As the United States continues its decades-long struggle to deliver affordable, accessible health care to all, two major developments—one in Texas and another in California—are drawing national attention to the complex interplay between insurance coverage, costs, and the ability of everyday Americans to navigate the health system. With millions of families facing potential premium hikes and others struggling to understand how to use the coverage they already have, the stakes have rarely felt higher.
In Texas, the ticking clock on the Affordable Care Act’s (ACA) enhanced tax credits is causing growing anxiety among both policy experts and ordinary families. According to new data from KFF, a nonpartisan health policy research and news organization, key subsidies under the ACA are set to expire, putting at risk the affordability of coverage for millions who rely on these credits. This is no small matter in the Lone Star State, where ACA enrollment has tripled since 2020 and nearly 4 million Texans are now covered through the program.
The numbers are stark. If Congress fails to act, premiums could more than double for many in 2026, jumping from an average of about $888 this year to over $1,900 next year. That’s a gut punch for families already squeezed by rising costs elsewhere. In Travis County alone, about 145,000 people are enrolled in ACA plans. For a 21-year-old earning roughly $37,650 a year, the annual premium could shoot up by nearly $1,700 if the enhanced tax credits vanish. That’s enough to make anyone’s head spin.
Alec Mendoza, a policy advisor with Texas 2036, urges Texans not to panic just yet. “We want people to know that there are low-cost or no-cost plans that are out there for them and their families,” Mendoza said, emphasizing that while premiums are likely to increase, “affordability remains within reach for most Texans.” He added, “I think what we are going to be seeing is that premiums will increase and we will have higher premiums here this year. But they need to shop for these plans themselves and really compare their options, because there are options out there.”
But for many, the prospect of shopping for coverage in a shifting landscape is daunting. The uncertainty is compounded by political gridlock in Washington, where efforts to end a government shutdown have taken center stage and left little room for consensus on health care. Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz acknowledged the lack of clarity, stating, “These are ideas that we’re still working on in part because until the government shut down formally ends, we don’t have all the people in the room we need to work on these programs.”
The political divide is clear. Democrats in Congress are pushing hard to preserve the ACA tax credits. Senator John Fetterman of Pennsylvania put it bluntly: “I want to make health care more affordable for Obamacare, but I also think that our government should never be held hostage. We need to find a way forward because I strongly, strongly support those tax credits to make health care more affordable.” With open enrollment for ACA plans continuing through January, the clock is ticking—higher premiums would not take effect until the 2026 plan year, but unless Congress renews the credits, millions could soon feel the financial pinch.
While Texans brace for possible premium shocks, another battle is playing out on the West Coast. In Contra Costa County, California, officials are tackling a different but related challenge: ensuring people know how to use the coverage they already have. In 2024, the county saw 116,000 ambulance dispatches, with nearly one in five calls for non-life-threatening emergencies. That’s a staggering number of people turning to the emergency room for care that might be better handled elsewhere—an expensive and often inefficient way to get help.
Enter the Healthcare Literacy Council of Contra Costa County, which has launched the “Right Care, Right Way” campaign to help residents better understand their health coverage, especially those on Medicare and Medi-Cal. The pilot program, spearheaded by Supervisor Diane Burgis in collaboration with the Contra Costa Fire Protection District, Kaiser Permanente, and Contra Costa Health, aims to educate the public on how to navigate the health care system and avoid unnecessary ER visits.
Burgis brings a personal perspective to the effort. “At 4 years old, I had an open-heart surgery, so I’ve been in the health care system all my life, I’ve learned how to maneuver it personally and had to experience that,” she shared. “I have a son who has a rare genetic disease. … I had to maneuver through that. So, I’ve had that experience and know how hard it is.” She argues that the system “could do better,” especially when it comes to helping people make choices that improve their health and reduce costs for everyone. “(By) having a primary care physician that is overseeing your health, you have a better outcome. If you don’t need to go to the emergency room, can you call an advice nurse or go to urgent care, or make an appointment for next week,” Burgis said.
Fire District Chief Lewis Broschard echoed the need for change, noting the strain on emergency services. “We’ve created a fiscally sustainable model, but we realized that we were running up against operational barriers, because operational sustainability was a challenge for us. So, we wanted to come up with something that we could be a part of to try and change the dynamic of people receiving health care, and not necessarily always having to fall back on the emergency departments and the 911 system.”
With $750,000 in initial funding, the “Right Care, Right Way” campaign is running through 2026 in District 3, covering Antioch, Oakley, Brentwood, and surrounding unincorporated areas. The program’s ambitions don’t stop there—plans are in the works to expand countywide as the campaign matures. Eight Los Medanos College students have been tapped as ambassadors, trained to spread health care literacy in the community. Monique Grant, one of the ambassadors and a second-year nursing student, described her approach: “I plan on getting the word out there. That starts by canvassing at the local churches in the area, busy businesses, and grocery stores where I can hand out flyers to invite people to our class and hear about what’s going on.”
Dr. Grant Colfax, Contra Costa Health Director, underscored the campaign’s importance in a changing health care landscape. “Having coverage is not the same as knowing how to use it. This campaign is about closing that gap, helping residents know where to go and where to get it.” Residents are encouraged to visit rightcarerightway.org for guidance on making smart choices about their care.
Both stories—Texans facing higher premiums and Californians striving for better health care literacy—highlight the ongoing challenges of the American health care system. Whether the issue is the affordability of insurance or the ability to use it wisely, the need for clear information, effective policy, and community engagement has never been more urgent.
For millions of Americans, the next year could bring big changes, for better or worse. The outcome will depend on decisions made in Congress, the effectiveness of local initiatives, and the willingness of individuals to seek out the information and support they need. One thing’s for sure: the conversation about health care in America is far from over.
