Everything’s bigger in Texas — including the potential shockwaves when health policy changes. As 2025 draws to a close, home care agencies in Texas are watching one countdown closely: the expiration of enhanced Affordable Care Act (ACA) subsidies.
These ACA subsidies made health insurance dramatically more affordable for millions. But if Congress allows them to lapse, families, caregivers, and agencies could all face higher home care costs.
For Texas — a state with the nation’s largest uninsured population — the impact could be especially harsh. Let’s explore what happens if this financial lifeline disappears and how it might reshape the cost of home care.
ACA premium tax credits—often referred to as ACA tax credits or subsidies for the Affordable Care Act—lower the cost of health insurance for individuals buying plans on the marketplace.
Congress expanded these subsidies during the pandemic and later extended them through 2025 under the Inflation Reduction Act.
The result was historic: nationwide marketplace enrollment doubled to more than 24 million people, while Texas enrollment nearly tripled — from 1.3 million in 2021 to 3.9 million in 2025.
That’s remarkable progress in a state that still has one of the highest uninsured rates, now down to 16.3% from 23% a decade ago.
If these enhanced Affordable Care Act subsidies expire at the end of 2025, the safety net vanishes for millions of Texans who finally found affordable coverage.
In one word: shock.
Without the enhanced ACA subsidies, Texans will face steep increases in insurance premiums. A KFF analysis estimates the average subsidized enrollee’s premium would jump 114%, from about $888 a year to $1,904.
In Texas, where families currently pay an average of $1,632 a year for ACA plans, that number could more than double to $3,400 once ACA subsidies expire. Insurers have already requested an average 24% rate increase for 2026.
That’s not just a line item in a household budget — it’s a deal-breaker. Health experts warn that over one million Texans could lose coverage, representing roughly a quarter of all Americans expected to become uninsured nationwide if Congress does nothing.
Families paying more for insurance will have less to spend on home care in Texas. Seniors on fixed incomes, or adult children supporting aging parents, may cut back on professional caregiving hours or delay starting care altogether.
A $200 monthly increase in health premiums can easily mean 10–15 fewer caregiving hours per month, affecting everything from medication reminders to meal prep. Those lost hours can translate to hospitalizations and emergency costs — far higher than preventive in-home care.
Texas families who rely on private pay care are particularly vulnerable. In a non-Medicaid-expansion state like Texas, there’s little cushion for middle-income families caught between rising premiums and rising home care costs.
The pressure doesn’t stop at the client’s doorstep — it extends to the caregivers inside.
The median annual wage for home care workers is around $22,000, and most lack employer-provided health coverage. – Workforce Data Center
Many buy Affordable Care Act marketplace plans or go uninsured. If their premiums double, a caregiver could lose an entire month’s pay to stay insured.
That’s a crisis in the making. When caregivers feel financially unstable, retention drops — and that instability ultimately raises costs for the agency. In other words, higher caregiver costs today become higher client rates tomorrow.
Texas is unique — and not in a good way when it comes to coverage gaps. Because the state hasn’t expanded Medicaid, low-income adults depend heavily on Affordable Care Act subsidies for coverage. When those disappear, they’re left with few alternatives.
Without those funds, the state could see a wave of uninsured residents, straining hospitals and pushing costs into other areas — including home care in Texas. For home care agencies, that means tighter margins, delayed payments, and a potential slowdown in demand from cost-sensitive clients.
The threat is real, but preparation makes all the difference.
Home care agencies in Texas can start by modeling “what-if” scenarios.
If 10% of clients reduce care hours or caregiver wages rise by 15%, how will that affect your bottom line?
Next, focus on retention. Help caregivers navigate coverage options, connect them with navigators, or offer small stipends toward premiums. The cost of losing one trained caregiver far exceeds the cost of keeping one healthy.
Finally, stay vocal. Join Texas home care associations advocating to extend ACA subsidies. With over 1 million Texans at risk of losing coverage, this is a moment for collective leadership.
Home and healthcare policy doesn’t live in Washington — it lives in every caregiver’s paycheck and every client’s living room. The expiration of ACA subsidies is more than a political debate; it’s a financial and human issue that will shape how care is delivered across Texas.
Agency owners who act early — by protecting their workforce, tightening efficiency, and engaging in advocacy — will not only weather the policy shift but strengthen their reputation as trusted, forward-thinking leaders.
The question isn’t just what happens when ACA subsidies expire — it’s how will your agency respond? Because in Texas, resilience isn’t optional. It’s the heart of care.
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