Texas residents shop for ACA health coverage through HealthCare.gov, the federal marketplace, since the state has not built its own exchange. Texas consistently has more marketplace enrollees than any other state, given its large population and high uninsured rate before the ACA.
Texas has not adopted Medicaid expansion under the ACA. The state's traditional Medicaid eligibility rules for adults are especially narrow, which means a substantial number of low-income working adults fall into a coverage gap, earning too little for marketplace subsidies to make coverage affordable but not qualifying for Medicaid.
Because so many Texans rely on marketplace subsidies, getting income estimates right during enrollment matters even more here, especially for self-employed and gig workers whose income can vary. Given the coverage gap, community health centers and county-level assistance programs can be worth checking for residents who don't qualify for either Medicaid or an affordable marketplace plan.