Health insurance application form. (krisanapong detraphiphat/Getty Images)
Far fewer Ohioans signed up for insurance marketplaces after the Republican-controlled U.S. Congress allowed the subsidies to expire earlier this year. This likely means many more people are uninsured.
The U.S. Centers for Medicare and Medicaid Services reported on January 12 that 463,000 Ohioans purchased insurance on HealthCare.gov from the start of open recruitment on November 1.
Almost 600 thousand in the Buckeye State purchased insurance on the exchanges in 2025, according to the Health Policy Institute of Ohio. If current numbers continue, that would mean at least a 21% decline in enrollment.
Last week, The New York Times reported that student enrollment has increased across the country decreased by 1.4 millionwhich means a decrease of approximately 6%.
The subsidies were created during the coronavirus pandemic in 2021 and are used by the expansive majority of people attending markets. Most of them have average incomes.
About 70% people on the ACA exchanges meet 250% or less of the federal poverty guidelines. For a family of four it is approx $80,375 per year.
KFF, a nonprofit health analytics organization, predicted last year that the average consumer would see the cost of their insurance more than twice if the subsidies expired. But after a 43-day government shutdown amid a fight over a subsidy extension, Republicans in Congress voted to let them die.
They did so after voting last summer to extend President Donald Trump’s 2017 tax cuts – $1 trillion of which The richest 1% of Americans will benefit in the next 10 years i add $4.1 trillion to public debt. At the same time, the bill cuts of over $1 trillion from Medicaid and federal food assistance during the same period.
Municipal Institute and Robert Wood Johnson Foundation estimate that nationwide, 4.8 million Americans would lose insurance coverage entirely in the absence of ACA subsidies. In Ohio, that would ultimately mean adding thousands of newly uninsured people in a state that already did so saw 600,000 people lose their Medicaid coverage between 2023 and 2025.
According to a 2012 report by Families USA, people who don’t have insurance are more likely to get unwell, go into more debt and die earlier.
Other reports describe downward spiral where the stress of medical debt can cause your health to deteriorate further, causing more debt and sometimes even premature death.
And emergency departments are legally obligated to treat people regardless of their ability to pay.
Emergency room doctors warn that Ohio’s growing population of uninsured residents will put additional financial strain on hospitals – especially in rural areas and low-income neighborhoods.
This will cause longer waiting times, circumscribed service and in some cases hospital closuresthey said.
Meanwhile, an October survey monitoring the health status of KFF found that 78% of adults believed subsidies should be extended, compared to just 22% who said they should not.
With them expiring and ACA enrollment plummeting, some Republicans support renewal.
On January 8, 17 Republicans in the House of Representatives joined Democrats in voting for a three-year extension. These included Ohio in the US Representatives David Joyce, Max Miller and Mike Carey.
But despite the subsidy’s popularity, there is widespread skepticism that the three-year extension will pass the Republican-controlled Senate.
A bipartisan group is said to be working on a compromise, but so far it has produced nothing.
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