Ken Paxton on Health Care: His Lawsuit to End the ACA, the DACA Coverage Case, and Texas Medicaid Cuts
Ken Paxton, the Texas attorney general running for U.S. Senate in Texas, led a 20-state lawsuit in February 2018 to strike down the entire Affordable Care Act, the law behind the marketplace coverage and protections for preexisting conditions that Texans use. When a federal judge in Fort Worth sided with Texas in December 2018, the Texas Tribune reported the ruling could throw the nation's health care system into chaos. In 2024, Paxton's office joined a multistate suit that led the federal marketplace to cancel 2025 coverage for DACA recipients in Texas and the other plaintiff states.
As a Senate candidate, Paxton urged passage of the One Big Beautiful Bill Act on July 1, 2025. The Texas Tribune reported that over 300,000 Texans could lose their health insurance under its Medicaid changes. In September 2026, he told lobbyists that cuts to mandatory spending, including Medicaid, were unavoidable (Texas Tribune).
Ken Paxton's Lawsuits and Statements on Health Coverage
- Paxton Led a 20-State Lawsuit to Strike Down the Affordable Care Act in 2018. On February 26, 2018, Ken Paxton and the Wisconsin attorney general led a 20-state coalition lawsuit arguing that all of the Affordable Care Act was unconstitutional. Paxton said, "Through our multi-state lawsuit, we hope to effectively repeal Obamacare." On December 14, 2018, U.S. District Judge Reed O'Connor ruled the whole law must fall, and Paxton said in a statement, "All Americans will again have greater choice about what health coverage they need."
- Paxton Joined the Lawsuit That Ended Marketplace Coverage for DACA Recipients in Texas. Ken Paxton's office signed the August 28, 2024 amended complaint in Kansas v. United States as counsel for the State of Texas, challenging a rule that let DACA recipients buy marketplace plans. After the court's December 9, 2024 injunction, the federal marketplace canceled 2025 enrollments for DACA recipients and others covered by the rule in the plaintiff states.
- Paxton Urged Passage of the Law That Cuts Texas Medicaid Funding by $39 Billion. Ken Paxton posted on July 1, 2025, "Now it's time for the House to pass the Big Beautiful Bill." Using CBO estimates, KFF projects that Texas will lose $39 billion in federal Medicaid funds over the next decade, and the Texas Tribune reported the law also makes it harder to enroll in Affordable Care Act marketplace coverage.
- Paxton Told Lobbyists in 2026 That Cuts to Mandatory Spending Are Unavoidable. At a September 24, 2026 fundraiser, Ken Paxton called for "reasonable cuts to mandatory spending" and said, "Or there is no solution," according to a recording obtained by the Texas Tribune. Medicaid is one of the three programs that make up around three-quarters of mandatory spending (CBO).
What the Health Cuts Ken Paxton Backed Mean for Texas
- Over 300,000 Texans could lose coverage once the Medicaid changes start in 2027. Medicaid covers over 4 million Texans, and the Texas Tribune reported that over 300,000 could lose their health insurance under the law, in a state that already has the highest uninsured rate in the nation. People who lose coverage put off care or face medical bills they cannot pay.
- Texas hospitals face billions in added uncompensated care. The Center for American Progress found coverage losses will add billions of dollars in uncompensated care costs for Texas hospitals over the next decade, with 22 Texas rural hospitals already at immediate risk of closure before the law passed.
- Texas receives the smallest rural health fund payment per rural resident. KFF found that the law's rural health fund pays Texas $66 per rural resident, the lowest amount of any state, leaving rural Texas hospitals with little offset for lost Medicaid revenue.
- The Rio Grande Valley is especially exposed. The Texas Tribune reported that the Medicaid cuts could be particularly potent in the Rio Grande Valley, which has an outsized number of Medicaid recipients, and in rural areas where hospitals rely on Medicaid payments.
Frequently Asked Questions Ken Paxton on Health Care
What is Ken Paxton's record on health care under Trump?
Ken Paxton urged passage of the One Big Beautiful Bill Act on July 1, 2025, a law the Texas Tribune reported could cost over 300,000 Texans their health insurance and Texas $39 billion in federal Medicaid funds. As Texas attorney general he led the 2018 lawsuit to strike down the Affordable Care Act and joined the 2024 suit that ended marketplace coverage for DACA recipients in Texas. In 2026 he told lobbyists that cuts to mandatory spending, which includes Medicaid, were unavoidable (Texas Tribune).
Did Ken Paxton sue to end Obamacare?
Yes. Ken Paxton led a 20-state lawsuit filed on February 26, 2018 to have the entire Affordable Care Act declared unconstitutional, and he said the aim was to "effectively repeal Obamacare."
What did Ken Paxton do about health coverage for DACA recipients?
Ken Paxton's office represented Texas in Kansas v. United States, a 2024 suit against a rule that let DACA recipients buy marketplace plans. After a December 2024 injunction, the federal marketplace canceled 2025 coverage for those enrollees in the plaintiff states, including Texas.
Would Ken Paxton cut Medicaid?
Ken Paxton said at a September 2026 fundraiser, "There's no doubt we have to cut some of the mandatory spending," according to audio obtained by the Texas Tribune. He also endorsed the 2025 law that KFF projects will cut 10 percent of Texas's federal Medicaid funds over a decade.
Last updated: 2026-10-28