley, where Flores lives, stands to be disproportionately affected by the expiration of these subsidies.
“’I’m going to go ahead and pick a plan, and I’m just going to hope for the best,” Flores said, adding that he hopes that Congress will at least extend the subsidies for one more year. “Take that one year, look at what works and what doesn’t, and come up with something better.”
The Rio Grande Valley saw some of the fastest growth in ACA enrollment in Texas between 2020 and 2025.
During that time, enrollment quadrupled in the Valley, where 20% of the population has ACA coverage. The highest enrollment was in Starr County which saw about 27% of its population enrolled in the ACA.
One factor for the enrollment boom is a 2021 federal law that expanded the value of and eligibility for tax credits that reduce ACA enrollees’ premium payments — the enhanced premium tax credits that are expiring at the end of the year.
“It was like gangbusters,” said Ryan Kennelly, a licensed insurance consultant who assists clients all over the country, including in Texas. “All of a sudden, instead of one application a day, we had 10 per broker. Everyone wanted insurance, because it was dirt cheap.”
The bill made two major changes. It ended the income cliff — 400% of the federal poverty level — allowing people earning more money, typically pre-retirees or small business owners, to qualify. And it lowered the maximum amount that people qualifying for the subsidies could pay towards their premium as a percentage of income. People earning between 100% and 150% of the federal poverty level — $32,150 to $48,225 for a family of four — qualified for tax credits that drove silver plan premiums to be free.
In the Valley, 98% of ACA enrollees received an advanced premium tax credit that lowered their monthly payments, with 70% of consumers paying $10 or less per month for their plans in 2025.
But with the enhancements to those premium tax credits set to expire by January, health care providers are worried that health plans will become unaffordable to many or that healthy enrollees will simply drop their coverage, not wanting to pay for something that previously came at no cost to them.
Those insured are expected to forgo visits to their doctor for regular checkups. It could cause serious health conditions, especially those that could have been treated, to go undetected and worsen.
More sick people
Throughout the Rio Grande Valley — which includes Hidalgo, Cameron, Starr and Willacy counties — a handful of resources offer health care services at a low cost to provide some relief to this undeserved area.
Among those resources is Nuestra Clinica Del Valle, a federally qualified health center. Such centers are funded by the federal government to provide primary care services to low-income communities. Nuestra Clinica does so by offering their services on a sliding fee scale.
But even with a resource like Nuestra Clinica, residents will often delay seeking care until their health problems have already become severe.
“I’ve seen a bunch of patients who come in and the first time they see a primary care doctor is after they’ve been to the hospital after they had a heart attack or a stroke,” said Dr. Carlos Medina, the chief medical officer for Nuestra Clinica.
About 3.1 million adults in Texas, or about 13% of the adult population, have diagnosed diabetes. That prevalence skews much higher in border counties including those in the Rio Grande Valley.
In addition to diabetes, Valley residents are at high risk for hypertension and high cholesterol, Medina pointed out, so screening is critical to prevent worsening health conditions.
Health care providers like Medina see the expanded tax credits as an encouragement for residents to visit their doctor regularly.
“That, at the time, has been translating into more outpatient care for patients with chronic conditions and also for more screening of preventive measures for those now-insured patients,” said Dr. Eduardo Candanosa, a family medicine physician.
If people decide to not renew their insurance because of the higher cost, Candanosa predicts that will translate into difficulty in obtaining needed medication for chronic health conditions and a heavier reliance on emergency rooms for acute care.
In Hidalgo County, 20% of their population benefit from ACA tax credits, said Dairen Sarmiento Rangel, director of Hidalgo County’s health and human services department.
In 2025, Hidalgo County had a total of 200,636 ACA enrollees, the fifth-most of any Texas county despite ranking ninth in total population.
Without the expanded tax credits, previous ACA policy holders could go without insurance, either because it is too expensive or because they simply don’t want to pay more, and drive up the region’s uninsured rate, which sits at about 28%, more than double the national rate.
“That could result in unmanaged chronic illnesses, more uncompensated visits to the ER,” Sarmiento Rangel said. “We’re gonna have a sicker community.”
Since county officials became aware that the enhanced tax credits could expire, they’ve been preparing to take on more clients through existing programs like their indigent health care program, which provides coverage for low-income people.
