How much more are ~4 MILLION TEXAS ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and recently it was revealed that over 2.6 million ACA exchange enrollees had already been priced out of the market as of February, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at TEXAS:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

The good news is that unlike most states, Texas is one of a handful which actually saw plan selections during the 2026 Open Enrollment Period increase over the 2025 OEP...by around 5.2%. That's right: Over 200,000 more Texans signed up for coverage this year! This is almost certainly thanks to Texas not only implementing full Premium Alignment pricing, but actually ramping it up a bit more (which caused Gold plans to cost 10 - 12% less than Silver plans on average this year.

As a result, enrollment increased in several income brackets while still dropping significantly in others (the 400 - 500% FPL enrollment was cut literally in half).

Onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. The first table is based on official metal level tiers, but it's the second table which is critical, since a huge chunk of ACA enrollees are usually enrolled in CSR Silver plans (which include Cost Sharing Reduction assistance). CSR assistance dramatically boosts the AV of Silver plans up to Platinum levels in most cases.

Here's where the bad news kicks in: While total enrollment went against the tide and increased, the average Actuarial Value of the plans enrollees selected still dropped significantly: Overall, it dropped from 82.3% to just 77.1%:

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so:

Again, the "good" news (relatively speaking) is that average net premiums "only" jumped by 56% overall...from $57/month to $89/month per enrollee.

The worse news is that the AV drop means that, by my best estimates, average out of pocket expenses shot up by 71%.

Combine the two and you're looking at an estimated per enrollee healthcare expense hike of ~66%, or over $1,200 apiece this year.

In addition, based on KFF's net data, average deductibles also increased by ~65% to over $3,100 for single coverage this year, and the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.

Next up: UTAH.