TX HB5455

Establishes the Texas Health Insurance Exchange as a state-based marketplace for individuals and small employers (2-50 employees) to purchase qualified health plans, replacing the federal exchange, with initial coverage beginning no earlier than January 1, 2028

Creates an 11-member board of directors with 9 appointed voting members (3 by governor, 3 by governor from speaker nominees, 3 by lieutenant governor) and 2 ex officio nonvoting members (Insurance Commissioner and HHSC Executive Commissioner), serving 2-year terms with a 3-term limit

Authorizes the exchange to charge user fees to health plan issuers capped at 3% of total premiums, accept grants and federal funding, and prohibits the use of general revenue appropriations

Requires the exchange to create an enhanced direct enrollment pathway for brokers and insurers modeled after the federal system, and mandates a third-party technology audit before the initial open enrollment period

Directs the exchange to submit recommendations by July 1, 2026 on implementing a state-administered subsidy program and pursuing federal Section 1332 innovation waivers addressing risk stabilization, health reimbursement arrangements, and premium tax credit reforms