Ohio Sees Major Drop in ACA Enrollment After Subsidies Expire - And the Fallout Could Be Severe
The numbers are in, and they paint a sobering picture for Ohioans relying on the Affordable Care Act (ACA) marketplace for health coverage. With federal subsidies now expired, enrollment across the state has taken a sharp dive - a signal that thousands could be left uninsured in the months ahead.
According to the U.S. Centers for Medicare and Medicaid Services, just 463,000 Ohioans signed up for health insurance through HealthCare.gov during the open enrollment period that began November 1.
That’s a significant drop from the nearly 600,000 who enrolled in 2025, marking at least a 21% decline. And if these numbers hold, the real-world impact is going to be felt far beyond the spreadsheets.
This decline isn’t just an Ohio story. Nationally, enrollment is down by 1.4 million - about a 6% dip - following the expiration of the enhanced subsidies that were introduced during the pandemic in 2021. Those subsidies were a lifeline for millions of Americans with moderate incomes, many of whom relied on them to afford even the most basic coverage.
Roughly 70% of ACA marketplace users earn 250% or less of the federal poverty level. For a family of four, that’s an annual income of $80,375 or less. Without the subsidies, many of these families are now facing premiums that have more than doubled, according to projections from KFF, a nonprofit health policy organization.
The subsidies expired after a 43-day government shutdown ended with Republicans in Congress voting against their extension. That decision came on the heels of legislation to extend the 2017 tax cuts passed during the Trump administration - a package that includes $1 trillion in benefits for the wealthiest 1% of Americans over the next decade, while also slicing more than $1 trillion from Medicaid and federal food assistance programs during the same span.
So what does this mean for people on the ground?
For starters, the Urban Institute and the Robert Wood Johnson Foundation estimate that 4.8 million Americans could lose coverage entirely without the ACA subsidies. In Ohio, that could translate into thousands more joining the ranks of the uninsured - in a state that already saw 600,000 people lose Medicaid coverage between 2023 and 2025.
And when people lose insurance, the consequences go far beyond skipped checkups or postponed prescriptions. A 2012 report from Families USA found that uninsured individuals are more likely to get seriously ill, fall into medical debt, and die prematurely. It’s a vicious cycle - debt leads to stress, stress leads to worse health, and worse health leads to more debt.
Hospitals, especially in rural and low-income communities, are bracing for the fallout. Emergency departments are legally required to treat patients regardless of their ability to pay, and as the number of uninsured patients rises, so does the financial strain on these facilities. Physicians are warning that the system is already stretched thin - and this added pressure could mean longer wait times, reduced services, and even hospital closures in some areas.
Despite the popularity of the subsidies - a KFF poll from October found that 78% of adults supported extending them - the political will to bring them back remains uncertain. Earlier this month, 17 House Republicans joined Democrats in voting for a three-year extension, including Ohio Representatives David Joyce, Max Miller, and Mike Carey. But the proposal faces an uphill battle in the Republican-controlled Senate, where skepticism about the extension remains high.
There is some movement behind the scenes, with a bipartisan group reportedly working on a compromise. But so far, there’s been no breakthrough - and with each passing day, more Ohioans are being priced out of coverage.
The bottom line: this isn’t just a policy debate in Washington. It’s a real, urgent crisis unfolding in communities across Ohio and the country. And unless a solution is reached soon, the ripple effects could be felt in doctors’ offices, emergency rooms, and family budgets for years to come.