This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.
Since the Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010, Texas has reviewed and debated the different policy directives of the legislation. In 2011, Texas decided against administering a state-run health insurance exchange and opted in to a federally run exchange. This decision occurred prior to the Supreme Court decision on the constitutionality of ACA provisions. In 2013, after the 2012 Supreme Court decision allowed states to decide whether to expand Medicaid, Texas chose not to expand Medicaid eligibility and enrollment.