Texas leads the nation in newly insured during the 2023 Marketplace Open Enrollment Period


Boram Kim


A record number of Texans signed up for health plans for 2023, according to the latest figures from CMS. More than 2.4 million individuals signed up for health insurance during the Open Enrollment Period (OEP), 570,000 of whom were previously uninsured.


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Marketplace enrollment in the Lone Star State has outpaced every state in the country in terms of growth at 31% compared with the 12.4% national average. 

Texas lawmakers passed Senate Bill 1296 in 2021, which requires insurers to align insurance premiums across different tier categories. The policy offered many residents the opportunity to purchase 2023 plans with lower deductibles and little to no premiums. The policy led to a 16% increase in zero-premium offers across all coverage levels. 

CMS estimates 73% of Texas consumers had access to zero-premium gold plans in 2023. In 2022, 43% of Texas all marketplace plans had zero-premiums. 

Officials in Texas estimate more than one million Texans will no longer be eligible for Medicaid once the public health emergency unwinds. Texas maintains the highest rate and number of uninsured residents in the country based on 2022 calculations

While plans to reintroduce Medicaid expansion are underway this session, doing so will require the support of Republican lawmakers and Gov. Greg Abbott. On Sunday, the Dallas Morning News Editorial called on Republicans to expand Medicaid this session, saying doing so would cover an additional one million low-income Texans. 

Texas remains one of 11 states that have yet to expand Medicaid enrollment under a 2014 provision of the Affordable Care Act. One Texas study found that the state is losing access to $5.4 billion in federal funding a year by refusing to expand enrollment.

The Texas Association of Health Plans (TAHP) outlined its legislative recommendations for this session to further promote marketplace engagement, including programs that close the gap for low-income, working Texans and policies that raise price transparency and market competition. 

“So one piece of legislation that we’re really advocating for this session—it hasn’t been filed yet, but that we’re really trying to work to get filed—is having what we call a mandate fiscal note,” said Jamie Dudensing, CEO of TAHP, in a recent interview with State of Reform.

“Other states have this. Some of them happen very much like the fiscal note process [that] happens in Texas right now. Others have outside entities that provide this research for the legislature, but it really allows and creates an independent entity to provide an answer [to] these questions so that elected officials can decide whether new coverage pieces really make a positive impact both financially and economically for Texas because of how it improves health while others sometimes are really just about protecting someone’s profits.”

Nationally, CMS reported 16.3 million Americans signed up for individual market health insurance coverage during the 2023 OEP, a 12.4% increase from enrollment last year.