Since 2016, when enrollment peaked at 12.7 million, the number of Americans with coverage under Affordable Care Act marketplace plans has dropped by over 7 percent. Brazoria and Galveston counties saw enrollment fall by the same proportion, with 23,813 signing up for marketplace plans in 2018. The Congressional Budget Office projects lower enrollment and more uninsured starting in 2019, when the individual mandate will no longer be in effect, a provision in the new tax law. The latest numbers from the Census Bureau in 2016—when ACA enrollment was at its highest—show the number of uninsured in our two counties fell by 5 percent. It stands to reason that trend will be reversed until a viable alternative is implemented. Our region has impressive health care resources, but without affordable insurance coverage, they may be out of reach for some.