Fewer Ohioans Enroll in Health Coverage as ACA Subsidies Expire, Costs Rise
COLUMBUS, Ohio — Ohio has seen a significant drop in the number of residents signing up for health insurance through the Affordable Care Act (ACA) marketplace during this year’s open enrollment period, with rising costs cited as a major factor behind the decline.
Preliminary data released by the Centers for Medicare and Medicaid Services reveals that approximately 463,000 Ohioans enrolled in marketplace coverage by January 3, 2026. This figure represents a decrease of about 120,000 enrollees compared to last year. Although open enrollment continued through January 15, the early numbers indicate a concerning downward trend. Experts warn that enrollment could further decline throughout the year if families find themselves unable to afford the increased premiums.
Rising Costs Impact Families
A key driver behind reduced enrollment is the expiration of enhanced ACA subsidies at the end of 2025. Families that previously benefited from expanded financial assistance now face significantly higher monthly premiums. For example, a family of four in Cleveland with an annual income around $60,000 is now paying roughly $221 more per month for the same insurance coverage, according to a cost calculator developed by the Kaiser Family Foundation (KFF).
How ACA Subsidies Work
The ACA marketplace provides critical health insurance access for many Ohio residents who don’t qualify for Medicaid and lack affordable employer-sponsored coverage. This includes self-employed individuals, gig economy workers, and people living in rural areas. More than 25% of farmers and ranchers in Ohio rely on the marketplace for health insurance.
Federal law offers premium tax credits to subsidize marketplace insurance premiums based on income levels. In 2021, Congress expanded these subsidies to cover a broader population, with KFF reporting that nine out of ten marketplace enrollees received some form of subsidy in 2025. However, the additional aid expired after Congress declined to renew it, leading to higher out-of-pocket costs for many families this year.
Ohio Experiences One of the Largest Enrollment Declines
Ohio has experienced the second-largest percentage decline in ACA marketplace signups nationwide, second only to North Carolina. The unattractive affordability of new premiums has contributed to this drop, raising concerns about the stability and accessibility of health coverage in the state.
Congressional Debate Over Renewing Subsidies
Meanwhile, political leaders are debating whether to reinstate portions of the expired enhanced financial assistance. Ohio’s Lieutenant Governor Jon Husted introduced legislation in December proposing a two-year extension of the enhanced premium tax credits. His bill includes eligibility restrictions to United States citizens, limits coverage of abortions to specific cases such as rape, incest, or when the mother’s life is at risk, and requires enrollees to contribute a minimum of $5 monthly toward their premiums, measures Husted argues would reduce fraud.
Husted described the situation as urgent, warning that without congressional action, many families will face steep premium hikes. “American health care is not underfunded; it is under-accountable,” he said.
The legislation has become a point of contention in Ohio’s upcoming elections. Senator Husted’s Democratic opponent, former Senator Sherrod Brown, criticized the proposal and accused Husted of inaction. “Ohioans are being forced to choose between paying more for their health care coverage or dropping their insurance altogether, all while Husted sits back and refuses to take action,” Brown said.
Looking Ahead
As open enrollment wraps up and policymakers continue to negotiate, Ohio families are grappling with financial strain caused by rising healthcare costs. The outcome of congressional debates on subsidy renewals will significantly influence the accessibility and affordability of health insurance in the state moving forward.
—
Anna Staver covers Ohio politics and related issues for Cleveland.com. For more information, contact [email protected].