Decline in ACA Enrollment in Ohio After Expiration of Subsidies
Ohio has seen the largest decline in Marketplace enrollment in the nation following the expiration of enhanced federal subsidies for Affordable Care Act (ACA) plans in January. A report from the Statehouse News Bureau highlights a significant 32% drop in ACA enrollment in Ohio from February 2025 to February 2026.
According to The Daily Yonder's analysis, based on Centers for Medicare and Medicaid Services (CMS) data, rural communities are experiencing a bigger loss in coverage compared to urban and suburban areas. This trend mirrors the end of Covid-era healthcare subsidies under the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, which had expanded premium tax credits to individuals and families earning up to 400% of the Federal Poverty Level.
The absence of renewed subsidies for 2026 has contributed to the decline in ACA enrollment. Higher premium costs have further exacerbated the situation, particularly affecting rural and nonmetropolitan counties where enrollment dropped by 12%, representing 29,000 fewer participants. Smaller metropolitan counties faced an 11% reduction, translating to a loss of approximately 154,000 enrollees. Overall, states using the ACA Marketplace platform saw an 8% decrease in enrollment, amounting to nearly 1.4 million fewer sign-ups.
CMS County-level Open Enrollment data shows a disparity between initial sign-up rates and actual effectuated enrollment, likely due to ongoing affordability concerns. A KFF Health News survey reports that 9% of Marketplace enrollees lost coverage post-open enrollment, while 17% of returning members expressed uncertainty about affording premiums.
The previous Enhanced Premium Tax Credits had capped premiums for silver benchmark plans at 8.5% of income for higher-earning households. Although these households made up just 3% of enrollees, they accounted for 27% of the enrollment decrease from 2025 to 2026. The KFF analysis examines all 50 states’ participation in ACA exchanges or state-based variants, offering a comprehensive view of the shifts in enrollment.
Lower-income individuals continue receiving federal assistance, facing fewer premium hikes and enrollment drop-outs. However, nonmetro areas, which see steep premium increases, comprise 532 of the 778 counties in the highest price increase quartile. In response, some states have implemented measures to alleviate these issues. Colorado, for instance, has established a premium assistance fund, while New Mexico recorded an 18% uptick in ACA enrollment due to its health insurance affordability initiative.