The health insurance exchange in Texas began with some timidity in 2014. However, it saw rapid entry of insurers and plans, and the lowering of many plan premiums relative to those of the dominant Blue Cross Blue Shield offerings in 2015 and 2016. By 2017 insurers had reliable information on the utilization experience. Several insurers withdrew from the exchange; others reduced the number of counties in which they offered coverage. In the 2017 open enrollment period, only health maintenance organizations (HMOs) were offered and premiums increased dramatically for most remaining insurers.