Ohio Faces Surge in Uninsured Risk Without Extension of ACA Premium Tax Credits

The expiration of enhanced premium tax credits under the Affordable Care Act (ACA) poses a significant financial risk to hundreds of thousands of Ohio residents who rely on these subsidies to afford health insurance. Approximately 513,000 Ohioans, or 88% of those enrolled in ACA marketplace plans, would face substantial premium increases, potentially doubling out-of-pocket costs in 2026. This increase could lead to a substantial rise in the uninsured population, with estimates suggesting an additional 140,000 Ohioans might go without coverage, raising the state's uninsured rate by 29%. The premium tax credits were initially introduced in 2021 as part of pandemic relief efforts and later extended temporarily through 2024. Since their implementation, average monthly premiums for federal marketplace enrollees in Ohio have declined from $215 in 2017 to $126 in 2024. However, without congressional action to extend these credits, premiums are projected to surge, adversely affecting individuals who are ineligible for Medicaid and lack employer-sponsored insurance. This potential coverage loss will not only impact individuals but also strain healthcare systems, potentially complicating access to care for the broader population. Legislative negotiations remain stalled, with Democrats advocating for a straight extension of the credits and Republicans seeking alternative approaches or shorter extensions. The delay in congressional action leaves many at risk of losing affordable coverage as the tax credits are set to expire at the end of the year.