The county health clinic is also available to residents for immunizations, family planning, prenatal care and, just this year, it began offering testing for hypertension, cholesterol and diabetes.
In September, the county also debuted an OnMed CareStation, a virtual care station that connects patients to a health care provider for primary care consultations, regardless of whether they are insured. In 2026, the county will also begin offering low cost lab services.
“We’re in a good place, to be able to pick up some of these people that will be losing their tax credit funds, but only time will tell,” Sarmiento Rangel said.
“Just cancel everything”
Sarah Loredo, an insurance broker in McAllen, has spent the last several weeks reaching out to patients to help them renew their insurance plans during the open enrollment period. But with the expected price hike, many who aren’t dealing with an existing health condition are questioning the worth of having insurance at all.
About 70% of ACA consumers in the Valley paid $10 or less per month for their plans this year but even a modest price hike is prompting enrollees to allow their insurance coverage to lapse.
“I do see people saying, ‘Just cancel everything,’” Loredo said.
“I had a lady today, like, okay, it’s going from $0 to $20, and she’s like, ‘Yeah, but I wasn’t paying anything,’” she said. “It’s a big, large group of people telling me, ‘Um, no, I’m just gonna go ahead and leave it for this year.’”
People earning under 150% of the federal poverty level currently have a maximum monthly premium payment of $0 under the current credit structure. A study of the tax credits undertaken by the Episcopal Health Foundation and Texas A&M University calculated that that payment would rise to a maximum of $33 per month for a single 45-year old adult earning under 138% of the federal poverty level, and $68 per month for those between 138% and 150%.
The rise is even more dramatic for middle-class people; a single adult earning between 200% and 250% of the federal poverty level, or $31,300 to $39,125, would see their maximum monthly premium rise from $85 to $221.
Indeed, those steep price hikes are expected for many of her clients, said Sarah Guerrero, an insurance agent trainer with Healthcare Educators, an agency in Harlingen.
“When I take a look at all my clients as a whole, those are the increases that I’m seeing for those with middle income — going from that $90, $100 up to $300, $400. And that’s just their responsibility, that’s not the actual premium.”
Guerrero’s own premium for her ACA plan is also expected to rise from $90 per month to $300.
Bracing for impact
The window to extend the enhanced tax credits before they expire is quickly closing and lawmakers in D.C. remain far from any deal to extend them.
The House recessed for the holidays, leaving little hope that the tax credits will be extended before they lapse on Dec. 31. However, House Democrats and four defecting Republicans voted to force a floor vote on the subsidies in January.
There is also a concern that there will be fewer insurers offering health plans through the ACA marketplace. Already, Aetna announced it would no longer offer ACA plans across the country come 2026. Molina Healthcare and Guardian, which offers dental plans, also stopped offering ACA plans in the four counties that make up the Valley, but there are still more insurers in the marketplace than in 2021 when the enhanced subsidies went into effect.
Fewer enrollees means less generous subsidies and that would decrease the amount of federal money flowing to insurers. That could lead more to follow Aetna’s lead and get out of the ACA business.
But the transition is not expected to be as volatile as it was during the early days of the ACA, said Benjamin Ukert, a professor at the Texas A&M School of Public Health who has researched the state’s ACA marketplace.
Ukert said insurers are already pricing in a smaller, sicker risk pool with their premium increases. But some say they see echoes of the chaos.
“Everyone was just over utilizing the plans [in the first few years],” said Kennelly, a licensed insurance consultant. “So there’s going to be another correction like that. They’re already increasing the deductibles, increasing out of pocket, watering down networks. I mean, there’s only so much you can do before the plans just don’t cover anything, as far as network or drugs.”
In the meantime, enrollees, insurers and experts are planning for higher premiums and the first instance of large-scale enrollment decline in the marketplace’s 12-year history.
Fewer people enrolled in health insurance will only further drive up costs, Guerrero said.
“If we just look at the Rio Grande Valley, there are so many underlying conditions, so many conditions that are starting younger and younger that, if treated at an early stage, could potentially save money on the back end as we start to age,” she said.
Reporting in the Rio Grande Valley is supported in part by the Methodist Healthcare Ministries of South Texas, Inc.
