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Open enrollment is underway for Texans who get their health insurance through the Affordable Care Act Marketplace.

According to a new study from Texas A&M's Bush School of Government and Public Service, if Congress doesn't extend tax credits, more than 1 million Texans stand to lose their coverage due to increased costs.

Lynn Cowles – director of health and food justice for the nonprofit group Every Texan – said if that happens, it will put a strain on the state’s health-care system, especially in rural areas.

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"Hospitals will have to transfer the costs of caring for uninsured people onto the insurance companies of people who do have health insurance," said Cowles. "So, we’ll see workforce effects. Right now, there are 21 rural hospitals across Texas that are at risk of closure."

Cowles said many hospital labor and delivery units are also at risk of closing.

Since 2021, expanded federal subsidies have lowered monthly premium costs for 95 percent of Texans who get their coverage through the ACA Marketplace.

According to the Center on Budget and Policy Priorities, a 60-year-old Texas couple who earns $82,000 a year would pay an additional $18,000 for their insurance without the tax credits.

Cowles said because of the many changes taking place, Texans should be proactive in deciding what they want for next year.

"Some may decide that they want to switch from a more expensive plan to a less expensive plan," said Cowles. "Some will decide that even with the higher costs, they might still want to pay those higher costs. If people decide not to reenroll, go to the front page of healthcare.gov and check the box that says, 'Do not auto reenroll me.'"

She said if nothing is changed, you will automatically be re-enrolled for your current insurance plan at its higher rate.

Cowles said there is still time for Congress to act.

"Contact their congressional representatives and say, 'I’m demanding that you figure this out. You must work across the aisle to come to negotiations – and agreements – on these tax credits with lawmakers from parties that are not your own.'"