Lauren Silverman/KERA News

There are nearly six million people in Texas without health insurance. The majority will be able to get coverage when the state marketplace opens in October, but not everyone. Undocumented immigrants won’t be able to sign up for health care through the exchange.

*The KERA radio story

Here’s what the Affordable Care Act (ACA) means for the undocumented:

No Coverage Requirement:

The ACA includes a requirement that most people be insured or pay a penalty. Undocumented immigrants are not required to purchase health insurance and will not be penalized for not having health coverage.

No Coverage:

Millions of Texans will be able to go to healthcare.gov in October and select from a variety of health coverage plans. Undocumented immigrants in Texas, estimated to make up 15% of the uninsured, or 800,000 people, will not be able to purchase health care through this site.

[More from KERA News: Obamacare 101: How The Texas Health Insurance Marketplace Will Work]

No Health Insurance Subsidies:

2.6 million Texans could qualify for health insurance tax credit subsidies to help purchase insurance on the exchange. Undocumented immigrants will not qualify for any federal help to buy coverage, neither on the exchange nor in the private market.

Alternative Options:

Private health insurance is one option for undocumented immigrants, although the cost may be out of reach for many, according to Devon Herrick, a health economist at the National Center for Policy Priorities.

Another option is getting health care through community clinics, such as Los Barrios Unidos in Dallas.

Los Barrios Unidos already serves more than twenty thousand patients a year, and staff is preparing for more people to walk through the doors in 2014. The community clinic also received $5 million dollars from the ACA to build a new clinic in South Oak Cliff. To find other federally qualified community health centers in Texas, check the state’s website here.

Finally, public hospitals, such as Parkland and JPS, will not turn away anyone based on their immigration status at their emergency rooms.

Impact of excluding undocumented immigrants from the ACA:

Devon Herrick argues Texas safety net hospitals might be in financial trouble because many undocumented immigrants without health insurance will continue to use their services. This alone, he says, won’t break the back of public hospitals, but it comes on top of financial cutbacks to safety net hospitals that had previously helped cover indigent care.

“And if [public hospitals] continue to attract those who don’t have health care and at the same time losing some of the subsidies to help cover those patients they’re going to have problems because of the cost,” he says.

Because immigrants tend to be both younger and healthier than the rest of the U.S. workforce, some argue (including HHS Secretary Kathleen Sibelius), that including undocumented immigrants in the federally run health system could help lower healthcare costs overall.