Small business owners in San Antonio, Texas, are confronting significant increases in health insurance premiums after the expiration of enhanced tax credits. Mark and Laura Humphries, who have relied on the Affordable Care Act (ACA) marketplace since its inception in 2014, experienced their monthly premium skyrocket from approximately $500 to nearly $3,000 when these credits expired at the end of last year.
Laura Humphries, a graphic designer, expressed the financial strain this has placed on their family, stating, “We would have had to take out a small business loan to pay for the policy.” The couple, along with their two children, is among many in Bexar County who are now seeking alternative health coverage options. In 2024, over 234,000 residents in Bexar County relied on the ACA marketplace, many of whom are small business owners, part-time workers, and early retirees without access to employer-sponsored plans.
The situation has become particularly dire for individuals with chronic conditions. Maria Lee, a health insurance broker in South Texas, noted that her clients include those currently undergoing cancer treatment or recovering from significant health events, such as strokes or heart attacks. “The transition period wasn’t as easy,” Lee explained, highlighting the challenges many face in finding adequate coverage.
For Americans under 65, the majority are covered by employer-sponsored health plans. Nearly all individuals aged 65 and older receive Medicare, often supplemented by private insurance. However, for small business owners and the self-employed, these options are often not available. The ACA marketplace was designed to provide affordable health insurance through HealthCare.gov, but the expiration of enhanced credits has significantly affected many enrollees.
While some families, like the Humphries, have been forced to seek temporary emergency plans, others have managed to switch to different plans within the marketplace. Mark Humphries, a commercial photographer, noted that although he found a new plan, it is much less affordable than the family plan they previously maintained.
“Time spent navigating this process could have been a paid job,” Laura remarked, expressing the frustration many face when dealing with the complexities of health insurance. “We feel like ping-pong balls sometimes,” she added, describing the labyrinthine process of finding coverage.
Despite the anticipated decline in marketplace enrollment due to rising costs, Texas has experienced an increase in participation. According to data from the Centers for Medicare and Medicaid Services, more than 4.1 million Texans enrolled in marketplace plans for 2026, which represents an increase of over 200,000 enrollees year-over-year.
Charles Miller, director of health and economic mobility policy at Texas 2036, observed that low- to no-cost plans continue to be available for many ACA enrollees. Despite some experiencing steep premium increases, Miller maintained that this group constitutes a relatively small portion of total enrollees. Approximately 75% of current enrollees, around 3.1 million Texans, earn below 200% of the federal poverty level and can access at least one $0-premium plan in 2026.
There remains a substantial population of uninsured Texans who qualify for no-cost plans under the marketplace, and efforts to enroll these individuals continue. Miller emphasized the importance of not letting headlines about rising premiums overshadow the availability of affordable plans. “The enhanced subsidies expiring makes things more expensive, but the vast majority of current enrollees still qualify for a free plan,” he said.
In 2023, over 316,000 Bexar County residents, or 16% of the county’s population, were uninsured, marking it as home to the fourth-largest uninsured population in Texas, according to U.S. Census data analyzed by Texas 2036. Miller is committed to ensuring that those who qualify for marketplace insurance are not deterred by the rising costs discussed in the media.
As the Humphries family navigates their health insurance options, they reflect a broader struggle faced by many small business owners in San Antonio and beyond. The challenges of maintaining affordable health coverage underscore the ongoing complexities of the U.S. healthcare system, particularly for those who rely on the ACA marketplace for their health needs.