MARY LOUISE KELLY, HOST:
Texas has the highest uninsured rate in the country - 1 out of 5 people do not have health coverage. And now that Congress has failed to approve an extension on the enhanced premium tax credits, premiums for the Affordable Care Act marketplace are expected to more than double for most enrollees. That includes the 4 million enrollees in Texas. KERA's Abigail Ruhman reports that without the subsidies that make ACA coverage affordable, more people will lose access to necessary care.
AUTOMATED VOICE: Floor seven.
ABIGAIL RUHMAN, BYLINE: Shanice Jordan embroiders a Christmas stocking for her niece in a hospital room at UT Southwestern Medical Center in Dallas. She's waiting for test results before she can be discharged. Hospital stays are kind of routine for her.
SHANICE JORDAN: I was diagnosed with SLE lupus in 2003.
RUHMAN: Lupus is a chronic autoimmune disease that causes Jordan's immune system to attack healthy parts of her body. Under the ACA, insurance became more accessible for people with chronic conditions.
JORDAN: It was just such a relief off of myself and my parents' shoulders.
RUHMAN: The ACA passed in 2010 and introduced federal marketplace - sometimes known as Obamacare - coverage. Jordan's premium is currently $173 a month. But with the enhanced tax credits set to expire at the end of the year, Jordan will be paying more in 2026.
JORDAN: My premium is going to be 942 a month.
RUHMAN: That's more than five times her current premium for the exact same plan. She debated a cheaper plan but didn't want to risk losing access to the specific doctors, medications and treatments she relies on.
A lot of families are facing similar difficult decisions. Lynn Cowles is with the advocacy group Every Texan and volunteers helping people sign up for insurance. She says people have to choose between two devastating financial situations.
LYNN COWLES: Pay $20,000 a year for your health insurance premiums or potentially pay hundreds of thousands of dollars per year if you have somebody in your family who ends up needing some major medical care. That's the position that the government is putting people in right now.
RUHMAN: Cowles says ACA enrollees are experiencing a lot of fear, anger, confusion and even betrayal. She says loss of coverage can lead to some alarming outcomes.
COWLES: In some cases, we'll see loss of life.
RUHMAN: Texas is expected to see the fourth-largest loss of coverage in the country, behind California, New York and Florida. Most of Texas' loss comes from ACA changes instead of Medicaid changes, according to KFF, a health policy research organization.
Stacey Pogue is a senior research fellow with Georgetown University's Center on Health Insurance Reforms. She says the role of the marketplace is even more important in Texas because the state didn't choose to expand Medicaid since it was an option in 2014.
STACEY POGUE: Even in Texas, the state with the highest uninsured rate, people want insurance. People want the peace of mind that health insurance brings when it's affordable to them.
RUHMAN: There are a lot of Texans that rely on subsidies, about 95% of enrollees. Certain people will still get some help, but most will lose all or some of their subsidies. And this isn't an issue that's unique to Texas.
POGUE: There's more than 20 million people in the marketplace - right? - that are in the same position that Texans in the marketplace are.
RUHMAN: Back at UT Southwestern, Jordan stands by her decisions, despite not knowing what next year is going to look like.
JORDAN: We might have to forego a lot of things, but at least I have health insurance.
RUHMAN: Advocates and experts say people may not feel the effects of higher premiums until they have to pay them alongside higher health care costs next year.
For NPR News, I'm Abigail Ruhman in Dallas.
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