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The expiration of tax credits that made health insurance affordable for nearly a quarter of a million middle-income people in Bexar County may put healthcare coverage out of reach for many. Texas Medical Association President Jay Shah, who is a doctor in San Antonio, said that being uninsured often forces people to skip seeing a doctor until they have no choice but to go to the emergency room.
"Our emergency rooms are full already," Shah said. "There's an increased burden on the hospitals. They're already doing uninsured care, and now they're going to have more uninsured care."
That will mean longer emergency room waits for everyone, Shah said. It will also mean rising insurance costs for everyone.
The enhanced premium tax credits for middle-income families were introduced under the American Rescue Plan Act in 2021 as a way to insure more Americans during the height of the COVID-19 pandemic. They were extended by the Inflation Reduction Act of 2022. The subsidies expanded access to affordable health insurance through the Affordable Care Act by extending subsidies to people who made up to 400% of the poverty level. In 2026 numbers, that means a single person making up to $62,600 would qualify for a tax credit, a two-person household making $84,600 would also be eligible, and a household of four with an income of $128,600 would qualify.
In Texas, expanded access to ACA coverage added more than 3 million uninsured Texans to the insured population, according to Shah. But he added that many of them will no longer be able to afford their insurance now that tax credits have expired.
In San Antonio, without subsidies, the expected cost increases are staggering.
According to Keep Americans Covered, in San Antonio Congressman Joaquin Castro's district, a family of four with an income of $133,750 a year will see their insurance premiums increase by 138%. That's an addition of more than $15,000 a year.
A family of four with a lower income will see a much larger percentage increase, but the real cost will be smaller. If the parents earn $66,000 a year, their premiums will spike by 189%, or more than $2,600.
Two 60-year-olds earning $85,600 a year will see their premiums spike by an eye-watering 352%. That's an annual increase of $25,345.
Health policy research organization KFF has developed a tool that calculates how individual insurance premiums will change without the subsidies.
Congress may reinstate the subsidies, with both the House and Senate considering compromises they might be able to agree on. Shah hopes they will be reinstated. Not only will those who have been able to afford healthcare because of the credits be able to keep their health insurance, he said, but it may keep everyone else's premiums from skyrocketing, too. "Because next year everybody's insurance is going up," Shah said. "Hopefully, that will decrease insurance premiums for everyone."
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