- ACA open enrollment has just ended, and preliminary numbers show that Texans signed up in record numbers this year despite cost increases for a lot of people.

Now, those final numbers might change once bills start coming in the mail with those new premiums.

The federal subsidies have changed, so what does that do to healthcare access in Central Texas and in Rundberg?

Let's get into it.

(attendees applaud) - [Attendee] Yeah, they're right.

- I've gotta give you- - Quick history lesson.

The Affordable Care Act marketplace started with the passage of, you guessed it, the Affordable Care Act in 2010.

- Once this reform is implemented, health insurance exchanges will be created, a competitive marketplace where uninsured people and small businesses will finally be able to purchase affordable quality insurance.

They will be able to be part of a big pool and get the same good deal that members of Congress get.

That's what's gonna happen under this reform.

(attendees applaud) (intriguing music) - The idea was to help people who fell into a coverage gap.

People who made too much money to qualify for Medicaid or CHIP but didn't have insurance through a job could get affordable medical coverage through this new federal marketplace.

Tax subsidies were always part of the plan.

They calculate things like where you live, how much you make, how big your family is, and offer you a credit based on those things to bring down your overall healthcare costs.

The idea was to make healthcare plans more affordable for lower-income families, but those were greatly expanded in 2021 as part of the pandemic relief legislation.

- The enhanced subsidies made it so that a lot more people enrolled.

- [Reporter] Laura Day is a researcher with Texas A&M University, and she says those changes led to a huge spike in enrollment.

- Since the enhanced subsidies, marketplace enrollment in Texas has more than tripled.

Last year it was around 4 million people.

That's about as big as the state's Medicaid program, which covers kids and elderly folks.

- But those enhanced subsidies expired on December 31st.

(sirens wailing) (gritty electronic music) Congress didn't vote to expand them.

Remember that whole government shutdown thing?

So for most of the open enrollment period, people didn't know if the cost was going to change.

- So open enrollment started November 1st.

- [Reporter] Ashleigh Alvarez is with Foundation Communities.

They've been helping people navigate the ACA marketplace for 13 years, and she said this year's been a little different.

- This year, our goal was to enroll 4,000 residents.

We're over 3,600, so we're very close to our goal.

- [Worker] I see you, Lakhani.

Thank you.

- Reyna?

- We kind of saw a decrease in appointments this year from last year.

There was just so much uncertainty.

(enrollees chattering) - [Reporter] So the expanded subsidies have expired, and ACA healthcare plan costs have skyrocketed.

A Kaiser Family Foundation study found that plans in Texas have increased by 35%, and researchers say middle-income families will be hit the hardest.

- Somebody with income on the higher end, so like just above that 400% line, is gonna have been paying around $450 a month with enhanced subsidies but is gonna be looking at 800 for a silver plan and 500 for a bronze plan.

Folks under 200% of the poverty line are still gonna have access to at least one $0 bronze plan, it looks like across the state, but it might not cover as much as it did before.

(staff and enrollees chattering) - But Texans still enrolled in record numbers.

Data released from the Centers for Medicare and Medicaid Services show that as of January 3rd, 4.11 million Texans had signed up for ACA marketplace plans.

That's up more than 6% from last year.

All right, so even with costs going up, Texans have enrolled in the ACA marketplace in record numbers.

So what does that mean for Rundberg specifically?

(gritty electronic music) The 2026 enrollment snapshot doesn't break down numbers by zip code, (marker swishing) but most recent numbers show that about 12% of Rundberg residents get healthcare through the ACA marketplace.

(numbers clicking) That's about 6,920 people.

On average, they saved about $543 through subsidies.

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 insurance according to US Census data.

- Yes, Rundberg is one of our busiest access points.

- [Reporter] Nicholas Yagoda is CEO for CommUnityCare.

They're 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 seven and 10% population growth every year successively for at least eight years.

So our capacity expansion is still trying to catch up to what the demand in the region is.

- [Reporter] Yagoda to says they only see a small percentage of patients with ACA plans, but he says folks may drop off those 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.

We expect that to be part of a transition, which we have historically worked with our partners, our close partners at Central Health, to ensure access to other support services.

- [Reporter] Researchers say that transition will tell us a lot more about who exactly has healthcare access in Texas.

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.

What we do know, though, is how many uninsured people are in Texas.

- Yeah, we definitely are still, have the highest nationwide rate of uninsured folks, unfortunately, so that's something that hopefully we can continue to make good progress on.

- [Reporter] Subsidies could be put back in place by Congress, but Alvarez says the impact would be felt way down the road.

- Basically, there's a credit people would receive, so it's not like they're gonna get a check in the mail.

- Marketplace enrollment won't open up again until 2027, but if you're uninsured, there are local programs that are available to you, like Lone Star Circle of Care, CommUnityCare clinics, and the MAP program in Travis County.

Alvarez says most important is know what your healthcare needs are.

- [Ashleigh] It's better, again, to know your options to make an educated decision as opposed to just rolling the dice and saying like, "Oh, I'll deal with that if I have to deal with that."

That's a very risky gamble.

(lively electronic music)