McALLEN — Alix Flores, a 62-year-old resident, has navigated various career paths over the years, ranging from nonprofit work to corporate roles, teaching in Brownsville, and serving in the regional office of the Texas Department of State Health Services. His priority has always been to maintain employment to ensure he had access to employer-sponsored health insurance.
“I always ensured that if I left one job, I had another lined up so I could keep my insurance,” Flores stated.
However, that dynamic shifted with the implementation of the Affordable Care Act (ACA), allowing him to take breaks from work. Currently, he serves as a part-time home health aide for his aging mother.
For the past two years, Flores has enjoyed a health coverage premium of just $12 a month. He incurs no fees to visit his primary care provider and pays only $10 for specialist appointments. Additionally, his medication costs nothing, despite a potential out-of-pocket expense of approximately $900 without insurance.
Next year, however, Flores faces a staggering increase in his monthly premium, which is set to rise to $275—23 times what he currently pays. This dramatic shift stems from the impending expiration of enhanced premium tax credits, which have significantly reduced health insurance costs for many individuals accessing the federal marketplace. The Rio Grande Valley, where Flores resides, is particularly vulnerable to the repercussions of these subsidy expirations.
“I’m going to select a plan and just hope for the best,” Flores remarked, expressing hope that Congress will at least extend the subsidies for an additional year. “Take that year to assess what works and what doesn’t, and develop a better solution.”
The Rio Grande Valley has experienced some of the most rapid growth in ACA enrollment in Texas from 2020 to 2025, with enrollment quadrupling in the area. Approximately 20% of the population now holds ACA coverage, with Starr County leading at about 27% enrolled.
A key factor contributing to this enrollment surge was a 2021 federal law that broadened the scope and eligibility for tax credits aimed at lowering premiums for ACA participants. This legislation introduced significant changes, such as eliminating the income cap of 400% of the federal poverty level, allowing higher earners, often pre-retirees or small business owners, to qualify for assistance. It also reduced the maximum percentage of income that eligible individuals would pay towards their premiums, making plans affordable for many.
In the Valley, 98% of ACA participants received advanced premium tax credits, with 70% of consumers paying $10 or less per month for their coverage in 2025.
Health care providers are now expressing concerns that the expiration of these enhanced tax credits will render health plans unaffordable for many individuals, potentially driving healthy enrollees to drop their coverage altogether, as they resist paying for what had previously been free.
This could lead to a significant decline in regular doctor visits, resulting in undetected and worsening health conditions. Dr. Carlos Medina, chief medical officer for Nuestra Clinica Del Valle, noted that many patients only seek primary care after experiencing severe health crises.
In Texas, around 3.1 million adults, or approximately 13% of the adult population, have been diagnosed with diabetes, with the prevalence even higher in border counties like those in the Rio Grande Valley. Alongside diabetes, residents also face high risks of hypertension and high cholesterol, underscoring the importance of regular screenings to prevent further health deterioration.
Health care experts like Dr. Eduardo Candanosa believe that the expanded tax credits encouraged more frequent doctor visits among insured patients, leading to increased outpatient care and preventive measures for those with chronic conditions.
However, if individuals opt not to renew their insurance due to rising costs, Candanosa warns of potential challenges in accessing necessary medications for chronic illnesses, resulting in a greater reliance on emergency services for acute care.
In Hidalgo County, 20% of residents currently benefit from ACA tax credits, with 200,636 enrollees in 2025, ranking it fifth among Texas counties for ACA participation despite being ninth in overall population. If enhanced tax credits are not extended, former policyholders may find themselves uninsured due to costs, further exacerbating the region’s already high uninsured rate of about 28%, more than double the national average.
<p“That could lead to unmanaged chronic illnesses and increase uncompensated emergency room visits,” cautioned Dairen Sarmiento Rangel, director of Hidalgo County’s health and human services department. “We’re headed towards a sicker community.”
County officials have been preparing for the potential influx of clients through existing programs designed to assist low-income individuals, such as the indigent health care program. The county health clinic offers a range of services, including immunizations, family planning, prenatal care, and recently, testing for hypertension, cholesterol, and diabetes.
In September, Hidalgo County introduced an OnMed CareStation, a virtual care platform that connects patients with healthcare providers for primary care consultations, regardless of insurance status. In 2026, low-cost lab services are also set to be made available.
“We’re in a good position to support those who may lose their tax credits, but only time will tell,” Sarmiento Rangel noted.
Sarah Loredo, an insurance broker in McAllen, has been actively reaching out to clients to assist with insurance renewals during the open enrollment period. Yet, with the anticipated premium hikes, many healthy individuals are reconsidering the value of maintaining coverage.
Despite 70% of ACA consumers in the Valley paying $10 or less per month this year, even a small increase in costs is leading many to allow their insurance to lapse. Loredo shared that she often hears clients express sentiments like, “Just cancel everything.”
“Today, I spoke with a woman who saw her premium increase from $0 to $20, and she said, ‘Yeah, but I wasn’t paying anything,’” Loredo recounted. “A significant number of people are opting to forgo coverage this year.”
Currently, individuals earning under 150% of the federal poverty level face a maximum monthly premium payment of $0 under the existing credit structure. However, a study by the Episcopal Health Foundation and Texas A&M University projects that this payment may rise to a maximum of $33 for a single 45-year-old adult earning under 138% of the federal poverty level, and up to $68 for those between 138% and 150%.
The increases are even more pronounced for middle-income individuals; for example, a single adult earning between 200% and 250% of the federal poverty level may see their maximum monthly premium soar from $85 to $221.
Such steep hikes are anticipated for many clients, as indicated by Sarah Guerrero, an insurance agent trainer with Healthcare Educators in Harlingen. “I see clients facing increases from $90 or $100 up to $300 or $400 in their responsibility, not just the overall premium,” Guerrero explained.
Guerrero herself expects her premium to rise from $90 to $300.
The deadline for extending enhanced tax credits is approaching, with lawmakers in Washington, D.C., seemingly far from reaching an agreement. The House has recessed for the holidays, casting doubt on whether the tax credits will be renewed before the December 31 expiration. Nevertheless, House Democrats, along with four renegade Republicans, have expressed a desire to force a floor vote on the subsidies in January.
There are also concerns that the number of insurers offering plans through the ACA marketplace may decline. Aetna has already announced it will exit the ACA market nationwide by 2026, while Molina Healthcare and Guardian have ceased offering ACA plans in the four counties comprising the Valley. Fortunately, the marketplace still has more insurers than it did in 2021 when the enhanced subsidies were first introduced.
A decrease in enrollment could lead to less generous subsidies and a reduction in federal funding for insurers, prompting more companies to follow Aetna’s lead and withdraw from the ACA market.
Despite these challenges, experts like Benjamin Ukert, a professor at the Texas A&M School of Public Health, believe the transition may not be as tumultuous as it was during the ACA’s early years. Ukert noted that insurers are already adjusting premiums based on a smaller, potentially sicker risk pool. However, some industry insiders are wary of repeating past mistakes.
<p“Initially, there was a surge in plan utilization,” Kennelly, a licensed insurance consultant, observed. “We might see another correction like that, with insurers raising deductibles and out-of-pocket costs while narrowing networks. There’s only so much they can do before plans become inadequate in terms of coverage.”
As the landscape evolves, enrollees, insurers, and experts brace for higher premiums and the first significant decline in enrollment within the ACA marketplace’s 12-year history. Guerrero emphasized that a reduction in insured individuals would likely contribute to escalating costs.
<p“If we focus solely on the Rio Grande Valley, there are numerous underlying health issues that, if addressed early, could save money in the long run as we age,” she concluded.
