Higher health insurance premiums and expiring ACA subsidies are squeezing the Rio Grande Valley’s middle class

Edinburg insurance broker Emanuel Pruneda watched a family with four children and two adults decline health insurance coverage after the monthly premium cost jumped 100% in just one year. 

It would have cost $1,200 per month for health insurance through the Affordable Care Act marketplace, which was outside their budget. 

“They had to cancel their insurance,” Pruenda said, and instead planned to simply eat healthy, exercise, and “try not to get sick.”

About one-quarter of his clients decided not to renew Affordable Care Act plans for next year. 

And he’s not alone; that’s what’s happening across the Rio Grande Valley with a program that’s been increasingly popular for the past decade. 

Health insurance gets popular

There were more than 292,900 residents in Hidalgo, Cameron, Starr, and Willacy counties covered by ACA health insurance plans in 2025, federal data show. 

There was an 8.7% increase in enrollment between 2024 and 2025 across the Rio Grande Valley. But the most significant jump was between 2021 and 2022, when there was an 80% increase in just one year. 

Since the health insurance marketplace began in 2014, insurance premiums have increased each year. There are federal subsidies for low-income residents, but enhanced subsidies enacted during the COVID-19 pandemic are set to expire on Dec. 31. 

The hardest hit consumers have been middle-class residents who earn more than the federal poverty line but not enough to keep up with rising costs, health insurance brokers told the Rio Grande Valley Business Journal. 

Pruneda, the insurance broker, knows that some former clients will simply cross the border for medical care. Medical tourists without health insurance often frequent cities such as Reynosa, Matamoros, and Nuevo Progreso, seeking medical care or cheaper prescription medication. 

But those with chronic illnesses don’t have much of a choice but to buy health insurance on the exchange, even at higher prices, Pruneda said. 

“It pains me that [there are] people who cannot afford it, but have to keep it,” he said. 

When subsidies expire

Fewer clients are re-enrolling in health insurance coverage, something Veronica Herrera, an insurance agent with Ontiveros Insurance, has noticed this year. Often, clients will say they want the zero-premium plans like last year, but she has to explain they may no longer qualify because the expanded subsidies have expired. 

The value of the subsidies was significant. Monthly insurance premiums of up to $533 would cost $21 when federal support was included, enrollment data for Hidalgo County in 2025 show. For a family of four earning less than $32,150, subsidies often covered the entire cost of the insurance premium — but even that’s changing. 

“In my experience, many people are not willing to buy insurance because they don’t want to pay more,” Herrera said in Spanish. 

Even if that’s the difference between paying nothing in premiums and $20, she said. Even so, she doesn’t typically recommend the lowest-cost plans because the deductibles are often several thousand dollars. 

She’s had more than two dozen clients cancel their 2026 insurance plans so far due to affordability issues. 

U.S. residents with legal status such as work or student visas can typically purchase Affordable Care Act marketplace plans. But individuals under the Deferred Action for Childhood Arrivals program, or DACA, are no longer eligible for health coverage through the marketplace. Undocumented immigrants were never eligible to purchase health insurance exchange plans. 

The clients with a challenging situation are those who are older than 55 but younger than 65 and still working full-time because they don’t qualify for Medicaid or Medicare yet. They are likely to pay higher premiums because of their age. 

Insurance premiums keep climbing 

Self-employed small business owner Daniel Pulido, CEO of Acument Insurance Group in McAllen, said he decided to purchase a costly health insurance marketplace plan until July, when he will qualify for Medicare. 

“I’ve passed the anger level. I’m going to bear it until July,” Pulido said. 

He remembers buying health insurance as a self-employed individual before the Affordable Care Act was created. It was a more competitive market, and the premiums were lower, he said. 

“We had a whole host of choices where the carriers were competing for business. That created a very affordable environment,” he said. “The financial impact was minimal. Now it’s one of the biggest items in your budget.” 

Most of his clients are still enrolled in Affordable Care Act plans for next year, even though he says there was pushback from those going from zero-dollar premiums to $30 a month. 

“If it’s a family of three that makes $25,000 a year, that’s a big impact,” he said. “With the initial notification from the marketplace that went to every home, they were in shock.” 

The most significant premium increases were for middle-class families, some of whom were faced with spending 25% of their income on health insurance. 

In 2025, a 35-year-old in McAllen paid $383.99 a month for a Blue Advantage Gold HMO Standard plan, which carried a $1,500 deductible and a $7,800 out-of-pocket maximum. In 2026, the same plan would cost $590.68 per month, with the deductible rising to $2,000 and the out-of-pocket maximum increasing to $8,200.

That means the plan is not only more expensive every month — or nearly $2,500 more per year — but it also starts covering medical services later and requires more out-of-pocket costs. 

“Demand for ACA plans has been strong because subsidies make coverage affordable,” said Luis Hinojosa, another insurance agent with Ontiveros Insurance. 

So instead of buying a gold or silver plan, some customers are bumping down to bronze plans with higher deductibles and more out-of-pocket costs. 

“People are still really interested… they are still enrolling…but affordability is the concern,” Hinojosa said.