Ohio ACA Enrollment Declines: Federal Funding Loss Cited

ACA Enrollment Declines in Ohio Following Subsidy Expiration

Columbus, OH – February 16, 2026 – Enrollment in Affordable Care Act (ACA) health care plans in Ohio has dropped significantly following the expiration of enhanced federal subsidies at the end of 2025. The decline is raising concerns among healthcare advocates and lawmakers about increased costs for consumers and a potential rise in the number of uninsured residents.

According to data released by the Centers for Medicare and Medicaid Services, approximately 463,000 Ohioans have signed up for coverage this year, a decrease of around 120,000 enrollees compared to 2025. This represents a 20% decline in enrollment, making Ohio the state with the second-largest percentage drop in signups nationwide, behind only North Carolina.

The expiration of the extra federal assistance, initially implemented during the coronavirus pandemic in 2021, means many Ohioans are now facing substantially higher premiums for ACA plans. The subsidies were used by the vast majority of people participating in the marketplaces, particularly those with moderate incomes. Approximately 70% of those utilizing the ACA exchanges earn 250% or less of federal poverty guidelines – roughly $80,375 a year for a family of four.

KFF, a health care policy nonprofit, had predicted that average consumer costs would more than double if the subsidies were allowed to expire. The subsidies were a point of contention in Washington, ultimately expiring after a 43-day government shutdown stemming from disagreements over their extension. During that shutdown, Congress voted to extend tax cuts enacted in 2017 that primarily benefit high-income earners, while simultaneously proposing cuts to Medicaid and federal food assistance programs.

An Ohio legislator, a fellow doctor, and a retired Ohioan recently expressed concerns about the potential long-term consequences of the enrollment decline. The loss of coverage could lead to delayed medical care, increased emergency room visits, and poorer health outcomes for Ohio residents.

Advocacy groups estimate that more than 113,000 Ohioans are now without affordable care act coverage. Enrollment could decrease further throughout the year if individuals are unable to afford their premiums and subsequently lose coverage, according to KFF.

Ohio’s U.S. Senators are reportedly involved in discussions regarding potential legislation to address the rising premiums. Some Republicans have expressed support for a two-year extension of the enhanced credits, while others believe a comprehensive overhaul of the healthcare system is necessary before any further subsidies are considered.

Open enrollment for ACA plans ended on January 15, 2026, but the final enrollment numbers may still shift as individuals continue to navigate the marketplace and assess their coverage options. The situation remains fluid, and the long-term impact of the subsidy expiration on healthcare access in Ohio remains to be seen.

The Urban Institute and the Robert Wood Johnson Foundation estimate that nationally, 4.8 million Americans will lose insurance coverage in the absence of ACA subsidies.